Ep. 212: How to Handle Out of Network and Shopper Calls
Price-shoppers and insurance worries are two of the biggest reasons dental offices lose new patients on the phone. Jeff and Sabri break down step-by-step methods to flip these calls into opportunities that fill your schedule.
Phone Skills Course - https://ddssuccess.com/p/phone-skills-2-0
Phone Scripts - https://www.mgeonline.com/the-mge-new-patient-phone-scripts-ebook
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Questions From This Episode
How much of a real difference can improving new patient phone conversion actually make?
The national average conversion rate for new patient calls sits around 23 percent, meaning roughly one in four callers actually becomes a scheduled patient. Simply getting that up to 50 percent, without spending an additional dollar on marketing, effectively doubles new patient flow for the average practice.
What's the fee strategy Sabri recommends for handling patients who are out of network, and why does it work so well?
Set preventive and diagnostic fees at the plan's UCR, usual, customary, and reasonable, rate rather than the full private fee, since that UCR figure typically still gets covered at 100 percent, while raising basic and major fees up to a comfortable percentile for the area. This actually solves the real reason patients leave when a practice drops insurance, they're used to paying a copay for a filling or crown, but a sudden copay on what used to be a free cleaning is what genuinely upsets people.
What is a receptionist's actual job when handling a new patient call, according to Sabri?
Not to answer every question or act like a diagnostician, but simply to schedule the patient. Their only function on that call is bringing the person into the practice so the doctor can actually take a look and handle everything else once they're there.
How should a practice handle a patient calling about a plan the office no longer accepts, especially one like Delta where the check goes directly to the patient?
Rather than opening with a flat we don't take that plan, verify what specific coverage the patient has and tell them what will be covered, since preventive care is often still covered at or near 100 percent even out of network. For plans like Delta that won't allow the practice to accept assignment, a common and increasingly popular solution is putting a credit card on file and charging it automatically after 30 days if the patient hasn't brought in their insurance check.
Why do shopper calls convert so poorly on average, and what's the actual strategy for handling one well?
In over a thousand mystery shopper calls MGE has placed into prospective client practices, only about 2 percent converted, largely because staff refuse to engage or offer a flat we don't quote prices over the phone instead of having a real conversation. The better approach is asking genuine questions, who told them they needed treatment, where in the mouth, whether they're in any discomfort, since dental diagnosis genuinely varies by provider philosophy, then offering a free consultation instead of a number, an approach that converts 60 to 70 percent of calls when done well.
Episode Transcript
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Jeff: Say I'm a prospective new patient and I call your practice. Your receptionist answers, and I ask how much you charge for a crown, an implant, whatever it might be. What do they say? We don't quote prices over the phone, and abruptly end the call, or I'm sorry, we can't discuss fees, something along those lines? Or say instead of asking about price, I lead with, do you take my insurance, and it happens to be a plan you're not in network with. What happens then, do you just say no and end the call?
Jeff: Your receptionist is genuinely the make-or-break point for new patients in your practice. Someone who's on the ball and knows what they're doing can bring in an additional 10, 20, even 30 new patients a month. But these two specific situations, handling what we'd call shopper calls, and handling patients you're out of network with, are genuinely big problems we see constantly, especially with newer clients. When we listen to call recordings with these clients, these are consistently the types of calls that get mishandled.
Jeff: So for this week's episode, we're tackling this head on, and to help me do it, I have Sabri Blumberg, our Deputy Chief Operating Officer, who was just on the podcast a couple weeks ago. If you've been listening for any length of time, you know Sabri, she's our top technical delivery person here at MGE. We're going to cover these two issues, shopper calls and out-of-network patients, and Sabri's going to teach you how she trains clients to handle these calls. She's actually been running a lot of live sessions with client teams on exactly this lately, and what she shows them genuinely works. Sabri, welcome.
Sabri: Hello, Jeff.
Jeff: Before we jump into the actual scripts, is there anything you'd want to establish first?
Sabri: A couple of things. First, you can't teach someone a script for handling new patients on the front desk unless that person already has the basic qualifications to be a receptionist, meaning they genuinely like people and have real communication skills. You've talked about this before too, reception at a dental practice is not an entry level position. You want your best person there, because every dollar you spend on marketing, every phone call, flows through reception first.
