Doing More High-Value Cases to Reduce Your Dependence on Insurance

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Intro: You are now listening to another episode of the Insurance Untangled podcast, where we explore the various challenges faced by dental practices due to their reliance on insurance. Join us in this podcast as we dive deep into the issues surrounding dental insurance dependence and offer practical solutions and strategies to help you take control of your practice’s financial future.

Ben Tuinei: Welcome to another exciting episode of the Insurance Untangled podcast. My name is Ben Tuinei, and I’m one of the co-hosts on this podcast. And as you know, we’ve developed this podcast for you to help you untangle yourselves with the mess of insurance that we all have to deal with on a day-to-day basis. So today we have a very fun and interesting topic that we’re gonna cover, and I have my co-host Naren, who I’ll be interviewing. Naren, how are you, my friend?

Naren Arulrajah: I’m doing great. Uh, I’m doing great. And yourself, Ben?

Ben Tuinei: Doing wonderful. Thank you. Wonderful. Looks like you’re in, uh, different digs today, huh?

Naren Arulrajah: Yeah. It’s a change of scenery, for sure.

Ben Tuinei: Yeah. Yeah. I’m used to seeing those, uh, square photos in the, in your background, but—well, wonderful. So, today’s topic is actually a really, really good topic. It’s doing more high-value cases to reduce your dependence on insurance, but I love it, you know, ’cause there are a lot of dental practices that want to do more full-arch cases, um, or, you know, do bigger surgical cases. Um, and doctors spend a lot of money acquiring a higher skillset to do those procedures. And many of them, in fact, most of them that I see, um, they only do a few cases a year, you know, the big cases that they really want to do. Uh, so naturally they can get stuck in the whole crown and bridge and minor restorative procedures, uh, most of the time. But, but Naren, I’d love to pick your genius marketing brain about this concept here. So, if I’m a dentist and I’m thinking, you know, why is my practice so busy, but I’m still not making enough money? Maybe we can start from that perspective and then build up to, to, to the topic of the bigger cases as it ties into marketing. So, I’ll repeat that question as like, why, why is my practice so busy, but I’m not making money?

Naren Arulrajah: That’s a wonderful question. Uh, and I know the topic that we are gonna be covering is gonna be a very exciting topic. And if you want to, you know, take a pen and start writing some notes, go for it. Uh, yes, like you said, before we get into high-value cases and how you can use that to increase profitability and, uh, reduce dependence on insurance, uh, let me answer your question, Ben. Um, like a lot of practice owners, I’m sure have said this to you, and I’ve heard this many times too, which is like, I’m working harder than ever, but I’m not making enough money. And it’s kind of interesting, right? A lot of people equate hard work to more, uh, you know, more success. I know that’s true for medical school, that’s true for pretty much you pre-business, but that’s not necessarily true in business, right?

Naren Arulrajah: I mean, um, there are companies like, um, Google and Apple and, you know, uh, Facebook that make billions of dollars. I’m pretty sure those CEOs are not, you know, like working 24 hours a day. So there’s no relationship between how hard you work and how much money you make. And unfortunately, what happens is a PPO practice, um, you know, is, is a practice where the more patients you see, the less money you make. Let me explain, right? Uh, PPO fees haven’t really gone up in the last 40 years, maybe 10 or 20%, but your expenses have like gone up 5, 6, 7, 8 times, right? You know, even 10 times. Uh, what you used to pay somebody 40 years ago, you know, you have to pay them literally 5, 6, 7 times today to get the same caliber of person. So the expenses have shot up, but your PPO reimbursement hasn’t.

Naren Arulrajah: So fundamentally what’s happening is the more patients you see, the less profits you’re making per patient from those PPO plans. And in many cases, you don’t even cover your costs. Uh, in other words, like for hygiene, for example, in some states, what the PPO plans are paying you don’t even pay the hygienist’s wages, uh, because hygiene wages have skyrocketed. So leave alone your receptionist, your team, your rent, your electricity, your supplies, all the other expenses—it doesn’t even just cover one of the many costs associated with, um, you know, taking care of the patient, which is the salary you have to pay for the hygienist. So the funny thing is, the more busier you get, sometimes you could actually be making less money. It’s kind of really counterintuitive, like you would think, the harder I work, the more money I make, right?

