Episode 414: Take Your Power Back: Winning Fee Negotiations with Tessina Bullock

Lester De Alwis: Welcome to the Less Insurance Dependence podcast. I’m your host, Lester De Alwis. This show is dedicated to helping dental professionals build stronger, more profitable practices with less reliance on insurance. This episode is brought to you by Ekwa Marketing, the digital growth partner behind this podcast, and a trusted resource for dental practices looking to strengthen their online presence and reduce their dependence on PPOs. Today I’m excited to welcome Tessina Bullock, President of Veritas Dental and Co-Founder of Veritas Dental Resources. Today’s episode is called Take Your Power Back, Winning the Negotiations. We are going to talk about why so many practices accept PPO fees they should never have agreed to, and how to start negotiating for what their work is actually worth. Tessina, welcome to the show.

Lester De Alwis: I know you have been fighting for dental practices since 2008 and even got an insurance commissioner to halt an insurer’s practices. What pulled you into this fight?

Tessina Bullock: I was living it every day. I was an office manager trying to advocate for my patients and for my doctor and his practice. Knowing the hard work the doctors put into this, it just sparked a fire in me. I don’t know why I decided I needed to be the one to protect all these doctors and patients, but it seemed like such a huge injustice and such a huge complication. I started out much more angry than I am now. I’m actually less angry at the insurance companies, believe it or not. It’s come from a place of learning and understanding that there’s a huge miscommunication and a huge disconnect between insurance companies and dental offices. If that was repaired, we wouldn’t be in the spot we are with all the doctors who are struggling so heavily. Part of what I do now is helping offices understand that yes, we’re fighting back, yes, we’re taking our power back, but more so we’re closing that gap, including pieces of information the office never had access to, so they can make more informed business decisions moving forward.

Lester De Alwis: Why do so many dentists treat their PPO fees as fixed when they’re not?

Tessina Bullock: They treat them as fixed because that’s what they’re getting told very often by insurance companies. Especially as an independent practice, you don’t have very much leverage, or you don’t know what leverage you have. That’s the miscommunication: not knowing what to say to insurance companies or how to approach them. Normally they reach out and say these fees are too low, we can’t afford it, and the insurance company says, too bad, that’s all we’ve got. Then you’re forced into take it or leave it. Practices also have the misconception that if they go out of network, they’ll lose all their patients. So they say, I have to take it, there’s no other choice, and the insurance isn’t increasing the fees, so it’s a fixed rate. They start squeezing other areas of the practice to live within those reimbursement rates. There’s a much better way. They’re not a fixed flat rate. They do negotiate. You can also be an out-of-network provider. There are so many options offices aren’t aware of.

Lester De Alwis: So basically, a low fee treated as fixed is costing practices real money, right?

Tessina Bullock: Yes. So much money.

Lester De Alwis: So when a practice negotiates better fees, how does that change what their marketing dollars can actually deliver?

Tessina Bullock: Negotiating the reimbursement rates is the main focus. It sounds like that’s what everybody wants, but because they believe they can’t negotiate, they shift toward cutting costs. Everybody’s kind of given up: well, we can’t negotiate fees, so let’s cut costs and reduce overhead. That’s a huge issue, and we’re seeing a common trend across the country. Offices cannot keep good staff on hand, or well-trained, well-educated staff, because they can’t afford to pay them. The quality of clinical dentistry starts going down, and our ability to market goes down too. A lot of doctors are not marketing beyond in-house efforts, because they can’t afford it, or because they don’t want to market to patients with insurance that doesn’t reimburse them well enough. Then they’re filling the chair time with patients who can’t pay the bills. Negotiating those reimbursement rates changes a lot more than just marketing. It changes the entire health of the practice. It improves clinical dentistry and the staff you’re able to have, and now you can market on your own. One of the reasons I bring up marketing is that when you sign a contract with a dental insurance company, the write-off is supposed to be a marketing fee. If you said, I’m going to pay 30 to 50% in marketing for my business, that would be ludicrous.

Tessina Bullock: That’s too high. And so you can reduce your dependence on PPOs and say, I can still see these patients as an out-of-network provider. I can still treat them and do my own marketing, and I don’t have to pay that high a cost. You can hire a marketing team and see those patients as an out-of-network provider, or with less dependence on PPOs, and start filling your chair time. Your existing patients will already be filling that chair time, but now they’ll be paying you what your practice is worth, what your high-quality dentistry is worth.