Sabri: You've mentioned this stat before too, the national conversion rate for new patient calls, meaning people calling in inquiring about becoming a patient versus how many actually schedule, sits around 23 percent. So roughly one out of four potential new patients actually makes it into the office.
Jeff: Some of that's genuinely unavoidable, say someone's on an HMO and needs to go to a specific network practice. But we can absolutely do better than one in four. Even getting to just one in two, without spending another marketing dollar, doubles new patients for the average office.
Sabri: Exactly right. So having the right person on reception matters enormously, making sure they're actually trained for it, and making sure they don't view answering the phone as a nuisance because they're already overloaded with checkout, insurance, and check-in duties all at once. If that's happening, they simply don't have the bandwidth to do a good job on the phone, and that's not what you want a new caller to experience.
Sabri: There are a couple of other assumptions built into how I handle these calls, especially the in and out of network ones, worth clarifying first. With our clients, we set it up so out-of-network fees for anything that would normally be covered at 100 percent, hygiene visits specifically, get set at the UCR rate rather than the full private fee.
Jeff: So just to walk through this for everyone listening, say I have insurance through a company we'll call Acme.
Sabri: If you're in network with Acme, they pay whatever their negotiated rate is, say $55 for an adult prophy, at 100 percent. If you're not in network, they'll pay based on what's called UCR, usual, customary, and reasonable, which might be $99 for that same code. So as long as your office doesn't charge more than $99, Acme is still going to pay 100 percent of it.
Jeff: Worth noting, a small number of PPOs have started paying less than 100 percent even for UCR-covered preventive work, but that's still a minority, so let's not get sidetracked, since the strategy we're covering handles most scenarios.
Sabri: Right. So say your private fee, what you'd normally charge everyone, is $130. Now you've got three numbers: $55 in network, $99 UCR, $130 private. What I recommend, and what our clients do, is lowering diagnostic and preventive fees to that UCR rate, while raising basic and major fees up to whatever percentile they're comfortable with for their zip code, the 60th or 70th, for example.
Jeff: So that lower preventive fee is really more of a marketing spend than an actual write-off, since if the patient were still in network, you'd be writing off even more anyway.
Sabri: Exactly. The number one reason patients leave when a practice drops insurance isn't the copays they're already used to, fillings, root canals, crowns. It's that their cleaning suddenly isn't free anymore, and they weren't expecting that. Lowering that specific fee to UCR eliminates that problem entirely.
Jeff: Here's the actual punchline. If I've got 80 percent of my patients in network getting $55 a prophy at 100 percent, and I go out of network and start charging UCR instead, I'm now getting $99, that's effectively a fee increase, even while I'm charging my private-pay patients a little less than before.
Sabri: Right, and honestly, why not? Those private-pay patients have been the ones quietly subsidizing all the PPO discounts this whole time, there's no reason to keep penalizing them. It works out well on both ends, and it gets your profit margin back to where it actually needs to be to make ownership worthwhile, while still delivering quality care. And meanwhile your crowns go from $800 in network to whatever they should actually be, $1,500, $1,600, wherever your real fee lands.
Sabri: The other piece: your receptionist needs to genuinely understand their job on these calls. Their job is not to answer every question or act like a doctor. Their only function on a new patient call is to get that person scheduled. Everything is geared toward just bringing them in, we'll handle everything else once they're actually here.
Jeff: Can I add one thing here, since I've seen this come up a few times recently. This connects to why the receptionist's job has to specifically be scheduling. I've had clients ask me directly, what do I even charge for a second opinion, should it be free? I bring this up because without an actual agreed-upon policy, you get this instant collision inside the practice, reception doesn't know what to do with a caller like that.
Sabri: Right, there has to be a clear, agreed-upon policy running from reception all the way back to the doctor. Second opinion, here's exactly what we do, whether that's $29 or free. My own philosophy has always been, just bring them in. It's fifteen minutes of your time, you can charge for it if you want, we never did, because it's a genuine sales opportunity and you're already spending real marketing money to get new patients in the first place.
Jeff: Right, people sometimes get hung up on, well, I usually charge $29 for that, who cares, that's not the real issue given what you're already spending on marketing to get someone to call in the first place.
Jeff: Alright, let's get into the actual scripts. Which comes up more often, the shopper call or the in-network question?
