#AskT-Bone – Ep24 – Bringing In An Associate with or without insurance


Hello and welcome back for another episode of Ask T-Bone on the T-bone speaks podcast!

We have been getting quite a few questions and I greatly appreciate that. We want to encourage you to continue to send in your questions. To send in your questions all you have to do is visit www.tbonespeaks.com. Now we have both the ability to leave a written question and we have the ability to actually phone in your question and leave a voicemail, so we encourage you to use either or both to continue to send in your questions.

Again, thank you so much for your support of our podcast.

So today we have a question submitted by Gary, and it’s on the subject of Dental Associates.

His question reads:

I love the podcast, thanks for all the time you put into it. Thanks in advance for answering my question, I’m very close to adding an associate but I’m worried about keeping the new Doc busy. I currently am at no network, but I’m considering adding a couple once I have an associate.

My two questions are:

  1. My initials thoughts are to sign both of us in network because it will provide less headaches for the staff and I don’t want to ask my associate to do something I wouldn’t do. I know you were working your way out of networks while leaving your associate in. If you were starting from scratch, which system is better? Both Docs in or the senior Doc out?

  2. How would you choose which plans to join? How would you weigh the number of patients they could deliver versus the percentage of write-offs acquired. Any companies you recommend negotiate with insurance companies. Thanks for all you do, I’ve learned so much I can’t wait to come see you and Raleigh.

Well Gary, this is a great question and thank you for your compliments, and thank you for listening, and I really look forward to seeing you at one of our workshops. So, let’s talk about this. So I have questions and unfortunately I can’t ask you the questions and get the answer back to give you the response that I want to get to, but really my question is, or my thought is this:

If you were doing well enough not in network why in the world would you want to add yourself in network?

So, I have zero issue with you bring it on an associate and putting that person in network, but really what it is, is you’re adding a second practice to your existing practice. So what I would rather hear, or what I would want to know is, are you already busy enough to warrant a part-time associate? So if you’re not busy enough to warrant, let’s say for example you’re working 4 days a week and you’re booked Out 3, 4, 5, 6, 7 weeks on both, you know hygiene is maybe longer, dentally as a restorative dentist, you’re booked out at least four to six weeks, then certainly a part-time associate would make sense. But if you say to me, hey I want to bring in an associate to expand my business but I don’t have the patient base for it already, then I would say that really what you need to do you need create a little bit more demand before you ready to add on the associate. Now if you do have enough business already and you are in that situation where you simply have more demand than you have your own time, then I would say certainly you’re probably ready to bring in a part-time, maybe even a full-time associate, so certainly there. Now I would without question, if you’re not in network I would not consider taking myself in network, and I would certainly say, you don’t want to have your associate do something that you wouldn’t do. I would take great issue with that, and the reason I say that is, you want your associate to do the things that you don’t have time to do right now. So right now, you don’t have time to do fillings, you don’t have time to do single crowns. So the other thing that I look for is that you’re financially secure that you can take a pay cut to bring in an associate. Now when you can do that, then I would also say great, now what you can do is you can start expanding your practice taking things off of your plate to create your plate to be more empty to allow you to add on new procedures to your situation. So I don’t know much about your practice I don’t know if you’re already doing implants are you doing TMD therapy, are you doing Orthodontics, are you doing medical billing, are you doing all those opportunities that allow you to grow your practice without growing the number of new patients. And if you’re not doing those things I would encourage you to go into this with the mentality of let’s just use a pie for example, let’s say you have a pie with 4 slices I would want you to bring somebody in with you willing to give up 1/3 of your pie, and take that pay cut in the short term to allow you to focus your attention on doing the additional Dentistry that exist within your practice, but you simply don’t have time to diagnose and don’t have time to do. So to me that would be the more the reason to bring in an associate, and more how I would look at that. But to answer your question directly I would definitely try to leave the senior doc out especially given that you’re not in network already.

The other thing that you must take into consideration is if you go in network, how is that going to affect your overall production? because many of your patients will choose to see the younger doc, the associate doc, and they, you know, being in network means that they will get paid less so that will affect your overall production. So you really need to weigh that out, and quite honestly I’m not qualified enough in that area to help weigh that out and certainly you need somebody that can look at your specific numbers for that.

Now, how would I choose which plans to join?

I would make a spreadsheet and I would write down my fees for the top 20 procedures that you do, your standard fees that you’re getting paid already, and I would go through and I would list out the top five dental plans in your area, and I would look at those fees and comparison to your regular fees and I would add slowly one at a time those fees that are the closest at least amount of right off to my practice and see how that affects everything. So that way we can see are you slowly adding, do you really need to take as many plans as you think you may want to do? Or can you bring this and I step by step fashion? So maybe you bringing associated in with 2 days a week, then 3 days week, then 4 days week, then 5 days a week, and along the way you see how much Insurance you really need to add, if at all. So if you could do without insurance great, let’s do it without insurance. But we know that that is becoming harder and harder to do. So on a couple of notes there I would say that MetLife is generally speaking the worst in terms of fees, but they are also generally speaking the largest carrier in many areas, and probably because they are the least expensive to the companies, and therefore they’re the least expensive and released reimbursement. There is a company called unlock the PPO that does Insurance negotiations on your behalf, and can do a much more complete analysis of your insurance plans and situations. I’m hoping to get her on to the podcast to have a conversation, but I haven’t been able to work that out quite yet. So again, that’s called unlock the PPO, I’m sure there are other companies out there but I have use unlock the PPO, applied by 4 or 5 years ago, and we had very nice experience and good results, so I can only speak to them about 4 or 5 years ago, so I would certainly give them a call.

So Gary, thanks again for sending in your question and for everyone else listening www.tbonespeaks.com you can leave a written question or you can leave a voice mail question.

Thank you very much!

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