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Steps for Greater Success Staying In-Network

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In the previous articles, we talked about ways to evaluate what type of office (FFP or PPO) best fits your style/goals, and whether to consider dropping network status as a result. However, there are a variety of reasons 95% of offices across the U.S. are in-network.  Whether due to location, personality, desire to help the community, etc. there are many doctors who decide being in-network is the best option for them. As previously discussed in the first article of this series, you can be just as successful with either type of model.  Neither option is wrong, just different.

The key to achieving a high level of success in-network is to first break the common myth that in-network means offering the same high-end care and service for a lower price. This is unrealistic and, in most cases, not feasible. Now, this does not mean you cannot perform high-quality, clinical dentistry, it just means the process is going to look different. The most effective operating model for a PPO office is ‘high volume – high efficiency.” So, let’s look at several common dental office processes you might consider that will help you reach maximum revenue and profitability when “in-network.”

Phone Calls 

Phone calls need to be efficient, around 2-3 minutes long to be able to process more patients. The average front team member without specialized training will often languish on calls resulting in a lower conversion rate (only 35% of calls resulting in an appointment) and higher call times (8 minutes on average). Call handling, including intake of new patients/clients, is the number one most important aspect of almost every business. This is the critical central point where so many companies will succeed or fail. If you haven’t already, an in-depth look at how phones are answered, and new patient intake is handled with targeted team training in modern techniques could result in doubling your office success rate by turning callers into patients twice as often.

Treatment Discussions

Similar to how phones are handled, treatment discussions when “in-network” with reduced fees need to be shorter and result in higher acceptance rates. The average dentist has a 40% treatment acceptance rate. This is much too low whether you are in or out of network. Your target should be above 80% to be successful and profitable in-network. The two best ways to accomplish this is to track your treatment acceptance success rate and to train yourself and your team on this specific aspect of patient communications. What we say often matters far less than how we say it and most people are not naturally inclined to do this well without training.

Your time variable is important. Many dentists believe that the more they talk to the patient, the better.  Often the exact opposite is true.  In many cases, dentists tend to talk the patient out of treatment the more they speak.  Learning to be more efficient, speaking in terms the customer can best relate to, and not in “dental-speak” is paramount!

Lab Fees 

Lab fees need to be low, often below $100 per crown if you are receiving half the price in-network. It isn’t really feasible to have a $300 lab fee for a $600 network fee crown.  There are plenty of US-based labs that can produce high quality clinical care at a low price point.  The main difference is going to be cosmetics.  Researching available labs and testing product options on a somewhat regular basis will best insure you are receiving acceptable quality options at the best price point.

Now, this doesn’t mean you cannot offer higher cost care, it just means that you need to treat higher end care differently, which we will discuss shortly.


It is amazing that you can buy the same exact product from two different sources and pay widely different fees.  This happens a lot with supply companies, which is often a sore point for dentists.  However, even more important is to understand that many manufacturers will build the same product in the same factory for a lower price, just with a different name put on the package.  You are literally paying for that brand name’s marketing costs through higher supply fees.

There are a variety of nuances to learn in the supply world, not only about how different manufacturers function, but also about buying clubs that can reduce your fees even more by being a member.

Finally, you should understand what a formulary is and how this is one of the most important aspects on how corporate offices can achieve lower supply costs.  There is literally nothing stopping private offices from doing the same thing except lack of knowledge.  A formulary is a system that sets exactly what can and cannot be purchased by the team for equipment and supplies.  Anything outside the formula or list would need special permission from the owner or manager. This system makes sure that the practice is ordering the exact supplies that it needs without paying more for alternative items. Most suppliers will allow you to set computer-based limits on what can be purchased without authorization.

Coding and Billing

This is a big frustration for many offices.  In most cases, these frustrations come from a lack of knowledge. Dental insurance used to be a massive headache for me and my office staff. Now that my team and I have learned to understand it, insurance is now just a mild annoyance. The more you learn about how to bill correctly and what laws exist to protect offices and patients, the greater the efficiency and higher the collections/claim reimbursements you can achieve doing the exact same dentistry as you are doing now.

For example, Crown and Scaling and Root Planing claims should have a very low claim denial rate, under 1% for your office. However, nationally these are often denied 50% of the time or more. The solution to significant improvement all comes down to knowledge, training, and correct documentation.

As another example, learning how to effectively offer “upgrades” for higher cost procedures, lab items and supplies.  Many dentists do not realize the option to offer upgraded services is actually a part of the contract you signed.  Upgrades are what allow an in-network dentist to offer high end cosmetic or other care and charge the higher cost components to the patient.


The average office has a 92% collection rate, which means they are losing 8% of all the hard work that they do.  If you are not above 99% collections, something needs to change!  Simple changes may do the trick.  How you estimate, how you bill insurance, how you handle treatment presentations, and how you handle copays ALL have a part to play in the ability to move from a low collection rate to almost 100%.


The way we are taught is often the easiest way to teach someone to do dentistry but can sometimes be the least efficient way to do it.  Changing the steps in what you do day to day and rearranging the order can often mean accomplishing the same result in 25-50% less time.

Hear this, it is NOT about working faster!  Only about working smarter.  If you can provide 30% more dentistry in the same amount of time and not have to change the speed at which you do each step, don’t you owe it to yourself, your back, your office, and your patients to look closely at and challenge some of your more frequent processes?  

For the simplest example: using one less bur every time you prep a tooth can save time on every procedure.


With 95% of dental practices currently operating “in-network”, chances are that you are already successfully implementing several of the above tips and techniques. However, if you are not achieving the growth and profitability targets that you aspire to, and certainly before you change over to a full Fee-for Service model, it may be worth your time to delve more closely into one or more areas touched on above and see if there are some straightforward improvements which can make a big difference today.

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Old habits die hard. If your current dental insurance claims process hasn’t been updated, it’s likely outdated.

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