Naren Arulrajah: So I think the reason for that is typically people on PPO plans only want to do what’s covered by insurance. So you’re doing, you know, tiny procedures, and half of the money is not paid to you because of the fee controls that the insurance company places on you, because they don’t let you charge your usual and customary fees. The other way they hit you is, you know, even the reduced fee that they’re willing to pay, they don’t pay you the full fee. They’ll pay only a portion of it. So pretty much, um, you are losing a lot of money every single time you see a PPO patient. And those patients also don’t accept high-value treatment. You know, their first question is, "Is it covered by insurance?" So even if you have all these skills and all this, um, you know, let’s say extra training and experience, it doesn’t really help in terms of doing those bigger cases that pay more per hour, and also are the more profitable ones. So, uh, so almost like if you’re really being too busy, ask yourself the question: where is that busy coming from? If it’s coming from PPO, then it’s a negative correlation. So the harder you work, the less money you make.

Ben Tuinei: I love it. I agree on every point that you mentioned. It’s a common theme in dentistry that PPO practices are super busy, and the practice owners are wondering why they can’t enjoy the lifestyle of their predecessors or even sustain the practice in general. You know, it’s a very high-stress model these days, unfortunately. But there’s a way out of it, you know?

So I, I hear, Naren, a lot of the clients that I work with that do marketing, it seems like a common sort of complaint, if you will, or maybe feedback, is: why isn’t my marketing bringing in bigger cases and better cases, like what I want to do—like implants and full arch? As a marketing expert, Naren, why do you think that is? For practices that are doing marketing, how come they’re not seeing big cases that they want to do more frequently?

Naren Arulrajah: That’s a great question, right? Let’s say I’m running a restaurant, and my restaurant is a high-end restaurant where every meal costs a minimum of a hundred dollars, right? Now imagine I put that restaurant in a neighborhood where—low-income neighborhood, right? Or imagine I advertise in a magazine that perhaps people who are on the low end of the income scale read. What’s gonna happen is you’re attracting the wrong people.

You know, there’s always a buyer for everything. There are people who are buying Rolexes. There are people who are buying expensive cars. There are people who go to Starbucks. There are people who go to Whole Foods. There is a market for everything. But unfortunately, if you are fishing in the wrong pond, you won’t be able to do those high-value cases.

And many practices are getting most of their patients from PPO, and that’s definitely the wrong pond, like I alluded to. It’s the wrong pond because they’re price shoppers, and because they get so used to free dentistry, many of them don’t even show up. And when you do present high-end treatment, like I said, their first question is, "Is it covered by insurance?" So if it’s not covered, they don’t want to do it.

So I think, one, is to stop fishing in the wrong pond and take control of your own destiny, right? You know, the way I see it is that PPO is the lazy man’s version of growing my practice. But unfortunately, there’s nothing called a free lunch. In exchange, you’re paying a very high tax, which is the write-off—the difference between your usual and customary fees versus what you end up getting paid by the insurance company after all the deductibles and the fee controls.

Naren Arulrajah: Yeah. So in that particular example, you need to start by having effective plans to attract patients. I think that’s where I would start. In addition to PPO plans, the other things they might be doing wrong is they’re also hoping for referrals. I know referrals used to be a big thing maybe 25 years ago—that’s pre-Google, pre-internet. We would ask our friends, "Who did you know that provided that particular service for you?"

And I remember, going back 20 years, I had an expert I would call for different things. I had a healthcare expert I knew, which is my cousin who happens to be a doctor. I had a person who knows a lot about cameras. So anytime I was gonna buy a new camera, I would ask him what he thinks.

