Dental Marketing Experts Discuss Fee For Service Dental Office

Fee For Service Dental Practices? Are They Real?

In our latest podcast, dental marketing experts Mark and Howie discuss how to achieve a fee-for-service dental practice. If you listen to insurance companies, you’ll be led to believe you cannot survive without them. Of course, this is pure bunk. Not only can you survive, but you can THRIVE. With a little planning and guidance, you can transition to a fee-for-service practice. We lay out the exact steps that will get you there.

Podcast Highlights:

  • Defining “Fee-for-Service”
  • Getting Out of the Insurance Trap
  • It’s a Process
  • Replacing Your Insurance Patients
  • Never Go Cold Turkey

Podcast Transcriptions:

Hello, and welcome once again to the Dental Marketing Mastery Series. This podcast is brought to you by New Patients Incorporated, and I’m Howie Horrocks, the founder of New Patients Incorporated, along with me once again is my friend and partner and the President of New Patients Incorporated, Mark Dilatush.

 Howie: Hello, everybody. Welcome once again to our Dental Mastery Marketing series podcast. I’m Howie Horrocks. I’m here in Las Vegas. We got our good buddy out there in New Jersey. Mark. Mark. How you doing?

Mark: Hey Howie, good. I’m doing fine. How’s the, how’s the Raider stadium coming?

Howie: Ha. 85%. Done.

Mark: Get outta here. Really?

Howie: Yeah. That’s what they say in paper.

Mark: Last time I was, last time I looked at it. They were just putting the roof panels on it.

Howie: Yeah, yeah. I don’t know. I haven’t driven by it lately, but

Mark: I guess 85% is the shell. And then the rest is the other 15%?

Howie: It could be. Yeah.

Mark: Yeah. So, what do we have today?

Getting Out of the Insurance Trap

 Howie: Well, we’re going to talk about fee-for-service dentistry. And what that might mean, might have several meanings. And then we’re going to talk about, you know, how you can go toward that model, if that’s what you desire.

Mark: Oh, yeah, this must be from – I saw the….We wrote a guide, a fee-for-service guide to transitioning to fee-for-service.

Howie: Right.

Mark: And, um, you know, we use it to market our own business. And it’s been wildly successful.

Howie: Yeah

Mark: Wildly popular download from our website.

Howie: We produce guides.

Mark: We produce guides on, you know, sleep apnea and, and you know, how to promote implants. And,

Howie: yeah,

Mark: We have all kinds of guides, right? But this fee-for-service guide kind of jumped off the spreadsheet at us like. Wow!

Howie: Yeah

Mark: Look at all these people, who are really interested. And we said, we know, we have to do a podcast about this eventually. And here it is today.

Defining “Fee-for-Service”

So, first, let’s define, because there seems to be a moving definition for fee-for-service and American dental-lore. And basically, our definition is; less dependence on insurance plans for new patients.

Howie: Yeah.

Mark: The quest to be less dependent on insurance plans and their participation in insurance plans for new patients. Let’s just define it as that. Because if you put 10 dentists in a room, they’ll all argue about what fee-for-service really is. So, we’re, we’re, we’re elevating ourselves to the point of being able to define it, for at least the purposes of the next 20 minutes for this podcast.

Howie: Yeah. Okay.

Mark: So, um, so we’re hearing this feedback from listeners on the Dental Marketing Mastery Group on Facebook, websites, emails, whatever. And we’re hearing that fee-for-service dentistry is dead. And Howie and I kind of look at each other and go, “Well, we better not tell the hundreds of clients that we manage their marketing for, because they’re not dead.” Okay, they’re definitely there. They’re definitely you know, dentists!

Howie: Thriving!

Mark: Definitely in the United States, you know, definitely doing just fine. So, it’s, it’s obviously not dead.

And when I, when we get that, we understand where it comes from. Or at least, we believe we understand where it comes from. And most of the time, it comes from a dentist who has been using insurance plans to promote his or her practice, or using, you know, price incentives or offers primarily to generate a response to any outbound marketing. And really the only input they get, the only human input they get is: “How much is this? Do you take my insurance, and so on and so forth?”

Okay, well, that makes perfect sense. That dentist would eventually, after all that human feedback, saying, “How much is this? And do you take my insurance?” Sooner or later, almost every human being on Earth would believe that there are no patients out there who, you know, who want or would desire a fee-for-service type setting. Because everyone is feeding them back different information. So, we get it.

But that doesn’t mean they don’t exist. We’re here to tell you, I don’t know a market in the United States that doesn’t have a fee-for-service practice center.

Well, I’ll flip it completely around. And I’ll say if around your dental market, you’re going to find a fee-for-service practice. So, it’s not that they don’t exist, but you might not have one. That’s possible, okay. But they do exist, and they do exist all over America. So, if you aspire to go in that direction, then now we’ve got a whole bunch of questions.

