Episode #357: Why Is Reducing Insurance Reliance Important In Today’s Market, And How Can Dentists Confidently Make This Shift?

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 Alvis: Hello everyone. Welcome to the Less Insurance Dependence podcast, your trusted source for insight, strategies, and expert advice to help you take back control of your dental practice and career. I’m Lester De Alvis, your co-host. I’m thrilled to bring you another empowering episode with a very special guest, Margaret McGuckin.

Uh, on this episode, our mission is to help dental professionals reduce their reliance on insurance and create thriving, profitable, patient-centered practices. Before we dive in, a quick word from our sponsors, actually an opportunity to anyone listening in: Ekwa Marketing, our sponsor, is offering you a complimentary marketing strategy meeting where you can actually analyze how to attract high-value new patients, rank number one on Google locally, and consistently grow your new patient calls.

So, if you want to analyze your digital presence or your online visibility, you can visit lessinsurancedependence.com/marketing-strategy-meeting to book your complimentary session.

Lester De Alvis: And with that said, if you’re looking for coaching or mentorship to create a thriving fee-for-service practice, schedule a complimentary coaching strategy meeting with Gary Takacs at thrivingdentist.com/csm.

Now, on to today’s episode. I’m excited to welcome Margaret McGuckin, co-founder of I3 Ignite, a company dedicated to helping dental practices accelerate growth through smarter business strategies. Margaret is a respected industry leader who has helped countless practices rethink how they operate, grow profitably, and reduce their dependence on insurance.

Today, Margaret will share her perspective on why reducing reliance on insurance is so important in today’s market and how dentists can confidently start making that shift. Margaret, we’re excited to have you on here. Thank you so much for being part of the podcast.

Margaret McGuckin: Well, thank you for inviting me.

Lester De Alvis: So, let’s start here. Why do you believe reducing reliance on insurance is more critical today than ever before?

Margaret McGuckin: I was the founding Chief Operating Officer for ClearChoice Dental Implants and really helped create that model. And that model was created without, without any, um, basically without any, um, of the traditional payment methods that were being used in dentistry a million years ago when we founded ClearChoice. And the reason we went away from insurance was because we felt that, um, accepting insurance would inhibit our ability to grow and to be profitable.

So, you know, my introduction to dental was in a fee-for-service environment. So I’m a huge proponent of thinking about reducing a practice’s reliance on insurance. And I think it’s critical in today’s environment because we have to, as an industry, find ways to increase revenue. Reimbursements are going down, and you’re kidding yourself if you think they’re going to be coming back up anytime soon. RCM is so important, um, and there are great tools in the RCM space.

Margaret McGuckin: There are great companies in the RCM space who can help you manage your, um, basically your reimbursements. But if you aren’t at the top of your game in terms of revenue cycle management, you’re leaking money. You’re leaking money because you aren’t able to manage, or as effectively as you should for your practice, your ability to get every dollar from insurance that you need to get.

So I think it’s a combination of those two things. Reimbursements are going down, they’re not gonna come back up. And if you aren’t really on top of your revenue cycle management, you’re leaking money.

Lester De Alvis: Exactly. The question that I have as well, that I wanted to ask you, is that now most dentists have this question: do they need to go out of network, or do, is there, like, do they need to just reduce a few of the plans?

Margaret McGuckin: So I’ve worked with — so I’ll just give you an example. One of my clients, um, 18-practice, 18-chair practice up in the Northwest. Um, very successful practice.

Lester De Alvis: Mm-hmm.

Margaret McGuckin: And we have been working this issue for, I don’t know, five years. And, um, I feel like, I feel like if you can really get a handle on how exactly you are going to execute against any reimbursement model, right? And you are really, really on top of that, you know, I think it can work. Um, does that answer the question or not?

Lester De Alvis: Yes, it does. It does.

Margaret McGuckin: But I will also say — I mean, this was an 18-chair practice, very successful. We help — I helped them grow revenue by well over 20% a year. We partnered with somebody who really understood the reimbursement market in the state of Washington and could help our practice manager and the rest of our team on the kind of accounting side, could help them ensure that we had every single possible fix in place so that we knew exactly where we were in terms of uncollectible, late payments, all those types of things.

