Spending Time Building Relationships with Patients Can Help You Reduce Your Dependence on PPOs!

Ben Tunei: Welcome to another exciting episode of the Insurance Untangled podcast. My name is Ben Tunei, and I’m one of the hosts on this podcast that’s built to help you—help you get untangled from the mess of insurance that we all deal with every single day. Today, I have my good friend and co-host with me, and I’m gonna be interviewing. I have Naren. Naren, how are you?

Naren Arulrajah: I’m doing great, Ben. Uh, I’m really looking forward to our topic. What is our topic today, by the way?

Ben Tunei: I love it. So today, we’re gonna talk about spending time building relationships with patients and how that can help you reduce your dependence on PPO plans. And I really like this topic because, you know, one of the biggest challenges we hear from dentists these days is that, you know, it’s no secret—everybody feels trapped with dental insurance. You know, the schedule is packed, margins are thin, and there’s barely enough time to breathe, you know, let alone build meaningful connections with patients.

You know, but what if—what if the key to independence isn’t just about dropping PPOs or adjusting fees? And so that’s what we wanna explore. You know, what if it’s about spending your time differently, focusing on patients who trust you, value—people that value your care and make your practice thrive, right? Let’s focus on those people.

Ben Tunei: So today, um, you know, Naren’s gonna—well, he’s here to sort of educate us and talk to us about how we can build relationships and, um, how to do time management the right way that can help us create somewhat of a fee-for-service model as soon as we can, right? That’s more profitable and more fulfilling for us. So, Naren, thank you for being willing to talk about this topic here.

So, first question for you, Naren: many dentists say they love to be less dependent on insurance, but they feel entirely stuck, right? So, how does spending more time with patients actually help them move towards a fee-for-service, insurance-independent model?

Naren Arulrajah: You know, that’s a great question, and I’m so glad you brought it up because I know the feeling, and I talk to clients a lot, and they feel stuck. So I do think you bringing that up right off the bat and addressing the elephant in the room is the right thing to do.

Naren Arulrajah: So, when, you know, um, patients are, you know, insurance dependent, they get used to a model where it’s about treating more people in less time, right? Mm-hmm. Uh, because that’s the only way you’re gonna make up for the difference between your usual and customary fees versus what you actually get paid. And usually, it’s 40% lower than your usual and customary fees. So you’re kind of running your business—uh, you’re doing almost twice the work for the same money.

Uh, so now you need to change it. Insurance-driven models push volume over connection, right? Uh, you know, like, how can you connect with people if you have to do double the dentistry with the same team and same hours, right?

Um, in a fee-for-service model, time becomes your advantage because you know you’re getting paid full fees. So, you know, imagine doing some work for another—another one patient who’s a PPO patient, and you’re getting paid 50 cents on the dollar. And you imagine doing the same work for the same patient…

Naren Arulrajah: Now you get to keep a hundred cents on the dollar. You’re talking, you know, double, right? So instead of $400, $800 for that amount of time you’re spending. Can you spare a few minutes when you get paid an extra $400 for that amount of time to get to know the patient, find out a little bit about who they are, what they’re trying to do with their oral health, and what they want to do with their smile? You know, even get to know them as a human being—like their family, their ambitions—’cause, you know, healthcare is very personal to us. So it’s one of the very, very key places in our life where we value the relationship, we value the person, you know, uh, we are dealing with. So in a fee-for-service model, you can, you know, use that time to build relationships.

Naren Arulrajah: And when patients feel heard and understood, they trust your care and follow your recommendations. I’ll tell you a true story. You know, my late mom, when she was living with me—she passed a couple of years ago—you know, we went to an ophthalmologist. You know, our primary care doctor said, "You should go consult an ophthalmologist." And she asked simple questions, you know, and he wouldn’t answer. He was like, "No, that’s not what you’re supposed to look at here."

And because he had made it into this machine—like, literally, she was a number. He made five bucks on the parking, so that was a parking thing going on. So he was making probably like 700 bucks on parking, and he had like seven people. She was just being processed. Here’s a woman—she’s 87 years old, you know, she can’t walk.

Naren Arulrajah: So just getting to the doctor’s office was such a big pain, and she’s being treated like—he doesn’t even talk to her. She looks at something, signs something, and he says, "Go there." You know? Literally. You know what I mean? Like, yeah. How do you trust a person like that? I mean, she’s not a doctor—she’s well-educated, she’s a teacher and everything else—but she’s like, "Never in my life am I going back to that office ever again. Even if you force me to, I’m not coming." You know? I mean, literally—like, no way. "Even if I have to die because of something to do with my eye, I’m not going to that guy." Right?