Like, when in my practice’s life would I even think about going there? How do I get there? What are the steps? What are the processes? What are the risks? What are the costs? Is it even worthwhile? Will I be successful?

Right? That’s where all the questions come in. And all the uncertainty starts to cloud everything over.

Howie: How much suffering, how much suffering will I have to endure?

Mark: Right! Will I have to endure or am I going to lose all my patients? Right? Is every patient that’s on an insurance plan going to leave my practice?

You know, so the answer, the answers to all those are not really that uncertain. It’s, it’s just a series of processes that you go through. So, let’s, the guide, the fee-for-service guide goes this in much greater detail. I couldn’t even read you the guide in 20 minutes for you know, for the time it’s going to take for this podcast. So, if you want to read the guide, just go to our website and download the guide.

It’s a Process

But the thousand-foot elevation view is, I have a dental practice, it’s producing, I’m just going to use round numbers.

It’s a solo practice, I have four or five chairs, and one and a half hygienists a week and one dentist and I’m producing $750,000 a year. And half of my office is under some kind of a plan, some kind of a PPO plan. And I participate with five or six insurance plans. And that’s where half my new patients come from. And I want to know how to get out of that. Okay, so.

There’s good news and bad news right off the bat. The good news is you can get out of it and we know how to do that. But the bad news is, is that this first year or two of your transition is going to be a difficult one because you’re already spending. What does insurance participation cost? It’s like, I think is 19 to 26% of revenue, something like that.

Howie: Yeah, something like that. Yeah.

Mark: Right. So

Howie: A good chunk of money.

Mark: Yeah, I mean, insurance is you know, it’s a marketing medium. And it’s costing you 19 to 26% of your normal, I mean, it’s not revenues. It’s, it’s, you’re just saying, “Okay, if you send me patients, I’ll just do this work for 19 to 26% less.” Okay?

Howie: Yeah, this is marketing.

Mark: It’s basically, it’s a marketing medium. It’s just a really expensive marketing medium. Because marketing should really cost you about 5% of your revenues.

So, this first year as you go through this transition, you’ve got to do both. Which is, you know, you need to financially plan for that you need to, you know you’re going to write off the 20-26% anyway. And you need to go in your pocket for 5% more to dig yourself out.

Okay. That’s, that’s what makes it SO difficult. It’s that FIRST year. It’s why SO many dentists DON’T do it. Okay? But, I mean, the payoff is just amazing.

Howie: It is a classic case of delayed gratification.

Mark: Yeah.

Howie: Right? You have to be willing to put off gratification for a while. And when you do and you follow these steps we’re about to go into, you’ll come out the end very happy about it.

Mark: Exactly, it’s the very opposite of how you got yourself in this trap to begin with. Because when you got into this trap, it was instant gratification that you were looking for. Cycled insurance plans, the phone rings, it’s a patient. Instant gratification. Okay.

Howie: Yeah.

Mark: But it costs you in 19 to 26% of your revenues. Okay, that’s the pay. That’s the devil. Okay. And we’re now,

Howie: Uhm. Mark.

Mark: Yeah.

Howie: We should take a break here. And then we’ll come back and, rock and roll on the rest of this. So, don’t go away. We’ll be right back.

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Howie: Okay, we are back. We’re talking about fee-for-service.

Mark: How to get, how to start transitioning out. So, if insurance participation costs you 19 to 26% of your fees. Now you got to take 5% out of your pocket and start investing in marketing to drive more fee-for-service patients into your practice. Okay.

Now, these transitions, and again, this is 1000-foot elevation view. We have a guide that you can just download and read on the details of the steps.

But from 1000-foot elevation view, what you want to do, you want to go get all the patients that are part of the plans that you participate with. And you want to create a list.

So, let’s say, I’m just going to use common names. Aetna, Delta, Prudential, Met Life, United Concordia, let’s say there’s you have five plans.

What you want to do is, you want to know the number of patients who are part of those plans that are in your practice right now. And so, let’s say it comes out to 400, 300, 200, 100.

What you want to do is you want to invert that list. You want to know who has the most patients in your practice to the least patients in your practice. Then you want to take that list and invert it so that the least patients is the first one. And that’s the one you’re going after first.

Replacing Your Insurance Patients

So, let’s say in this scenario, it was 100 patients, let’s say it’s United Concordia. 100 patients in your practice and United Concordia is, let’s just say it’s the least, they reimburse you the least for your fees. So, you look and you say “I have to replace those hundred patients with my own marketing.”

So, you pull 5% of your revenues out of your pocket, and you start properly promoting dentistry in your market. And you get whatever seven or eight new patients a month, who are non-United Concordia patients, and you replace those hundred patients in one year from now.

One year from now, you and your team get to call. You have a cake and candles with “UCCI” on it. And you have a party. And this is the day that you’re going to release your practice from United Concordia, because you just replaced those hundred patients.