And you know, if you don’t have that type of guidance — and you guys do that — so then use a professional like you all, because you’re just leaving too much money on the table. You are leaving way more money on the table than you are saving money by not using somebody. Because if you think — I’m just gonna use the practice manager as an example — if you think the practice manager in their quote unquote spare time is going to be really overseeing RCM, you’re wrong. They don’t have any extra time. They’re relying on their team, who may or may not be strong enough to really ensure that your collectibles are getting collected on time.

Lester De Alvis: Exactly. Exactly. So I think those are some great nuggets and some great, great experiences that you just shared. Um, and it’s very, and understanding why it’s critical right now, um, more than ever before. So, but the biggest roadblock for many dentists is fear. So let’s explore that. Many practice owners hesitate to go out of network because of fear — losing patients, revenue, or both. From your perspective, how should dentists start thinking differently about this transition?

Margaret McGuckin: Dentists have to increase their revenue, and they’ve gotta drop more of their revenue to their bottom line, which means you have to be doing exactly what we’re talking about right now.

So I really think that in terms of thinking through — if you can literally map out on a piece of paper your, and this has to be based on data, who your practice is generating the most revenue from that’s collectible, and then you rank order all of the, you rank order all of the, you know, the companies that you’re using in terms of RCM — but you rank them by those that are giving you, in essence, the most amount of revenue every year.

And then you put on another spreadsheet — so you’ve got the most amount of, you rank order most amount of revenue from which sources — then on another spreadsheet, or on the same spreadsheet, how has that changed over time so that you can see who in the last two, maybe three years is paying you more and more, either because you’re generating more patients from them or because they are not — as we all know this — some companies are way harder to work with in terms of reimbursement than others.

Margaret McGuckin: And so you end up having a bunch of payables, right, from some of these dental companies.

And if you can rank order those two things — where are we generating the most revenue, and then what’s happening over time from each one of those sources in terms of our revenue — then you really have data that you can sit with. Simple data. I’m not asking for anything complex. But you’ve got data that suggests, you know what, maybe there are only — and this was actually the case up in the Northwest — there were four different companies who we just, their process for us was very time-consuming in terms of everything related to RCM.

And our revenue from them was declining, meaning the patient base they were sending us was declining. And so we looked at them and we said, you know what, these bottom four or five we are going to eliminate next year.

And I think you need about a year to make this whole transition. And you’ve got to plan for, okay, we’re losing eight patients, potentially. How do we help minimize that loss? Could we get that down to maybe losing one patient? And if so, how the heck do we do that?

And it’s all about starting a year early, helping them understand what you’re going to be doing, what the benefits are to them, how much you would love to continue to serve them and see them, and, excuse me, potentially think about offering them a discount their first year without that insurance plan if they stay in your practice.

So give them some benefit to staying in your practice. Because if you are giving exceptional service, they’re gonna be like, "God, that’s a really — I really appreciate this," is what they say. "I really appreciate that. Thank you. I’m gonna need a little bit to think about it." You go, "Great, we’ll contact you in, you know, 90 days and see how you’re doing."

And that has proven to be a really effective way — this kind of gentle disconnect — to reduce the loss of current patients that you have.

And as we kind of moved through this with this one large practice — I mean, we eliminated probably 10 different insurance companies after we saw this rank order. And again, we did it over the course of a year. I think we lost one patient.

Margaret McGuckin: That was a big win. Well, it’s all about communication, right?

Lester De Alvis: Mm-hmm.

Margaret McGuckin: And putting yourself in their shoes and really knowing, you know, do you want to — in Washington State, Delta Dental is by far the largest provider, right?

Lester De Alvis: Mm-hmm.

Margaret McGuckin: And they are in many states. Yeah. Well, do you really want to start with Delta Dental? No. No, you don’t. Get some experience working at the low end of your ranking, making sure you have this nailed — you know exactly what to say, to whom, and when — and then think about, you know, moving on to bigger plans.

Lester De Alvis: Great perspective. I think that fear makes sense. But as you often emphasized, it’s interesting — those verbal cues you just explained. It’s about the relationship with patients and the communication you just mentioned.

So now, following the same question I wanted to ask — now, let’s talk about trust and communication. How do they play into this? What role does patient trust and communication play in successfully reducing insurance dependence?