I mean, that’s the experience. But I bet he was just optimized for whatever algorithm—how do I get the most out of whatever that I’m gonna make and so forth.

Naren Arulrajah: He didn’t spend the time. And how can you expect a PPO doctor to spend the time when they have to do double the work just to make ends meet? Remember, your rent is not half because you’re a PPO practice. Remember, your team is not working for half. When you are a PPO practice, you are the one who’s getting hit, you know, by that difference—not anybody else, right? Everybody else is getting paid full fees. Only you, the owner/dentist, is getting hit.

So, when patients feel understood, they trust you. They take your recommendations. You can, you know, offer them ideal dentistry. You can help them create beautiful smiles. You can help improve their, you know, oral health. A lot of times, many things are not covered, right? You know, only the basics—just survival—is covered with insurance. And even then, there are 700 rules. Or you’re one day too early for your hygiene visit? Too bad.

Naren Arulrajah: But I mean, anybody with logic says, "What nonsense is this?" You know? Like—because you—and then who do they yell at? Not the insurance company, because the insurance company’s not in front of them. That’s this thing in the back. They yell at the doctor: "Why didn’t you tell me that I’m one day early?" Like, you know what I mean? It’s—it’s like all this nonsense, and you are optimizing for, you know, dealing with this, this, this mess called insurance.

And then, when they start trusting you, they feel heard. They feel like you are listening to them. You really are trying to help them. They trust you. That creates loyalty. That creates higher case acceptance. Like, I have clients who literally work 24 hours a week and make $2 million, right? Mm-hmm. He does ideal dentistry.

Naren Arulrajah: He only does the kind of work he wants, and the patients love him. So it’s like a win-win for everyone. The team loves it. Which team doesn’t want to work 24 hours a week and get paid full fees, right? I mean, they love it. They go the extra mile. Anything he wants, they have—because he’s able to do that. He’s able to give them a lifestyle that none of his competitors are able to give to his employees. Pay them, like, really good money for working 24 hours a week.

So this idea of "we have to work harder and harder and squeeze ourselves"—you know, it doesn’t work. So, anyways, uh, so that’s why I do think spending time with patients really makes a difference.

Ben Tunei: No, I love that. I think, um, yeah, it makes perfect sense to me. You know, if—if—um, you know, when you look at the most trusted professionals, who comes up as number one consistently? It’s—it’s the professionals that, um, we have a sense of relief when we see them, right? It’s our nurses, and hygienists fall in that category. But those are people—those are the healthcare workers that spend the most time with people, right? They’re the ones building those relationships.

You can’t really measure, you know, in—on a P&L—how much spending a little bit more time is gonna do for you, right? You can’t measure it today, but you will see those results tomorrow. Right? It’s a time investment.

So, you know, Naren, I hear a lot of dentists tell me that their marketing sort of feels like it’s just bringing in anybody that has insurance, right? People that—especially people that don’t have any loyalty or trust to you, that you haven’t earned just yet. You know? So how—how can doctors start attracting the kinds of patients that would make for great, loyal patients that would value somebody’s time and the quality dentistry that they’re offering?

Naren Arulrajah: Absolutely. That’s a great question. You know, I have gone through the same experience myself, so this is very personal to me. Um, I think Pareto is a genius. I’m sure we’ve all heard of Pareto’s law, right? Mm-hmm. 20% of people produce 80% of the results. 20% of people have 80% of the wealth. You can go on and on, you know, in life. And 20% of your time is producing 80% of your results. Uh, you know? Mm-hmm.

So I think one of the best places to master the Pareto’s law and have this 20% work for you—meaning we all want all of our time to be that 20% time that’s producing five times the results, right? Start by defining your ideal patients and what matters to them. Like, for example, if you really want to do bigger cases, what are the keywords they’re typing in?

Naren Arulrajah: And are you the one they’re finding, you know, when they type those keywords in? Because—are you attracting the ideal patient? Like, if that’s what you want. If you want implant patients, you should be ranking for 50 keywords organically related to implants. Now, everyone who’s looking for an implant patient in a three-mile radius, without you spending one cent on ads, should see you. Right?

Define your ideal patients, and then target them. Again, don’t target them by running ads, because the minute you run ads, they don’t trust you. Um, now, in addition to SEO, you also want to educate them. You want to connect with them.

