Episode #366: Finding balance, the hybrid approach to insurance participation

Intro: This is the Less Insurance Dependence podcast show with my good friend Gary Takacs and myself, Naren Arulrajah.

Intro: We appreciate your listenership, your time, and most of all, we appreciate your intention to reduce insurance dependence in your practice. Our goal is to provide information that will help you successfully reduce insurance dependence and convert your practice into a thriving and profitable dental practice that provides you with personal, professional, and financial satisfaction.

Lester De Alwis: Welcome to another episode of the Less Insurance Dependence podcast, your trusted source for insights, strategies, and expert advice to help dental professionals take control of their practices and careers. I’m Lester De Alwis, your co-host, and I’m thrilled to bring you another value-packed episode that challenges the conventional view of insurance in dentistry.

Today, we’re joined by a dynamic industry leader, Dr. Tarun Agarwal, better known as T-Bone. Dr. Agarwal is a practicing dentist, educator, and thought leader known for helping dentists modernize their practices with practical, results-driven strategies.

In today’s episode, Finding Balance: The Hybrid Approach to Insurance Participation, Dr. Agarwal will share how dentists can strategically stay in-network with certain plans while leveraging patient demand, technology, and smart business systems to build greater independence and profitability.

Before we dive in, a quick message from our sponsor. Ekwa Marketing is offering a complimentary marketing strategy meeting where the experts will show you how to attract high-quality patients, rank #1 on Google locally, and grow your patient flow steadily. So, if you are ever wondering what your online visibility is like, visit lessinsurancedependence.com/marketing-strategy-meeting to book yours. It’s complimentary.

And if you’re ready to create a thriving fee-for-service practice, schedule a complimentary coaching strategy meeting with Gary at thrivingdentist.com/csm.

Now, let’s jump in. Dr. Agarwal, we are excited to have you here. Thank you for joining us.

Dr. Tarun Agarwal: Uh, thank you, Lester, for having me. And, uh, I’m excited to share maybe, hopefully, a different perspective on dental insurance and, uh, kind of a more practical approach to dental business in general.

Lester De Alwis: Amazing, amazing. So let’s start with your perspective. Yeah. What inspired you to explore this hybrid model, and how can it help dentists take control of their business without completely, completely dropping insurance?

Dr. Tarun Agarwal: Yeah, I think, lo… uh, before I kind of get into that, let… let’s kind of back up for a second and, and look. Yeah, I… I want to be clear. Not every dentist can or should drop insurance plans. It’s a very emotional decision. It should be a decision that’s based in fact, and it should not be a rebellion against the insurance companies, but instead about creating the freedom and the type of practice that you want.

And with that being said, for me, uh, moving to a hybrid approach was kind of a necessity. For me, uh, it… it… mm-hmm… it was… you know, basically what it boils down to is, I get that most of us dislike dental insurance. Uh, we don’t like the control of the fees. We don’t like the mindset of the patients. But the reality is, the harsh reality is, for the vast majority of us, not dealing with insurance in some form — whether you’re in-network, whether you’re out-of-network — not dealing with insurance in some form is almost not possible.

Dr. Tarun Agarwal: And… and so we have to accept that living with insurance is a necessity in our profession and in our life. And… and so our goal should be, how do we reduce the focus on insurance and the control that insurance companies provide?

And… and I was always seeking freedom. My goal in life is to seek freedom and flexibility in everything that I do. Uh, and… and so for me, the hybrid approach was, how do I serve my business and my needs as a business, but also give me the freedom and flexibility that I need to be able to make choices of where I wanted, the type of clinical work I wanna do, and the patients I wanna work on.

Lester De Alwis: Exactly. I mean, that’s… that’s a very fresh, refreshing perspective. Not demonizing insurance, but understanding how it fits strategically. Yeah. Now let’s talk more about that. How can dentists actually use supply and demand to make smarter participation… uh, decisions?