But today, we don’t ask those people anymore. We literally go to Google and we discover things. So some people are still expecting referrals to bring in patients, and it doesn’t work anymore. Today, referrals are like your Google review. So of course, it’s coming from anonymous people who are not referring their friends, but rather somebody reads a review that one person wrote, and it’s like a wonderful five-star level review—and it’s working for you.

Even Facebook—I know every practice owner has a Facebook page, and they’re posting on that page. But we know how the Facebook algorithm works, which is, unless you’re an influencer, nobody sees your post. So if you’re an influencer, like thousands and thousands of people will see your post, and some of them will live in your area, and you would get traffic.

And the way I’m defining an influencer is someone who has like tens of thousands of followers—typically like a hundred thousand plus. But for 99% of the doctors, they don’t get any of those kinds of patients from Instagram or Facebook because they’re not influencers, and nobody’s seeing their posts.

And the other problem is ads. Now, the problem with ads—whether it’s a Facebook ad or a Google ad—people don’t trust that. So even if they do click on it, their first instinct is, "What’s wrong? Why is this dentist advertising? Of course, if he was good, he shouldn’t be advertising. The fact that he is advertising means he is not good." So they’re coming in—or clicking—with doubt. You are paying $5, but the first question they’re asking is, "What’s wrong?" So the conversion rate is much, much, much lower.

Naren Arulrajah: So if you’re converting somebody, let’s say, who discovers you through organic search—where you are just showing up without paying for an ad—they trust that result because that’s what they were looking for. That’s why they went to Google. But here, an ad is just, you know, in their face, and they clicked on it, but they have that doubt in their mind. Now, they don’t convert.

Just like, you know, PPO patients don’t accept treatments, here they don’t show up—even, you know, because they don’t even remember. Because a lot of times, especially with social media ads, you know, I’m watching something that I’m excited or interested in—because remember, social media hacks your brain. It understands what you like. I like cat videos, or I like to listen to certain kinds of people, and I follow these people. It’s showing me that content, and all of a sudden this ad pops up.

I don’t even remember clicking on that ad. And remember, the ads nowadays make it so easy for people to fill a form. For example, you don’t even need to enter any information. You press a button, and they store all the information and send it to that lead, right? Because they want to show that they sent you a lead. But those people don’t show up.

So, PPOs typically don’t work. Referrals don’t work. Social media—unless you’re an influencer—doesn’t seem to work. And of course, ads don’t work because of the trust issue.

And the last mistake I see people making is discounts. We think discounts will attract more people. It actually kills your business and kills your brand. Because again, just like ads make people trust you less, discounts make people trust you less. Because they’re again asking the question, “What’s the catch? Why is this person giving a discount? Is he just learning? Is he just new? Is he not good? That’s why he has to give discounts to attract people?”

So you gotta be really, really careful in what not to do as much as what to do. And a lot of times, anything that sounds too good to be true or a quick fix usually doesn’t work.

Ben Tuinei: Yeah, no, I like that. I think you kind of mentioned a lot of important nuggets there with that answer, so thank you there.

And Naren, what do you think stops most practices from getting more high-value cases out of their marketing?

Naren Arulrajah: Yeah, I think, you know, I’ve heard this quote, and I think I’m sure many of you have heard the same quote too: if you don’t have a plan or if you don’t have a destination, you’re definitely not gonna get there, right? That’s step number one. You need to know where you want to get to. And most practices don’t have a clear vision on, like, what is my ideal patient? That’s the first question. And then the second question is, how do I attract my ideal patients who want to work with me versus those who don’t want to work with me because they just clicked on an ad, right?

So, you know, that’s really, really important. Start with the end in mind. Start with your destination. Start with your goal. Most people accidentally sign up for a PPO plan because they’re desperate and they have all the bills to pay.

And then one plan turns into two, turns into three, turns into four, turns into five. And then again, accidentally they start with Google Ads, and they’re spending so much money and not seeing results because of the trust issue—just like I talked about.