Sabri: In-network questions are a bigger issue right now.
Jeff: Let's start there then. Say I call your office, you've dropped a plan, we'll call the insurance company Acme.
Sabri: Alright, let's play it out.
Sabri: [as receptionist] ABC Dental, this is Sabri, how can I help you?
Jeff: [as caller] Hi, my friend goes to your office and said you guys are really good. I wanted to know, do you take my insurance?
Sabri: [as receptionist] I'll check that for you. Can I get your name and contact information, just in case we get disconnected?
Jeff: [as caller] Sure, it's Jeff Smith, and my number is...
Jeff: So you'd go through the normal new patient intake from there, I'll skip ahead to the actual question.
Sabri: [as receptionist] So your question was whether we take your insurance, you mentioned Acme, do you have the Acme PPO or the HMO, do you know which one you have?
Jeff: [as caller] Um, I'm not sure.
Sabri: [as receptionist] Do you have your insurance card handy?
Jeff: [as caller] Yeah, it says Acme PPO.
Sabri: [as receptionist] Perfect, and you're looking to come in for a cleaning?
Jeff: [as caller] Yes, exactly.
Sabri: [as receptionist] Great, Acme covers 100 percent of your cleaning here. Let's get you scheduled, and if you need anything beyond the cleaning, we'll verify your full benefits ahead of time so we already have that information ready. When would you like to come in?
Jeff: I like what you did there, you told me my insurance covers 100 percent of the cleaning, which is completely true, and you let me know you'd verify anything further before it became relevant. You never actually said the word in-network or out-of-network at all.
Sabri: Right. So breaking that down into a real process: first, you're simply polite, this is another human being, not a click-and-hang-up interaction. You thank them for calling, get their information, treat them like a person, standard new patient intake. Then you ask for their insurance card and identify the plan, and you tell them what's actually covered, in this case, 100 percent of the cleaning. And that's it, you schedule them.
Jeff: What if I'd said I had the Acme HMO instead?
Sabri: [as receptionist] Do you see a doctor's name listed on your card?
Jeff: [as caller] Yeah.
Sabri: [as receptionist] That's actually the only doctor you're able to see if you want to use that specific insurance.
Jeff: [as caller] Oh, I already saw that guy, I didn't like him.
Sabri: [as receptionist] Understood. We do have a new patient special right now, could you do $98 for your first visit?
Jeff: [as caller] Yeah, I could do that.
Sabri: [as receptionist] Perfect, let's get you scheduled with the new patient special. We'll take great care of you, and I think you'll really like our doctor.
Jeff: That's smart, and it reminds me of a client we have in central Florida whose practice pulls a large share of its patients from the corporate HMO office right across the street.
Sabri: Exactly that dynamic. You offer the HMO option first, and if they'd genuinely rather not go back to that doctor, you offer the new patient special instead and bring them in. Most of the time, if someone's calling with an HMO, they've already been to that network doctor and don't want to go back, so don't write them off.
Jeff: Good point.
Sabri: The one plan that works a little differently is Delta. If you're out of network with Delta, they won't let you accept assignment, meaning the check goes directly to the patient, not to you.
Jeff: That reminds me of a client with several practices in a heavily Delta area who dropped it entirely. He decided, even knowing Delta wouldn't officially let him accept assignment, he'd just see what happened. Most of the time, since Delta's actually quite efficient, and I probably shouldn't be complimenting them given everything else we say about insurance, they kept sending the check directly to the practice anyway. He took a modest hit for a few months from the patients who didn't forward their checks, but the majority did, and he was fine with the tradeoff.
Sabri: That's genuinely become more common, and there's really no issue with it. The other approach I see: you tell the patient their cleaning is covered at 100 percent, but since the insurance company sends the check to them rather than the office, you put a credit card on file, and if they haven't brought in the insurance check within 30 days, the card gets charged automatically.
Jeff: That's smart, don't create unnecessary barriers to people actually showing up.
Sabri: Right, so you've really got three options if you know a plan won't allow assignment: wait for the patient to receive the check and bill them directly, put a credit card on file with a signed authorization to charge it after a set window, usually 30 days, or simply require payment upfront. Most practices are landing on the credit card option at this point.
Jeff: And usually the patient's already been paid by the time that 30 days is up anyway.