Dr. Tarun Agarwal: You know, I think… what I’m seeing, and… and for the audience that doesn’t know me, is, look, I’ve been practicing 26 years. I… I started my practice fee-for-service for the first year. Almost went bankrupt as a startup dental practice. I’ve been in-network with insurance since 2002. I’m happy to be in-network.

Uh, I run a company, an education business called 3D Dentists. And, you know, I work with, at this point, you know, 60 offices that participate in insurance. So I have great insight into dental insurance and how to navigate, uh, the business side of building your practice.

And… and so what we have to… what we have to understand is the goal isn’t to just keep building bigger. Because there’s no shortage of patients. There’s no shortage of the number of insurance plans that you can take. The different umbrellas you can get under.

Dr. Tarun Agarwal: There’s no shortage of the ability to negotiate a $5 fee increase. We have to, at some point, decide there’s a capacity that we’re gonna fill to. And it’s clearly, at the end of the day, it’s a law of supply and demand.

If you have more demand than you have supply, it’s time to… it’s time to make smart decisions. We may triage our patients better to decide how many — I’m using examples here — how many Delta Dental patients we wanna let in, how many MetLife patients we wanna let in. Or we may decide that it’s time to limit how… no more new patients from certain insurance companies. Or we may decide it’s time to no longer participate with a specific company.

But the answer can’t be keep growing bigger. The answer can’t be add more dentists, add more hygienists. Because an unprofitable practice that’s just bigger is a bigger noose around your neck every month. That… that doesn’t work.

Dr. Tarun Agarwal: So… so it’s… it’s understanding that when you have more patients than you know what to do with, it’s a… it’s a time of power. And that’s a time to get strategic about saying, hey, maybe I drop certain plans, maybe…

And the hybrid approach is really about the senior dentist not participating, but the practice still participating. So in our practice, we’re in-network. Raleigh Dental Arts is in-network with, I wanna say, seven or eight insurance plans. Me, as the owner and senior dentist, I’m only in-network with one insurance plan.

Uh, so… so that’s what the hybrid approach really is about. It’s about the senior doctor, the owner dentist, being more specific about what plans he or she participates in, but allowing the practice to still grow with insurance.

And then the secondary component of that is, we were in-network with 12 or 13 plans just a few years ago. And now we’ve trimmed that down to six or seven plans over the last several years. And… and maybe we’ll trim some more, maybe we will add some more. It’ll be a reaction to market conditions.

Lester De Alwis: Exactly. Excellent framework. And I love how you explained with the supply and demand perspective, which adds more value into that… um… that thought.

Now, once a dentist makes those decisions, the next challenge is execution. Communicating with the team and the patients. What are the best ways to make that transition seamless?

Dr. Tarun Agarwal: Yeah, you know, I… I’ll probably go against conventional wisdom here. The last thing I’ll do ever is send a letter to all my patients letting them know that we’ve dropped a plan or we’re considering a plan, or as of this date… I… I don’t like… I don’t like leaving the decision to patients in terms of, do I stay? Do I not stay? Are they saying they want me, don’t want me? Are they saying my insurance is no good or not good?

I prefer for that conversation to be very… a very personal, eye-to-eye conversation with the patients. I also don’t like to allow my team members to randomly just say anything to patients because they may say it incorrectly or not the way I want it to be said.

So to me, it’s… it’s a very planned, strategic approach. Okay. And what I mean by that is, number one, I’m gonna start with the smallest plan first.

Dr. Tarun Agarwal: Okay. So if I’m gonna drop a plan, I’m gonna start with a plan that has the least number, even if it’s the best fees, but the least number of patients. So it has the least impact on my practice. And I’m gonna consider that one a trial run of dropping insurance.

Okay. And then number two is, I’m going to practice with my team members all the questions. I’m gonna make sure they’re written out. I’m going to do mock phone calls. I’m gonna do mock patients saying, "Does this mean I can’t come there?" Uh, I’m gonna do mock trials of patients saying, "Well, I guess I’ll go to another dentist."

