Episode #370: How to attract more patients that prefer fee- for- service care?

Intro: 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.

Don Adeesha: Welcome back to another episode of the Less Insurance Dependence podcast. Today, we are diving into something that comes up all the time: how do we attract more patients who prefer fee-for-service care? I’m Don Adeesha, your co-host for this episode. We’re talking about those patients who value quality, trust, and relationships over just what their insurance covers. And who better to unpack this than Naren Arulrajah, CEO of Ekwa Marketing and longtime advocate for helping practices reduce their dependence on insurance. Naren, let’s start there. Why is it so important for dentists to attract more fee-for-service patients today?

Naren Arulrajah: Thank you, Don, for having me. I’m really happy to be here, and I think that’s a great place to start. Why is it so important for dentists to attract more fee-for-service patients? Let me be blunt. Half of Americans do not have an insurance plan, which means half of Americans—literally 150 to 170 million people—have no insurance plan. So there’s a huge market that a lot of dentists are ignoring.

The second reason is when you are in the fee-for-service game, it’s kind of like running a restaurant that is not a soup kitchen where the food is free, right? Think about it. If you’re a PPO practice, the mindset is: is it covered by insurance? Then I’ll have it. If it’s not covered by insurance, I don’t want it. Imagine you work in a soup kitchen all day long, and the only reason they come there is because the food is free.

Naren Arulrajah: It’s not very fulfilling, right? You went to school to really become the best dentist you can be, to really make people healthy, create beautiful smiles. For those who are just coming there because it’s free, all those motivations you had for becoming a dentist don’t matter. It’s like, you’re not free? I don’t care, I’m not going to come to you. It’s kind of like someone going to you to get dentistry, and the only reason they’re going there is because it’s cheap. They’re not going there for quality. They’re not going there for any kind of expertise. They’re just going there because it’s cheap.

So I really think that alone, from a psychological perspective, is a really strong reason for every practice owner to aspire to take care of people who are willing to appreciate them by paying a fair fee for that.

Naren Arulrajah: That’s what we call fee-for-service. And also, you gain freedom, right? You can choose your material. When you get paid full fees versus 50 cents on the dollar, you can hire the best labs, you can pay your team better, you can spend time talking to your patients to get to know them. Why? Because you have full fees to take care of them.

Otherwise, you do a thousand dollars’ worth of dentistry and you only get paid half. So you have to somehow make do with half of the revenue, with all your expenses. So what do you do? You make your people work harder, you pay them less, you try to get the cheapest lab because you can’t afford the high-quality labs. You can’t afford the best materials.

I mean, is that why you went to dental school? To be the worst or the lowest common denominator dentist? Or did you go there to be the best—always taking continuing education, always investing in technology?

Naren Arulrajah: So a lot of personal reasons. I’m finding there’s a huge movement of dentists who may not go all the way to fee-for-service, but who are getting rid of the worst plans—the plans that pay them pennies on the dollar, plans that don’t even cover the expenses—and starting to only work with one or two really good plans, and the rest are fee-for-service patients. And like I said, given that half of America doesn’t have any insurance, again, there’s a huge ocean that nobody is fishing in, that you can also fish in.

So for those reasons, I see a huge number of people moving more and more towards fee-for-service, Don.

Don Adeesha: Right? And that makes so much sense, Naren. When it comes to marketing, however, what kind of messaging actually speaks to those patients who prefer fee-for-service care?

Naren Arulrajah: I think a lot of dentists, unfortunately, have been in the PPO world, so they don’t understand that half of the world lives outside of the PPO world. They get so conditioned to thinking every human being thinks the way half of the PPO patients think, which is: is it free? If it’s free, then I’ll do it. If not, I won’t do it.

They get conditioned—and that’s not true. I mean, we pay for things out of pocket every day. We go and buy that Starbucks coffee, we go to Costco, or we go to an organic food store because we care about our kids’ health. We go on a vacation, we get Botox. We do all these things not because we have to, but because we choose to. We work hard for our money, but then we spend that money on the things that matter to us.

Naren Arulrajah: So the number one thing you have to do is shift your mindset from thinking, "Hey, I am a dentist whose worth is zero because the only reason they come to me is because everything I do is free," to "I am a dentist just like any other professional—restaurant owner, plumber. I’m a person who adds value in my community, and what I do is valuable. People pay out of their own hard-earned money."

Just changing that mindset, I think, is where everything starts. Being confident, caring about who you are, and being proud of who you are. Remember, you can’t be a dentist in the United States unless you go through extensive training. You have all the credentials, you have all the accreditation—all of these things, right? I mean, there’s extremely high quality that you have to meet to be a dentist here.