Sabri: Right, sometimes they just call in the card to pay directly instead, or use their own card and collect the points. Either way, it's simple. So really, the only patient you're likely to lose in this whole scenario is a committed HMO patient. And there's also a small, growing minority of plans, maybe 10 percent, where out-of-network preventive coverage runs at 90 percent instead of 100, sometimes even 80.
Jeff: I think insurance companies have caught on that a lot of us are pushing back on this publicly now. There used to be a site, MetLife had one, that showed in-network versus out-of-network fees, and the out-of-network numbers were almost a joke, sitting in like the 30th percentile. That site's since disappeared, we've referenced it on the podcast before. I think we should expect more insurers to start trimming that out-of-network percentage.
Sabri: Right, but even then, we're usually talking about the difference between covering 100 percent of UCR versus 90 percent, which often works out to something like a $15 copay. So if a patient calls and you know they'll have that small copay, you simply say, your copay for the cleaning will be about $15, is that workable for you? And nearly everyone says yes.
Jeff: You actually made a great point about this at a seminar once, about a mom bringing her kids in for a cleaning. If our own kids were little, say eight and ten, and we were used to insurance covering everything at 100 percent, and suddenly we were told there's a $150 copay, that would be a genuine shock, not necessarily a hardship, but definitely not something we were expecting, especially with finances already tighter when kids are young.
Sabri: Exactly, versus if that same family was told a crown carries a $1,000 copay, that's expected, you're already mentally prepared for a financial conversation around bigger treatment. Nobody expects to have a financing discussion over a $25 or $100 hygiene visit, but a crown or a filling, absolutely.
Jeff: So to summarize the out-of-network approach: you're essentially answering the patient's question without directly answering it. Fewer people actually ask are you in network specifically, most just ask do you take my insurance, but even the more savvy callers who do ask directly get handled the same way, you find out their specific plan, verify their actual coverage, and simply tell them what's covered and get them scheduled.
Sabri: Right, you never even have to say the words in network or out of network. Just bring the patient in, let them fall in love with the practice and the doctor, and they'll be genuinely happy to pay out of pocket for whatever else comes up.
Jeff: Great, let's move to the shopper call.
Sabri: So, when clients ask us to run a mystery call for their practice, we always call in as a shopper, nothing rude about it, just a genuine price inquiry. The average conversion rate we've seen across well over a thousand of these calls, where we count a conversion as actually being willing to schedule, is about 2 percent.
Jeff: That's genuinely poor.
Sabri: It really is, and some people get outright rude with a shopper call, since there's still this odd stigma around it. I always ask groups, have you ever bought something on sale? Of course you have, everyone shops around sometimes, that's completely normal. And here's something most people miss about a shopper call specifically, if someone's asking how much a single crown costs, they almost certainly need more than one, since nobody's going to switch dental offices to save $200 on a single procedure.
Jeff: Right, and shoppers actually make great patients once they're in, they're already partway through the buying process, they already know they need the work done.
Sabri: Exactly, there's this strange, almost superstitious attitude that shoppers are somehow a lesser type of caller, and it's simply not true.
Jeff: Let's play this one out too.
Sabri: [as receptionist] ABC Dental, this is Sabri, how can I help you?
Jeff: [as caller] Hi, how much do you guys charge for a crown?
Sabri: [as receptionist] It really depends on what kind of crown you need, can I ask you a couple of quick questions first?
Jeff: [as caller] Sure. I think I know the specific code, it's D2740, how much is that one?
Sabri: [as receptionist] Sure, but first, what made you think you needed a crown?
Jeff: [as caller] Full disclosure, I actually saw another dentist and they told me I need a few crowns.
Sabri: [as receptionist] How many were you told you need?
Jeff: [as caller] I think three.
Sabri: [as receptionist] And where are they located in your mouth?
Jeff: [as caller] Upper left, the two in the back, and then one on the bottom front, I think I hit it on something.
Sabri: [as receptionist] Are you in any pain there right now?
Jeff: [as caller] Not right now, but sometimes if I drink coffee or soda, the back ones really hurt.
Sabri: [as receptionist] And you don't currently have crowns on those teeth?
Jeff: [as caller] No, I don't think so.