So how do we… how do we kind of try to help the patient stay in our practice?

And… and so I’ll run through all of those. And then I’m gonna… I’m typically gonna do a six-month window where, before we drop, we start informing patients eye-to-eye and being very specific with them about what this really means.

And honestly, the vast majority of the time, it means nothing different for the patient. It usually means maybe $50 a year difference to the patient to stay in a place they know, they love, they trust, where they know what they’re getting.

Uh, and… and so to me, I’m gonna take a start-with-the-smallest-plan-first, train-train-train, practice-practice-practice with your team members, and… and give the message to your patients eye-to-eye, provider to patient.

Lester De Alwis: Exactly. Exactly. I think the communication piece is so critical, and none of this happens overnight. It has to do with all the training and the practice. Now, beyond systems, the dentist’s own mindset often defines success. How does adopting a different mental approach help them run a more balanced, profitable practice?

Dr. Tarun Agarwal: Yeah, again, it comes back to the goal of the business — to be profitable, to do great work, to create an amazing culture. Not in any order, okay?

And so, you know, if… if you hate insurance, your team is gonna hate insurance. If you hate insurance and your team hates insurance, your patients are gonna hate insurance. And so… so it kind of comes to what I talked about at the very beginning — just have a relatively positive mindset about insurance.

It’s a way to help. It’s a coupon that helps patients choose your practice. It’s a coupon that helps patients pay for part of their treatment. And help your team members understand that insurance isn’t the devil. Help your team reframe the conversation — that insurance isn’t going to pay for all the treatment. And… and that’s okay.

Dr. Tarun Agarwal: And so to me, it’s… it’s that mindset that insurance is normal. And then you train your team members that we’re so happy you have insurance — not, "Oh, you have insurance." And when you train your team members that it’s okay if you don’t have insurance…

And really, to me, it’s… it’s been this fundamental philosophy that I’ve had most of my career — that we don’t lead with insurance. You don’t lead any conversation with insurance. You don’t say, "Oh, your insurance pays for a crown," or, "Your insurance doesn’t pay for this." You say, "Hey, your insurance is gonna help you with this. How much it helps, you know, it varies on each individual plan."

And I really think what most dentists hate about insurance is that we allow it to dictate our treatment planning. We allow it to dictate our fees. And it doesn’t have to be that way.

Patients can elect to pay for high-end dentistry above and beyond what the basic dentistry that insurance pays. Patients can elect — if we give them the right choice — to do all of their dentistry at one time. Not just, "How do I maximize my insurance for this year and then postpone dentistry for next year?"

You know, insurance doesn’t dictate if the tooth needs a crown or a filling — you dictate that. And then the insurance will pay whatever they pay. And if you do appropriate treatment, very rarely does the insurance say, "No, this should have been a filling," when you have good documentation and good sound judgment around it.

So… so the mindset has to lead. As the owner, as the owner of the operatory or the practice, insurance is okay — but we’re not gonna allow it to lead our conversations.

Lester De Alwis: Exactly. Such an empowering message. Now, let’s wrap up with something actionable. What steps should dentists take now to move forward with a more flexible hybrid approach?

Dr. Tarun Agarwal: Yeah, so number one, uh, I… I want to talk about how I became hybrid, okay? Mm-hmm.

With my insurance, number one — as my clinical skills increased, I was doing more and more dentistry that, generally speaking, was not covered by insurance or covered very little. So, for example, if I’m a comprehensive dentist, a complete dentist, I may do six fillings, four root canals, three crowns on my patient all at one time. All insurance-covered procedures. But I got tired of… I didn’t want to always do that literally one tooth at a time, because that’s what insurance covered.

I wanted the insurance to be a thousand-dollar or $1,500 coupon. So for me, I became out-of-network, one, to allow my fees to be commensurate with my skill level. To allow me to charge — or have the freedom to charge — what I wanted for the types of services I was doing.