Now, once you start ranking—like every single one of our clients, you know—we can include some cases. If anyone is interested, send us an email. Ranks for a hundred or more keywords. Some of our 3-, 4-, 5-year clients rank for 500 keywords. Right?

Naren Arulrajah: And the reason is, you know, whatever these people are typing in, they keep showing up again and again and again. Um, now, when I go to that landing page, do you have videos that kind of answer simple questions I might have? Makes me kind of get to like you without ever calling your office or without even coming into your office?

So, do you have educational content to make people realize you are an expert, you’re someone they can work with—and not the opposite, right? What do most people do? They try to find the shortcut, which is sign up for more PPO. Uh, and of course, you’re attracting people only who are coming to you because your dentistry is free. Or you sell an offer—$90 off, free this, free that. And again, you’re attracting the wrong people. So don’t do that. Instead, attract the right people, you know?

Naren Arulrajah: Figure out who your right people are, and then make sure you’re dominating Google—not ads. And then make sure you have educational content, and make sure your expertise comes across through these videos.

And then finally, your website should reflect your values. You should talk about your values. Who’s your ideal—who do you want to be a hero to? And what makes you jump up, you know, jump up in the morning from bed every morning as early as you can and look forward to your day, right? Like, who do you want to be a hero to? Is it for people who care about their health? Is it for people who want to create the smile of their dreams? And then be focused on it, communicate it, and do just that—nothing else.

And finally, you know, we trust reviews more than anything else on a website.

Naren Arulrajah: So, are you getting 10 new Google reviews? These are all things that are important to increase trust in your practice. And marketing is all about getting people to like you and trust you, right? Mm-hmm. So the more they see you as an advisor, the more they trust you because of your reviews, the more they keep seeing you—because for all the things that they are looking for, that you are good at, you keep showing up. You keep showing up not through an ad, but organically.

So these are some of the ways I really think you can attract the right kind of patients. But now that you’re attracting the right kind of patient, you also need to optimize the back end of the funnel, right? Which is the way you answer the phone. Now, the person who’s gonna spend $30,000 might have some good questions.

And is your team ready to answer those questions? Is your team ready to, you know, get them to come in? Do they know how to influence? Do they know how to get an appointment booked?

So once you know who your ideal client is—optimize your marketing, optimize the phone and the entire process to that ideal client. Ignore everything else, and you will be successful.

Ben Tunei: I love that. I think that’s very, very wise advice there. You know, I want to kind of go back to—you know, I mentioned a comment about measuring, uh, you know, not seeing measurable results as a result of spending more time with patients, right? But it makes perfect sense. And from the perspective of when you spend more time with people, naturally you create somewhat of an emotional attachment to each other, right? Or at least you learn about somebody a little bit more, or they learn about you. That’s how you build trust and loyalty.

You know, some practice owners—I know many, not just some, but many practice owners—they get worried about the component of slowing down or spending more time with each patient. Right? It’s scary because it kind of is giving off the perception that we’re gonna spend more time and make less money.

What’s the reality when a doctor starts focusing on fewer patients, spending more time with them, and building better relationships with those patients? What is the outcome typically?

Naren Arulrajah: Yeah, I think, um, this is the problem, right? We always think the unknown is risky. Mm-hmm. I still know some people who have never gotten on a plane, and they’re like late forties, right? Why? Because, you know, maybe when they were a kid, their parents never took them on a flight, and they probably heard as a child, “Oh, the plane could blow up,” and, you know, they maybe watched some horror movie, you know, where some plane crashes, or whatever it is, right? And that made an impact on them.

And now—it’s kind of like some people don’t know how to swim, you know? And it’s not because they don’t have the money to go and learn or whatever—it’s just they have some kind of fear, right?

So, I do think dentists are no different. Because it looks risky—like, “I’m gonna slow down and spend more time with the patients. I’m gonna slow down and drop some of the PPO plans…”

Naren Arulrajah: They don’t take that step because it’s the unknown, right? I say, you know, tiptoe—just talk to one patient. You know, see how it feels. See if that patient trusts you more. Drop one PPO plan. See how that feels. See if it’s the end of the world. You know, what is the end of the world?

And now that you’ve taken that first step—remember, if you mess up with one patient, you only messed up with one patient. You didn’t mess up with the other 1,100 patients you have. It’s just that one, right? So there’s nothing to lose, right?

A lot of times we overthink the worst case, and we never do anything. Now imagine the fact you are not doing it. Look at the impact of you not doing something. Like, for example, you are not identifying your ideal customers, and you’re not attracting them.