Margaret McGuckin: This is one of my favorite topics. So I could talk all 20 minutes on this one.

So again, I started in dental with an organization that was totally new, that nobody knew about, and we did not accept any insurance. And the average payment was about $22,000.

Margaret McGuckin: So what we were able to create was a different way for doctors and patients and hygienists to think about kind of what they did, and to trust us — that we’re going to do the right thing for you.

And so this whole — we even did training on how to create trust. And I’m going to put a little plug in here for an AI company that I think is terrific, and I’m one of their senior advisors. It’s called Vora — A-V-O-R-A. And just generally think about AI tools in terms of how you can help build trust, because I have to say, there’s some great AI stuff on that topic.

And I started off, excuse me, with my searches on just, “How do you create trust with strangers?” Because as you know, when somebody walks into your office — if they’re a first-time patient — they don’t know you. They’re strangers to you and the practice.

Margaret McGuckin: And so that’s the question I started off with with AI. And then I kept going deeper, deeper, deeper into dental specifically. And I think that doing that — doing those prompts on your own as a practice owner or a practice manager, or the person in charge of patient financing — I think it’s a really great way to think about this whole role of patient trust and communication.

And they also have — you know, there are great tips on training.

At ClearChoice, we used to say our whole value premise rested on: We convert strangers to friends. That was it. We convert strangers to friends to friends.

And how do you treat friends? You treat them with respect. You’re genuinely happy to see them. You recommend what’s best for their health — not recommending what’s best for your practice.

And as I did these deeper and deeper prompts in AI, I got some great language. So, my little push for AI in practices.

Lester De Alvis: All right. So, um, when it comes to, like you just mentioned — AI, implementing AI and bringing in AI — since everyone is talking about AI and it’s been the hot topic, yeah, do you think this implementation is going to…

What is your take about it? Will having AI and working together with AI — because I think a few years ago, that was not the story, right? You had to basically work on strategies and you had to think about how to do this. But now that you have AI coming in, how easy is it? Or what is your take on that, Margaret?

Margaret McGuckin: You know, I think it’s relatively — I think it’s easy to use. You just have to be able to structure your prompts into the AI engine. And the better you get at that — and nobody’s good at the beginning — but it doesn’t take you very long to figure out how to create better and better prompts.

Then it gets to be, you know, gets to be less… I mean, it’s very important strategically, but kind of in the day-to-day work in a dental office, I think of it more as a thought partner, right?

Lester De Alvis: Mm-hmm.

Margaret McGuckin: It’s just somebody to test some ideas and thoughts with. And I’m recommending practice managers use it for that. You know — “Here’s the situation. Here are the outcomes I want. How would you suggest I get those outcomes?”

And there’s some really good stuff happening. And I think that the practices who use AI as a thought partner — and we know it works in terms of diagnosis, and there are some great applications on the practice management side — I think those, and I’m gonna kind of go back up to your initial questions, I think being able to use AI as this thought partner is going to help us de-risk things like reducing our reliance on insurance plans.

Lester De Alvis: Exactly. Exactly. Perfect.

So now, when it comes to strategies — practices need strategies and systems to replace insurance revenue — let’s dig into that.

So, you’ve guided practices on sustainable growth. What systems or strategies should practices put in place to replace lost insurance revenue with stronger, more profitable alternatives?

Margaret McGuckin: This is not gonna be a popular answer, because it’s really hard.

You have to have the data that allows you and your team to make informed choices — number one.

Number two, you have to have ways to teach and grow revenue — to teach your team and to grow revenue — to do case presentations more successfully. And this applies all the way from the docs down to the front desk.

But there are a lot of practices — and I’ve worked with many of them — who just are not willing to take the time. This takes a lot of time, it takes a lot of effort to teach people how to do case presentations successfully. But if you can’t do that, then you cannot reduce your reliance on insurance.

And along with doing case presentation successfully, I think a practice should create both doctor and team incentives that relate to performance at higher levels.

And what I’ve found is that when you have this combination of education around how to do case presentations well, and you’ve got some incentives, people just kind of — they like it. Because they’re being challenged to grow personally and professionally, and you’re providing an incentive for them to do it.

So I’ve seen that combination work really well, time after time.