Dr. Tarun Agarwal: And the other reason — and probably the main reason I chose a hybrid approach — was to answer that question of, "Well, doc, I’ve been seeing you for 20 years. Why can’t I see you to have this done?"

And now I have an easy answer: "No problem. You can see me for your single crown. My crown fee is…" — I’m making the numbers up — "…$2,500. But you are happy to see my partner in the practice, my associate, and the crown fee will be $800, of which your insurance is gonna pay 50%."

And then they can say, "Oh, so I can see somebody else and get the same work done for four or five hundred bucks." Or, "You can see me and pay $2,500." It’s totally up to you.

And it made that decision — of transferring a lot of my general dentistry and traditional bread-and-butter dentistry — it made that transfer to my associates in the practice significantly easier.

Dr. Tarun Agarwal: And ultimately, it made it the patient’s choice and not me saying, "No, I don’t want to" or "can’t see you."

And what that ultimately allowed is, it created me the margin and the freedom of time to really focus on my bigger case dentistry. More complex care dentistry. Charging my signature fee — what I call signature fees — that I want to charge. And not having to worry about the in-network concept with large, complex care dentistry.

So that’s really kind of where the hybrid approach came from.

Step one is, you gotta create a clinical skill set that creates demand. Okay? So clinical skill set that creates demand.

And then number two, to really go hybrid, you need to have another provider in your office so that you have somewhere to send your patients without sending them out of your practice.

And then number three is, you gotta get the numbers and the data on your insurance plans so you can make factual, not emotional, decisions about which plans to target.

And I always start with not the least-paying plans, but I always start with the smallest volume plan. So that way we can try it out and see what the outcome is.

Lester De Alwis: Exactly. Amazing. Now the last of it is, basically, if any policyholder listening to this episode wants to get in touch with you, yeah, what would be the best way to get in touch with you?

Dr. Tarun Agarwal: Well, look, the easiest way is on all social media channels. It’s @T-Bone Speaks — T-B-O-N-E-S-P-E-A-K-S — T-Bone Speaks.

Number two, you can find me at 3D-Dentists.com.

Or number three, if you love podcasts, you can listen to my podcast called Dentistry Made Simple. It’s probably the third or fourth best podcast in dentistry behind Gary Takacs and The Thriving Dentist Show and these podcasts.

But you know, if you’re after freedom, if you’re tired of burnout, if you’re tired of the practice running you… you want to be around dentists that want greatness and want to excel and be growth-minded, I’d love to engage with you — whether it’s remotely, whether it’s through in-person courses, or whether it’s fully.

I just want to help dentistry create freedom, not burnout.

Lester De Alwis: Amazing. Fantastic insights, Dr. Agarwal. Uh, this conversation really defines what independence looks like in modern dentistry. Thank you so much for joining us and sharing your insights on the hybrid approach to insurance participation.

Dr. Tarun Agarwal: Thank you, Lester. Thank you to the audience for listening.

Lester De Alwis: So, the key takeaway from today’s conversation is that insurance isn’t necessarily the enemy. It’s a tool that can be managed strategically. With the right data, mindset, and systems, dentists can build profitable practices and serve both patients and their financial goals.

And as always, this podcast is about taking action.

Firstly, if you are ever wondering about your online visibility, like I mentioned earlier, schedule a complimentary marketing strategy meeting with Ekwa Marketing at lessinsurancedependence.com/marketing-strategy-meeting to learn how to attract better quality patients and strengthen your fee-for-service base.

Secondly, if you’re looking for mentorship or personalized coaching on building a thriving, independent practice, schedule a complimentary coaching strategy meeting with Gary Takacs at thrivingdentist.com/csm.

Now, both of these are complimentary opportunities designed to help you take real steps toward the practice and the life you truly deserve.

Thank you again to everyone listening in and for joining us today. Thank you. Thank you to all our listeners for tuning in.

We’ll see you next time on the Less Insurance Dependence Podcast. Until then, keep moving towards a thriving, independent practice.