Lester De Alwis: I think you brought a good point about marketing and why marketing is important in reducing insurance dependence. Our friends at Ekwa Marketing are offering a complimentary marketing strategy meeting. You can book at lessinsurancedependence.com/msm. It’s complimentary. You can understand where your online visibility is and where you are actually losing money when it comes to online visibility. You’ll learn things about your online visibility that you won’t learn about your practice on your own, which is exactly why marketing matters, as Tessina said.

Tessina Bullock: Yeah, it’s huge, because you’re thinking, if I go out of network or reduce my PPO dependence, what’s going to happen to my patients? They’re in fear. It’s a myth that came from the insurance companies, that they won’t be able to get new patients or keep their existing patients. And that’s a lie. If you do the right marketing and you have a good team on staff, you’ll be very successful and your chairs will be very, very full.

Lester De Alwis: Talking about mistakes, what is the biggest mistake practices make when they try to negotiate or appeal the denial on their own?

Tessina Bullock: I would say on their own, they’re just calling the low-level reps or not sure how to get to the right contact at the insurance companies. And then also not sure how to angle that conversation, what to say to the insurance company in order to get the negotiations, doing it on your own. I hate to say this, because I’ve been in a practice, but I’m like, do it yourself. We’re short on money and can’t afford to pay all these consultants and third-party companies. But if you partner with the right people, that will increase your revenue threefold, because they have the specialized angles to get the success you can’t get on your own.

Tessina Bullock: So if you reach out to an insurance company and say, I want to negotiate, and they say yes but give you a fee schedule that isn’t desirable, how do you go from there? If the insurance company says that’s the best they have for your whole zip code, you have no way of proving them otherwise. But working with an organization or consultant that has access to the other reimbursement rates for that area can call the insurance company out. They can say, that’s not the best fee schedule right next door, this other doctor is getting a better reimbursement rate, and that’s not fair. They can also change the conversation to focus on clinical services and higher clinical care. Even if the doctor next door is getting higher or lower, your clinical dentistry might be at a higher quality level, which would earn you a higher reimbursement rate. Working with a specialist or organization is a huge game changer if you’re trying to do it on your own. The biggest mistake would be not knowing the conversation and not knowing who to have that conversation with.

Lester De Alwis: Working with experts is something most of our listeners would love to do with you. Talk a little bit about the services you provide.

Tessina Bullock: We’re going nationwide with an IPA, an individual practitioners association. Under this model, individual practices are not alone anymore. They’re grouped together, and our main focus is improving clinical quality, because higher clinical quality of care earns a higher reimbursement rate. We track all of that and take it to insurance companies to change that conversation, focusing on the clinical aspects for our whole group. An individual practice often doesn’t have the leverage a DSO might have. An IPA means you don’t have to sell your practice. You can own your own practice, but you join up and participate in a shared risk pool, sharing the risk together to focus on higher clinical care and change the conversations with insurance companies. We’ve been doing this for 10 years in a couple of states, and now we’re taking it nationwide. What we’ve seen in successful states is that it changes the relationship between insurance companies and providers, with better reimbursement rates, group healthcare coverage that individual practices can’t offer on their own, and discounts on supplies. Being part of an IPA is a game changer. The website is dentallinkipa.com, and you can reach me at tessina@dentallinkipa.com. Go check out the website. It’s fantastic.

Lester De Alwis: If you’re to share some advice, what is one thing a dentist can do this week to start taking their power back?

Tessina Bullock: Stop making decisions based on fear. Reach out to specialists in this field who can help you tackle this without fear, because fear is what’s holding you back. It’s a valid fear to a point. If you do it on your own, you’ll have to learn everything by yourself, which will naturally cause some attrition, because you’re fumbling around. By the time you figure it out, you’ve suffered some loss. But if you go to experts who have already done this and tested it, they can tell you what to watch out for, how to have those conversations with patients, and how to have them with insurance companies. You don’t have to struggle through figuring it out on your own. You’re not alone anymore. You can join an organization, specialist, or company that will help you succeed and excel way past what you had ever imagined possible, if you stop living in fear and start taking steps to find guidance for your practice.

Lester De Alwis: The biggest takeaway for me is that dentists have far more power over their fees than they realize, and taking that power back starts with one negotiation. If you want to take action on what we covered today, you can schedule a complimentary marketing strategy meeting at lessinsurancedependence.com/msm . If you’re looking for mentorship, you can book a complimentary coaching strategy meeting at lessinsurancedependence.com/csm . You can also find Tessina’s contact details in the show notes of this episode. The practices that break free from insurance are not the ones that accept the fee they are given. They are the ones that ask for more and get it. Know your worth, negotiate for it. Freedom follows.