So, a lot of people are not very thoughtful, and unfortunately that’s because dental school doesn’t teach business and doesn’t teach success in business, right? It’s all about clinical. And, you know, are you the best at doing the clinical side of dentistry—not necessarily hiring and marketing and all the other things that, unfortunately, no school is teaching you. So people, I think, don’t have a plan.

So I think step one is to figure out a plan. And the plan should really focus on: am I attracting the right patients? Who are the right patients? And how am I attracting them?

Is it working? Is it not? Do I know the cost of these different marketing methods that I’m using—which is costing me the least, but giving me the best patients? What’s the conversion rate? For example, if I get a call from a Google ad or a Facebook ad versus, let’s say, organic SEO, which patient or which call is converting higher?

And typically the ad calls convert the least. The best is SEO. The second best is Google Ads, even though it’s one-half or one-third of the effectiveness of SEO because of the trust issue, right? And social media is even worse because not only do they not trust you because it’s an ad, but also they don’t even remember you.

So when you call them back saying, "Hey, you’re 10 minutes late for the appointment," they’re like, "Who are you?" Because they don’t even remember clicking on your ad while they were watching or engrossed in that video they were consuming on their smart device.

So yeah, these are some of the reasons, I think, practices are not succeeding. So I really think if you want to change that, you need to start with a good plan.

Ben Tuinei: Mm-hmm. I love it, yeah.

Naren Arulrajah: Am I attracting the right patients? How am I gonna attract the right patients? How am I gonna measure myself to see that I’m on track and things are improving? So a really well-thought-out plan is key, I think, to success when it comes to attracting the right kind of patients, who are the high-value patients.

Ben Tuinei: Yeah, no, I love that. I guess that kind of leads me into sort of the money question for you, Naren. What kind of marketing actually does bring in those bigger cases and those high-value patients?

Naren Arulrajah: Yeah, so we started by talking about getting found by the right people, right? So let’s assume somebody’s looking for, you know, a holistic dentist. I know some of the clients we work with are holistic dentists, or, you know, they want ceramic implants. Or someone is looking for, you know, a full-mouth reconstruction case. They’re specifically looking for those high-value cases—why not cater to them? Why not let them find you?

So when I’m looking for implants, or Invisalign, or sedation dentistry, or holistic dentistry—whatever the thing that I’m interested in—you better show up, right? That’s like attracting the right people. It’s kind of like the same example I told you before: if you have a restaurant that sells $100 meals, you don’t want to attract people who are looking to spend $5 or $10 on their McDonald’s meal. It just doesn’t work, right? I mean, they’re not going to be good customers. They’re not gonna spend the money with you.

So, start by asking, you know:

Naren Arulrajah: How do I attract the right people? And I really think today that’s organic SEO. So when people type these keywords in, you want to show up—where they trust you implicitly. Remember, they went to Google and they typed in Invisalign, they typed in veneers, they typed in sedation. So when they type it in, you want to show up as the organic or the natural result, not the ad result.

So I would really, really focus on dominating Google. Now, Google domination is not easy. Only 5% of you will get 95% of the free traffic. And then 95% pretty much won’t get anything. Therefore, you now have to spend a lot of money with Google for Google Ads. That’s how Google makes hundreds of billions of dollars—just from ads alone. So I think I would start with getting found by the right people.

Naren Arulrajah: And then, of course, once they land on that page, you have to convince them that they did not make a mistake by coming to your page. And what I mean by that is: show some cases. Perhaps 2, 3, 4, 5 cases—include full-face after pictures so they can see the transformation. You know, somebody had crooked teeth—thanks to your work with Invisalign, they have a beautiful smile. Somebody had a missing tooth, and the work you did in terms of a full-mouth rehab—they have the best smile ever. They’ll start seeing themselves in those pictures.

And when you’re doing these cases, or when you’re highlighting these cases, pick people of different ages, pick people of different colors. Now, not everyone is going to give you the full-face before picture, especially if the smile was not optimal before. But they would love to give you the full-face after picture, because they want to show off how beautiful their smile is—something they never had, and now they have it.