Lester De Alvis: Perfect. Perfect. So I think, just like you mentioned — the data. The data is very important. I think data is your friend. So once you have that figured out, basically everything else in the puzzle falls into place.

Margaret McGuckin: It really does. And I am with you. I am a huge advocate of really using data to make decisions.

And if you aren’t using data to make decisions — to make this significant decision around what are we gonna do about insurance — then you’re gonna miss the boat.

Lester De Alvis: Exactly. Exactly. So again, very powerful strategies.

Now, for dentists who are just starting this journey, it can feel overwhelming. So let’s close with some practical first—

Margaret McGuckin: All of us. It’s overwhelming.

Lester De Alvis: Exactly. Yeah. So, with that end in mind, let’s close with some practical first steps that dentists can take if they’re just beginning to explore this path.

What are the first steps they should take to confidently reduce insurance dependence and set their practice up for long-term success?

Margaret McGuckin: I guess this is circling back to your first question, which is: start with data.

Lester De Alvis: Mm-hmm.

Margaret McGuckin: That’s in your RCM — everything related to revenue cycle management. Really get serious about pulling that data, right? And then make sure that you are collecting everything you’re due, and it’s being collected in a fair time range.

You know, the payments don’t happen six or nine months later because they’re being reviewed — and that review takes, I’ve seen it take as long as six months, which is ridiculous.

So start with your RCM, because that’s going to give you insight into your current situation — who the great, I’ll call them, partners are in terms of payment today. And when you’re really smart around your RCM, then I think you can start looking at exactly who the five are at the bottom that you think you should start with in terms of eliminating them from your payers.

Lester De Alvis: Exactly. And then, also the timeline — what do you think the timeline should look like from the preparation to the actual beginning of where we should start?

Margaret McGuckin: You know, I think it’s six months. And in some cases, practices have taken more like nine months before the data is good enough and they feel confident enough in the data that they can say, "Okay, we know where to start, and we know the risk with these 12 patients or 20 patients," or whatever it is.

Because we’ve talked to the people — we’ve talked to the hygienist who sees them quarterly. Or, "Hey, you know what, this group at the bottom of our data — they aren’t even coming in annually for a hygiene check. And oh, by the way, the dental company is slow pay. I mean really slow pay. And their reimbursement rates continue to go down."

Well, hey — right? Those are the ones you should start with.

So once you have the data, and you’re talking to your team about the people that are connected with this data, I think the decisions become — instead of really heart-wrenching — they become very clear.

Lester De Alvis: Excellent advice.

Margaret, thank you for breaking this down into such clear and actionable guidance.

Anyone listening in, I think they were able to take a lot of nuggets from this discussion.

Again, thank you so much for joining us today and sharing your insights on reducing reliance on insurance and building stronger, more resilient dental practices.

Margaret McGuckin: I’m so thrilled to have been part of your communication about this super important topic. So thank you for inviting me. It was great.

Lester De Alvis: It’s a pleasure, Margaret.

So the key takeaway from today’s episode is that stepping away from heavy insurance dependence isn’t just about revenue — it’s about creating a sustainable, patient-centered practice that thrives long-term.

And as always, this podcast is about taking action.

First off, if you want to attract more high-quality patients and reduce reliance on PPOs, schedule your complimentary marketing strategy meeting with Ekwa Marketing at lessinsurancedependence.com/marketing-strategy-meeting.

Secondly, if you’d like personalized coaching or mentorship to build a thriving insurance-independent practice, you can schedule a complimentary strategy meeting with Gary Takacs at thrivingdentist.com/csm.

Now, both of these—

Margaret McGuckin: Of course — go ahead and do it today. Make that call today, because every day that you wait, you’re losing money and you’re digging a deeper hole for your practice. So make those contacts today.

Lester De Alvis: Exactly, just as Margaret said.

Again, these are complimentary. There are no strings attached. These resources are here to help you take meaningful steps toward the practice and the future you deserve.

So if you found value in today’s episode, please share it with a colleague or a friend who could benefit.

Together, we can help more dentists take control of their future.

Thanks for joining us, and I look forward to connecting with you again on the next episode of the Less Insurance Dependence podcast.

Until then, keep moving toward a thriving, independent practice.