And, and you’ve already done it and it becomes this incredibly empowering, energizing team event. And you send your letter to United Concordia. And again, I’m just using United Concordia as an example. But you send your letter to that first insurance plan, saying that I’m no longer going to participate. And everybody checks off one out of the four or five, boom, one, we’re one down.

Then you get your next one in line, let’s say 200, they have 200 patients of record in your office. But now you’re through your first year. Now your marketing is really starting to gain steam, and it’s starting to become very consistent. And it’s something that is replicable, it’s duplicatable. So, and let me point this out, the second year, you’re going to stop, you’re going to start not paying 19 to 26% of your revenues to UCCI, okay? You’re not going to be, you’re not going to be writing those off, your write offs are actually going to go down. As your marketing budget is sustained at 5%. You’re not going to raise your marketing budget you’re going to leave it at 5%. Okay?

So, the second year you do this, the third year you do this, the fourth year you do this, the marketing kicks up steam, builds the revenues and your costs go down.

Which is an amazing thing for you and your team to witness as it works. It will work. You can do this almost, I’m not going to say everywhere, but there’s very few US markets where you can’t do this, the more competitive your area is, the longer it’s going to take you. The less competitive your area is, the less time it’s going to take you.

In an average market, three to four years. In an average US market, 1 to 1650, if you have three or four plans that you participate with, and that participation makes up 50% of your patient base, probably going to take you three or four years to dig out. Okay?

But it’s worth it. And that’s how, as you look around to the fee-for-service practices around you, you might think that those dentists were lucky, or those dentists had connections, or maybe they’re old, maybe they’re 70 years old. And you know, they started their practice before insurance was even a thing. Or you may come up with all these other extraneous, you know, reasons why this dentist has less of a reliance on insurance participation than you do.

But there’s also, fee-for-service practices around you with dentists who are in their 40s and 30s and 50s. Okay, which does not prove out what you’re thinking, Okay, these are realities. Not only are they realities, but a lot of these fee-for-service practices operate on three-day work weeks. Or four-day work week depending on you know, family, other business interests, hobbies of the owner. The owner gets to set the schedule, right? Maybe they, maybe they want to work three really long, 10- or 12-hour days and just have four days off every week. But they do exist.

Never Go Cold Turkey

And if you’re aspiring to go there, you NEVER go cold turkey. You ALWAYS have a plan. And if you have, you have the right plan. You have to be patient with it. Okay?

Howie: Oh man, how many times have we heard from dentists who’ve just gone cold turkey? In this effort to be free from their chains?

Mark: Right?

Howie: You know, and it just turns into a dog’s breakfast.

Mark: It does.

Howie: No offense to dogs.

Mark: Right. But it is very doable. It’s almost, for everyone listening to this. So, if that’s what you aspire to, then you’re not in the dark.

There’s you know, there’s a ray of sunlight, it might be at the end of a tunnel or behind a cloud. But there is a ray of sunlight, it does happen. It happens all the time, it happens every day, every month, every whatever. And we have tons of people who have already done it and continue to maintain fee-for-service practices in competitive environments.

Forty, more than more than 47% of the female population will not choose a healthcare provider based primarily on a price point. There will always be a market for fee-for-service medicine. Whether it’s dentistry or plastic surgery, or even internists. There’s always going to be a market for it.

Howie, don’t you have a fee-for-service plan for your health care?

Howie: Yeah, Yeah, I do.

Mark: Yeah. So, and he’s not the only guy trust me.

I know, there’s millions of them out there. Right?

So, anyway, it’s possible you have to do it right. It has to be laid out in a plan, right?

You do this and then that and then just like all the dentistry you do. You don’t, you don’t do any dentistry to any patient without a plan. Right?

You don’t go in there with the drill before you, you know, before the five steps that you need to do before the drill goes in. Right.

So, it’s the same thing. It’s the same thing with your business and moving away from dependence on insurance participation.

I’m hearing all over the country, the dentists are whining and crying about all the dental insurance lowering their reimbursement rates. I haven’t heard one say that they raised them.

Howie: No and it’s probably going to get worse.

Mark: Probably going to get worse, exactly. Okay.

So, anyway, I wanted to encourage every one of our listeners. That this thing that they think is impossible is not, it’s not impossible. And we also have tons of clients who take insurance plans and are just happy doing it. And they, you know, they use us for their, you know, higher quality new patients and their and their bigger cases, and that’s fine, too.

We’re not judging you. We’re just simply saying you’re not stuck. If you want to get unstuck out of there, you’re not stuck.

Howie: Yeah. All right. Well, that will conclude today’s podcast. We’re so glad you all are out there listening to us. We hope you come back again next time. Bye now.

We hope you’ve enjoyed our podcast today. You can get all our podcasts on iTunes, Stitcher and And on our website,, and

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