Naren Arulrajah: You are continuing to go down this PPO rat race and working harder and harder and harder for less money. And your back is starting to ache, and you’re starting to have physical illnesses, and you might even get permanently disabled. What’s the cost of not taking that risk? Not doing that change?

It’s 10 times, 100 times higher than, you know, you taking a chance and trying something new with one patient. Ten times, 100 times higher than dropping that one PPO plan—maybe a tiny plan.

And then once you start jumping in and start spending time, you’ll realize patients trust you. They’re more wanting to come to your practice. Of course, you have to give it some time, you know, and you have to be consistent. You can’t just, you know, be relationship-driven one day and the next day be the, you know, the rat-race dentist, right?

Naren Arulrajah: So of course, if you give it, you will start seeing everything start changing. They’ll start accepting treatments. They’ll start listening to your recommendations. They’ll start wanting to come there. They’ll start telling their friends.

It’s kind of like—I mean, becoming a doctor is a really hard road. I mean, I know because I live and breathe with doctors, and I’m surrounded by hundreds and hundreds of friends who all happen to be doctors. But somewhere, when they were a child, they believed they could do it, right?

I mean, like, think about it. If they didn’t, do you think they would’ve gone through what they went through for 10 years, right? Six, seven extra years versus any other career? Like, if you want to be a programmer or anything else, you finish your undergrad—you’re done, you know? Like, mm-hmm. But not when you’re becoming a doctor.

Naren Arulrajah: It’s 10 years of pain and suffering and, you know, living for minimum wage. You did it because you trusted in something, you believed in yourself, and you did what made sense for you. So I do think, you know, you just have to start doing that.

And what you’ll start noticing is: every year, as you drop more and more PPO plans and start attracting more and more ideal patients, the profits will go up. In other words, the amount of money you take home will go up. Versus in the prior years—it’s slowly coming down, coming down, coming down. You’re working for less and less and less and working harder and harder.

The other thing you’ll notice is you’ll start enjoying dentistry more. You’re spending more time, you’re getting to know patients. They love you, you love them. This becomes what it was meant to be—the reason you went to dental school—to make a difference in people’s lives, and they appreciate you for it.

Naren Arulrajah: Versus the PPO patient—it’s free. So I don’t appreciate anything that’s free. You know what I mean? The one who’s paying $100 at a restaurant is the one who’s giving a 20% tip—a $20 tip. Do you think McDonald’s people are giving you $20 tips? They don’t. Why? Because they don’t appreciate you.

When they pay more, and they pay out of their own pocket, they value it. It’s kind of crazy. You would think, you know, the more money somebody pays, the less they appreciate you. No, no—it’s the opposite. They appreciate you more.

So you are excited to come there. Your team is excited to come there because they’re not getting yelled at and screamed at about, “How come this is not covered by insurance?” and this and that every single day, seven days a week. They’re appreciated by people who work with their wallets—which means your team is getting paid better, they have better hours, they can smell the roses, get to know the patients.

But at the same time, it creates that positive momentum, right?

Naren Arulrajah: You see the patients you want to be a hero to—they love you. They keep telling their friends. Your team loves taking care of people who really want to take care of their oral health. Your team loves creating those beautiful smiles and getting rewarded for it—handsomely—for being very good at what they do, which is building relationships, taking care of people like they would want their own families to be taken care of.

So I do think it’s kind of counterintuitive. Seeing fewer patients, becoming less PPO-dependent, becoming more high-value services, spending more time with patients, becoming more relationship-focused—they all could be a game changer for you.

Ben Tunei: Mm-hmm. Yeah, no, I like that. You know, I’m thinking in my mind there—and this all sounds great in theory, you know, and I see it in practice every single day, and I know that you do too—in terms of clients that build their practices with a patient relationship in mind, right?

What kind of marketing would support a practice like that? In terms of having patients that are loyal from the get-go—right? You know, when you look at it from a marketing perspective, what should you do in terms of an offering or a marketing approach that aligns with that particular vision?

Naren Arulrajah: Yeah, I do think, you know, start by—we talked about—figure out who your ideal customer is. So, if you spent $50,000 on implants and you love implants and you’re really good at them, definitely, that’s part of your ideal customer base, right? Mm-hmm. If you want to take care of sedation patients, that’s your ideal customer base.

So I think step one from a marketing perspective is: once you know your ideal customer base, start Googling those phrases and see if you show up. Start going to Google Analytics and see if you show up. We make it super easy for our clients. So literally, they get a monthly report with every keyword they’re ranking for—and not ranking for. Um, and they can type in “cosmetic dentist” if that’s what they’re interested in. They know every keyword they’re ranking for on page one, and the ones they’re not ranking for on page one.