Sabri: [as receptionist] Okay, I'll answer your question directly, crown pricing varies enormously, it could run anywhere from a few hundred dollars to $2,000, it really depends. What's actually more important to understand is that different dentists can genuinely look at the same dental issue with different philosophies, one might recommend a crown where another takes a more conservative approach. So given that you mentioned some discomfort, I'd really like to bring you in for a free consultation so our doctor can actually look at those specific teeth.
Jeff: [as caller] But can't you just tell me the crown price now?
Sabri: [as receptionist] I really can't, since it could end up being a few hundred dollars, a couple thousand, or possibly not even need a crown at all, some dentists are more conservative. The doctor genuinely has to see it in person. So let's just get you in, it's free, we have a great doctor here who can take a look and figure out exactly what's needed. Do you have dental insurance?
Jeff: [as caller] Yeah.
Sabri: [as receptionist] Perfect, I'll verify that in the meantime, and hopefully it turns out you don't even need a crown. But this is genuinely the best way to get you an accurate price, once we know exactly what's needed and what your insurance covers, you can decide from there. Could we get you in today or tomorrow?
Jeff: So breaking that down into a process: you never get defensive with the caller, you genuinely engage them in real conversation. This is exactly where it usually goes wrong, someone asks how much a crown costs, and the answer is, we don't quote prices over the phone, click. Whereas you asked where the crown was located, whether it was sensitive to hot or cold, who actually told them they needed it, none of those questions were pointless, they were building a real conversation.
Sabri: Right, and the doctor genuinely isn't eager to cut down a tooth for a crown that isn't necessary either, so you're not just stalling, you're gathering real information. The point is getting to know the patient a little, and letting them get to know you, then bringing them in so the doctor can actually take a look. They may very well need those crowns.
Jeff: But the real benefit either way is that you've engaged them, you're in genuine communication, which is exactly what a shopper is actually looking for, a real connection, seeing you as an actual person who genuinely cares, because you do.
Sabri: Exactly, and this exact approach applies to fillings too, what makes you think you need a filling, are you in any discomfort, why don't we just take a look. Same with implants, there are different types depending on how much bone the patient has, so you'd never quote a firm price, you'd give a range, or in some cases skip the range entirely and just explain that the doctor genuinely has to see it first to know.
Jeff: And you've seen that handled well convert at what rate?
Sabri: Sixty to seventy percent of those calls schedule when it's done this way. Sometimes the patient will still ask for a ballpark once you're wrapping up, in which case you give a real range, say from a basic option up through something like a crown and buildup.
Jeff: Same logic with implants, a genuinely wide range depending on the case.
Sabri: Exactly, and the key is explaining, in a genuinely kind way, that there's real subjectivity in how dentistry gets diagnosed depending on a given dentist's philosophy, without ever phrasing it quite that clinically. Something more like, our doctor might have a different take on this, we really can't say anything for certain until we've actually seen you, let's get you a second opinion.
Jeff: I love that. This was genuinely great, and for anyone listening, I'd take exactly these two scripts, drill your team on them until they're completely comfortable handling both scenarios, and practice with real mock calls. Handled well, this alone can bring in an additional 10 to 20 new patients a month. And put your strongest team members on these calls specifically, not whoever's still in training, since a mishandled call is genuinely expensive for the practice.
Sabri: Completely agree, it's a real mistake to have someone still learning the ropes handling these specific calls.
Jeff: For training specifically, we have a Phone Skills course on our online platform, DDS Success, and we're actually in the process of building a second, more advanced course covering a much wider range of call scenarios. We haven't settled on a title yet, but it'll go deeper into the kind of situations that can branch off in five different directions.
Sabri: I saw the working list of scenarios yesterday, it's genuinely extensive, this course could end up running long.
Jeff: The basic Phone Skills course is available now on DDS Success, I'll link it on the episode webpage, along with a free ebook called Phone Scripts that covers some of what we discussed today. Definitely worth downloading, since this can genuinely bring in more new patients, make your day-to-day considerably easier, and make your marketing spend far more effective. Sabri, thank you so much for coming on and doing this.
Sabri: You're very welcome, glad to be here.
Jeff: Folks, that's everything we have for you this week. If you have any questions, you can find us online at mgeonline.com, or call us at (800) 640-1140. Have a great week, and we'll see you at the next episode.