Naren Arulrajah: Why not be proud of it? Why not lean into it? Why not talk about it? Why not talk about the advanced training that you get? Why not talk about the modern technology you have? Why not highlight these awesome people who you have, who are not doing free dentistry, but rather are also getting paid for their work because they do high-quality work and they’re being appreciated in a fee-for-service model?

So highlight all those things. Highlight relationships. For example, one of the best ways to highlight that is through reviews. If you are not a PPO practice that has to do double the dentistry to pay the bills, you can pay attention, listen to your patients, get to know them, and treat them like family. Those things will show up in the form of reviews.

Naren Arulrajah: Highlight those reviews, right? People really, really care about the relationship with their healthcare provider. Why? Because most of us know—especially once we pass the age of 30 or 40—health becomes the number one thing on our list. Without health, nothing else works. If you don’t have health, you’re just working so hard to get it back versus never having lost it in the first place.

So you really can lean in on the fact that you are healthcare providers. For many people, that’s their number one objective—to be healthy. Focus on long-term outcomes. Focus on quality. Focus on even things like beautiful smiles. Some of the things that many of you can do on the cosmetic side is create unbelievable smiles. Doesn’t matter where the patient came from or what their past is—you can change all that.

Naren Arulrajah: You can give them a new lease on life, a new lease on how they see themselves. So focus on all those things you can do with your training, with your expertise, and highlight those. Really stand proud and walk tall because you are doing something that is worth it—not something that people are coming to just because it’s free.

I think it totally changes when you start thinking like any other business owner. Every business in this country makes money. In other words, the services they provide—somebody takes their own credit card and pays for it. You are no different, but you have so much training and so much knowledge. Lean into it. Showcase that. Even cases—you can showcase the cases, showcase the transformation. These are all the things you can do to really start attracting those patients who want to work with their wallet and go to a practice that they really appreciate and value.

Don Adeesha: I really like that takeaway, Naren. I mean, when you start speaking about doubling down on the quality of care as well as the quality of relationships, and just being proud of the work you do, it’s fantastic. And I know a lot of dentists listening in are wondering, okay, but how do I actually reach these patients? What marketing tools or platforms really work for fee-for-service growth?

Naren Arulrajah: Again, going back to the same analogy of any business that gets paid for the work they do versus a soup kitchen that only exists because it provides free food—how do people find those businesses? They start by Googling it.

For example, I have a leak in my house and I need a plumber, and I know I have to pay a lot of money for that plumber. I go look for a plumber. I type in “plumber near me” on Google. Same way—if I want a beautiful smile, I might type in “best cosmetic dentist near me” or “veneers [zip code].” So I’m starting to look for the things I care about that you can do for me, just like the way I found a plumber or just like the way I found somebody to remodel my kitchen.

Naren Arulrajah: I’m looking for that best cosmetic dentist. Are you showing up? This is a secret: 95% of you will get no free traffic from Google, while 5% of you will get all the free traffic. Why? Because the 95% who get no free traffic then, in turn, give Google a lot of money in ads. So what Google does is it makes getting free traffic only available to a tiny pool.

Are you in that top 5% that’s getting 95% of the free traffic? The way you know that is you are ranking for 100 or more keywords and phrases on the top 10 results of Google. If you’re not, you have work to do. Lean in. Be the one who people are finding for all the different things you can do—and not through ads, but for free through search engine optimization.

Naren Arulrajah: Number two: as you build SEO, you might want to use ads as a way to make up for the difference. Now, the challenge with ads is people don’t trust ads. So six people from ads is equal to one person from SEO. Keep that in mind. Use it only strategically or only in the early days just to fill in a gap.

And last but not least—reviews, reviews, reviews, reviews, reviews. Today, we know a lot about a particular doctor in seconds. One of the things they will do, and studies are showing this, is they will look for your reviews. They will type in your practice name plus “reviews” or something like that. Are you getting 10 or more five-star love letter reviews every month? Google loves new reviews, and Google loves paragraph reviews. So get those 10 or more five-star love letter reviews.

Naren Arulrajah: So the fundamentals that apply to any business that gets paid good money for doing good work apply to you. Are you showing up on Google—and showing up for free—for hundreds of keywords? In the meantime, while SEO is building up, do you have an ad campaign, knowing that ads are going to be a lot more expensive and a lot less effective?

And last but not least, do you have reviews? Are you getting 10 or more five-star love letter reviews a month? When you do these three things well, just like any other business that gets paid good money for good work, you will get paid good money for good work. You will grow the fee-for-service part of your business, and the insurance part of your business will continue to come down and come down.

Don Adeesha: Mm-hmm. Now, you mentioned long-term relationships earlier. I would like to get back to that, actually. How can practices make paying directly feel easy and valuable for their patients?