So it’s very, very easy to get full-face after pictures. So definitely include that, and write some descriptions. Those are some of the ways you can really compel them to pick up the phone and call.

You can also embed Google reviews, for example. Go to Google—if the landing page that they arrived on is the Invisalign page, include reviews from your own Google My Business page that talk about Invisalign. You want to make sure that people are able to come to that page and trust you quickly. The cases and the reviews do that.

And finally, you know, the phone experience—this is a huge problem for a lot of dental practices. The average dental practice is only converting one out of three new patient calls.

Naren Arulrajah: And this is something we also offer. We tell you what your conversion rate is. If yours is 30–40%, like the average dental practice, then you have a huge opportunity. Now marketing is working, the phone is ringing, but you’re only booking half or one-third of the patients. So in other words, you’re spending, let’s say, a thousand dollars in marketing, but only 300 of those dollars are working for you. The other $700 are getting wasted because you don’t have a great phone experience. So figure out your conversion rate, put some training in place.

These are some of the things we help our clients with. And I think at some point, I’ve heard clients say, "This is so daunting. How do I get into the top 5% of Google?" That’s hard in itself. How do I work on these landing pages? How do I improve all the phone calls?

Naren Arulrajah: So one of the things that we do is we kind of make it easy. SEO—we totally take care of it so you don’t have to do anything except say, "Yes, approve this, approve that," that kind of stuff. And then on things like call coaching, we have a call coaching and review service. For things like getting those before-and-afters, we have a CMO service, which is a Chief Marketing Officer service.

Of course, if you’re a smaller practice, you may not need all of these things. The bigger you get, you can’t have any holes in your marketing funnel. You need all of these things fixed. So it’s not easy, but once you have a good plan to attract the right people—that’s where SEO comes in—and then you convince them on your landing pages, and finally you do an excellent job on the phone, now you are attracting and obviously booking those high-value cases.

Of course, then you have to learn how to present cases, but I’m not gonna get into that today because that’s, I think, beyond the scope of marketing.

Ben Tuinei: Yeah, no, you outlined a pretty good process there. And naturally, as I listen to this, it’s like, wow, this is not something that happens overnight, right? It sounds like something that you have to chip away at—you chip away slowly over time to create that massive momentum, you know? So, no, I love that, Naren.

Naren Arulrajah: Famous quote, right? "Overnight success—years in the making." I’ve been doing this for 18 years now, and I know a lot of practice owners that started from nothing and have like $3, $4, $5 million highly profitable practices. They just chipped away at these things. They continued to work at these things, and they continued to improve these things.

Of course, they’re getting more patients through SEO, they are converting more calls, their landing pages are better today than they were six months ago or two years ago. So just keep at it. And I agree—that mindset of continually working: once you understand the game, just get better at the game, right? So once you understand how this game is being played, just focus and get better at it. That’s really my two cents.

Ben Tuinei: Absolutely. And I firmly believe that where you’re getting the education and who you surround yourself with in terms of professionals makes a big difference, you know?

So let’s say, Naren, I guess final question I have for you today is: how do I know if my marketing strategy is even working the way I intended it to work?

Naren Arulrajah: Agree. I think you need to know your numbers, right? If you don’t know your numbers, it’s kind of like—imagine going to a doctor, and the first thing they do is an X-ray. I mean, you do that, right? As a practice owner, you want to get the dental X-rays done. So similarly, your numbers are kind of like your X-ray.

A few numbers I would really look at are: how many new patients are calling? How many are actually booking? How many of those people said yes to big cases? That’ll tell you if your marketing is working. Even if you’re not a marketing expert, if the answer to those questions is not satisfactory, you know something is wrong. Now you need to figure out: can I get there?

Of course, we talked about SEO being the best way—or the lowest-cost way—to get there. It’s like one-fifth the cost of ads or Google Ads, and one-tenth the cost of social media ads. So, you know, have somebody audit your SEO. Like, tell you: are you in that top 5%? Are you ranking 400 or more keywords on page one? Page one is the top 10 results. And if you’re not, why are you not?