Naren Arulrajah: And they can say, “You know what, let’s lean in more.” And if they’re doing really, really, really well with SEO, then the next place to look is your landing pages. Do those pages have the videos we talked about? Do those pages have really nice, well-put-together cases?

Remember, when people are working with their wallet, you have to convince them. They’re not just going to give you $20,000 just because you asked for it, right? They have to know they’re giving that $20,000 to somebody they want to give it to—meaning the best, right?

And how do you show you are the best? The Google reviews. Those cases. You know, the best pictures are the true full-face after pictures. Again, you don’t have to have a hundred pictures. Just get one—that’s already 100% better than zero, right? Get two—that doubles from where you are. Right? Get three. So over time, you just can get better at attracting the right people through SEO, convincing them through these cases and reviews and videos, and then finally, the phone experience.

So that’s the way I would think about marketing. But everything starts with your gut decision to become, you know, relationship-driven, to become, you know, high-value-services focused. And then doing all these steps: SEO, landing pages, phone.

Ben Tunei: Yeah, that makes perfect sense. You know, as I’m sitting here and I’m—you know, if I were a dentist kind of thinking about the practice model that I want to build, this—this is it. This is the practice model that I would think that I would want, you know?

So, and I imagine that there are probably others kind of thinking the same way—where their current practices, they want to have a shift. A paradigm shift, and a shift in the approach to achieve what you’re talking about today, Naren.

So if a doctor’s thinking, “This is the kind of practice I want to build,” what would you suggest in terms of the next steps to kind of start on that path of building a practice like this?

Naren Arulrajah: You know, that’s an excellent question. I do think, you know, you kind of heard at a high level a new way of thinking—relationship-driven, spending more time with patients, you know, and all the different components of success. Right now, you want to get an action plan—something that really helps you think through how this is gonna work, how this is gonna look, and also figure out where you’re starting from.

So I would recommend booking what we call a Marketing Strategy Meeting. We’ll put a link in the show notes: insuranceuntangled.com/msm. And, um, you know, book that marketing strategy meeting.

We will study you, we’ll study your competition. We’ll tell you—once we know who your ideal clients are—are you doing well for those ideal clients? Are you ranking? Are you attracting them?

Naren Arulrajah: If you are, then we will tell you how you can influence them, how you can convince them—both with SEO, with amazing landing pages—and where your gaps are. Like, what is the reason—every one of our clients within year one is getting 20 or more new patient calls and is ranking for 100 or more keywords. How are you ranking? How are you against that benchmark?

Are you in the top 5%—like the ones who are ranking 400 or more keywords? Or are you in the bottom 95%, who get pretty much no free traffic from Google or a tiny amount of free traffic? And then, how’s your competition doing in those metrics?

And then of course, once you know where you are, where your competition is—how do we go from wherever you are to the top 5% when it comes to attracting your ideal clients, doing all the things that we talked about in the marketing funnel, so you are successful?

So we’ll give you a complete roadmap. Take that roadmap—it’s our gift to you: insuranceuntangled.com/msm. And if you want to proceed with us, we would love to help. But if not, that’s okay too.

But at least now you know what you need to do to change your prospects, change your future, right? Instead of going down that same, you know, dark hole where every year gets a tiny bit worse than the last year—you can make a pivot. You can change things.

Ben Tunei: Absolutely. Yes. That website again: insuranceuntangled.com/msm to take advantage of that Marketing Strategy Meeting. I highly recommend it. We have clients that do that all the time, and when they report back to me, they report back with a great sense of appreciation on what they learned—in terms of a new path, a new angle of marketing that they had never seen or experienced before.

So, Naren, thank you so much for today. I think today’s episode is very important, right? A relationship-built practice—just as it is with almost any business, right?—when we get to know our customers and our patients, we tend to find better paths, better production from a long-term perspective because we have more trust. Right?

So, appreciate your time there, and I want to thank our listeners for joining us today on another amazing episode of the Insurance Entangled podcast. If you like this, share this with your friends. Give us some reviews on any of the podcast platforms that you’re listening to this on. That’ll help other doctors find this content.

And don’t forget to visit insuranceuntangled.com/msm for future webinars. All of our episodes are posted there as well.

Thank you again for joining us.

Until we meet next time, folks, we wish all of you the very best of success.

Take care now.