Naren Arulrajah: You know, I mentioned that half of Americans do not have a PPO plan, right? They still need dentistry. They still have a mouth, they still have teeth, they still need to take care of that. We all know, for example, two cleanings a year is very, very important for anyone who worries about taking care of their oral health. We also know the connection between oral health and diseases like heart disease and dementia, and so forth.

So make that part of a membership plan—a membership plan that might say you get two cleanings per year, and that membership plan is going to cost maybe $200–$300, versus an insurance plan, even the worst ones, which will cost $1,000–$1,500. So for $300–$400, somebody gets the fundamentals of dentistry—and it’s with that one practice they love anyway. So lean into membership plans.

Naren Arulrajah: And as part of that membership plan, you can also offer reduced fees for other services that are outside of the core service like cleaning. For example, if they want to get some cosmetic work done, they could get 10% off.

Now, from your perspective, cosmetic work is not covered by insurance. So pretty much that’s money you wouldn’t get anyway, because most of the insurance patients don’t want it since it’s not covered. So you are now opening up a huge opportunity for yourself to attract all those cosmetic patients who are coming to you because they’re going to save some money as well—because they’re part of the membership plan.

So I think that’s a good way to start helping people pay directly and build a relationship with you versus with the insurance company. And that’s a good way to go after that half of the population who doesn’t have PPO or insurance to begin with.

Don Adeesha: That’s a huge opportunity, as you mentioned. Now, just before we wrap up—I know you’re a busy person—but just one last question here. For our practices listening in, ready to start attracting more fee-for-service patients but not sure where to start, what should they do next?

Naren Arulrajah: You know, like I said, any service where somebody pays out of pocket—there is a methodology. Are you showing up on Google at least a hundred times? Why a hundred times? That means you’re going to get 95% of the free traffic looking for the kind of things you can do for your patients.

Find out. Book a marketing strategy meeting. One of the things we do in our marketing strategy meeting is we spend six hours looking at: What keywords are you ranking for? What keywords is your competition ranking for? If you’re ranking for dozens and dozens—eventually, you want to rank for 100+—that means keep doing what you’re doing. If not, at least you know where you stand.

Start looking not just on regular search, but also on Google Maps. How are you ranking? Also on Google AI Overview—how are you ranking? Start looking at the whole thing. These are some of the things we look at in the marketing strategy meeting.

To book the marketing strategy meeting, go to lessinsurancedependence.com/msm. 

Naren Arulrajah: Now remember, there are three key pillars. One is SEO—that’s one of the things we look at when you book that marketing strategy meeting. Once again, it’s lessinsurancedependence.com/msm. 

The other thing we look at is your website. Is it loading fast? Is it optimized properly? Is it going to convert? Is it more likely to help somebody pick up the phone and call you, or not?

And last but not least, we look at how you’re doing with Google reviews and your Google Business Profile. So get a report card and a plan. If you’re doing really well as per the report card, keep doing what you’re doing. If not, at least you know what the gaps are. We’ll tell you what the gaps are, and we’ll give you a plan on how to overcome those gaps.

So looking forward to it. Take advantage of this. That might be the first step.

The minute you make a commitment—“I want to get paid for what I do and I want to be appreciated for what I do”—start attracting those people. And they’re there. They’re the ones who buy Starbucks. They’re the ones who buy good quality food. They’re the ones who read reviews and go to a nice restaurant. They’re the ones who go on vacation. I mean, that’s everyone, right?

So that’s pretty much the whole world. Go after the world that appreciates and wants to pay for good quality dentistry. That’s a massive world. And that’ll make you stand up tall, walk smart, and also it’ll start creating a culture where everyone feels appreciated—because everyone in your office, including you, is getting paid fees for the work you do.

Naren Arulrajah: And that’s a good feeling—when you are not doing free work and the only reason they come to you, at least in the mind of the customer, isn’t because it’s free. It’s an awesome feeling. I know those of you who have been totally dependent on PPO, this is a new feeling. So you have to lean into it and build it. And the more you get into it, the more you will appreciate it, and the more you’ll want to do more of it.

Most of my clients start by dropping one plan—the worst one. Then they’re like, "Oh man, I’m not dealing with that set of patients anymore." And little by little, their confidence grows. They drop the second plan, and the third plan, and the fourth plan.

And when you have marketing to support you along the way—as you drop plans, you are replacing those patients you’re going to lose with marketing patients. These are fee-for-service patients who are coming to you because of quality, who are coming to you because of those reviews, those before-and-afters, and of course, because you keep showing up on Google again and again and again.

Don Adeesha: Well, Naren, that was incredibly insightful. I love that you highlighted how marketing isn’t just about getting more patients—it’s about getting the right patients who value the care that the dentists provide.

To all our listeners, remember: freedom from insurance begins with clarity and strategy. Start with your foundation, and everything else builds from there.

Until next time, thank you very much for listening in.