And this is something we do at no cost to our listeners. We call it a marketing strategy meeting, and the link is https://go.insurance-untangled.com/ShownotesMSM4  So we’ll put a link in the show notes as well. Go to https://go.insurance-untangled.com/ShownotesMSM5 and book that meeting. We spend hours and hours—we will study every one of your top competitors. We’ll tell you: are they doing better than you or not?

And if you’re not in the top 5%—meaning you’re not ranking for more than 100 keywords—we will even tell you why that’s the case. What are some of the challenges or issues that are stopping you from ranking? And that’s kind of where we come in and talk about, like, okay, yes, you’re getting an A for this, or B for this, or C for this. And anywhere you are getting less than an A—what do you need to do to get an A?

Once you’re getting an A in all the pieces within SEO, as well as the landing pages and the phone experience, then nobody can stop you. Every year is going to be your best year. You’re going to be spending the least amount of money and getting the best results.

Once again, I think the link is https://go.insurance-untangled.com/ShownotesMSM6 

Ben Tuinei: Wonderful, Naren. Thank you for sharing that. And of course, for those that are listening, that’ll be posted in the show notes.

So what I’m hearing is: you don’t often need a massive amount of more new patients—you just need the right ones, right? That makes a world of difference in terms of your profitability. And so, if you’re ready to attract these high-value cases and reduce your dependence on insurance, I think it all starts with that very focused strategy you mentioned—to kind of take a look at things globally.

So, you could also use https://go.insurance-untangled.com/ShownotesMSM7 . So book that marketing strategy meeting today to learn how to fill your chairs with the right patients and those that’ll say yes to the high-value care that you want to deliver and you want to do.

What a great way to grow the practice. So, there you go folks—that’s how you make your practice more profitable and more fulfilling: find those high-value cases and work with the right partners that can help you.

Naren, wow, this has been amazing. What you talked about today, I think, hopefully will resonate with the listeners—it did for me. Any final thoughts as we wrap up today’s episode, Naren?

Naren Arulrajah: Yeah, I mean, you worked really hard to become a dentist, and I do think the benefit of high-value cases is not just monetary, but also it’s satisfaction, right? You know, just fillings and extractions—that’s not why you went to dental school. You wanted to change people’s lives. You wanted to get better at your craft and specialize, and, you know, take those CE courses and do amazing work and create amazing smiles.

So to do that, you need to really get strong when it comes to attracting and taking care of high-value patients. And the reason many of you are struggling is you’re fishing in the wrong pond. And if you’re a PPO practice, or if you’re depending on Google Ads, you need to start coming up with a strategy to fish in the right pond, attract the right patients, and of course, then convince them—that’s where the phone and the landing pages come in.

Naren Arulrajah: I mean, I wish I could tell you there’s a magic wand, and humans will work differently if you wave that magic wand. They don’t. They don’t. Humans are humans. They work the same way whether they’re choosing a $100 restaurant or choosing you for their high-value case and giving you $20,000, right?

They start doing their research. Are you showing up? Do they trust you because you show up organically? And once they’re on the landing page, are you convincing them in a few seconds that you are the right answer—with cases and Google reviews? And then finally, how’s your phone?

Most doctors don’t pay attention to these things, don’t work on these things. So they’re kind of spinning their wheels and going in circles. If that’s you, I recommend at least do the marketing strategy meeting. Find out where you are and what you’re missing or what you need to do. And then, now that you have information, you can do something with it.

Ben Tuinei: Yeah, I love it. I love it. Thank you, Naren, for those final thoughts there. Truly appreciate you for the wisdom and knowledge that you shared with us today pertaining to these marketing concepts.

And I also want to take a moment to thank our listeners for joining us today on another amazing episode of the Insurance Untangled podcast. If you enjoyed today’s episode, don’t forget to share this with your friends and family on social media. But we also appreciate those reviews—those reviews will certainly help other doctors find this content.

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Folks, thank you for joining us again today, and we wish all of you the best of success. Take care now.