Competing against In-Network Providers When You’re Out-of-Network

One of my current coaching-program TCs called me this week with a challenge that most of my domestic client practices will run into from time to time; that being in the position of competing with a practice having the advantage of being in-network for insurance purposes. In this case, the TC’s prospective patient will receive an insurance benefit of $1000 by using a designated provider practice instead of hers. My client is therefore in the unenviable position of persuading this prospective patient to give up a significant financial savings by committing to her practice.

At first glance, this might seem like an insurmountable obstacle; why would a patient leave $1000 on the table to get treatment at your practice? That’s certainly the mentality that your new visitor will have at the beginning of this process. It is also the mind-set of the uneducated buyer.

Your job is to give them an education – and change their thinking.

If I were this TC, below – verbatim – is what I would say to patients who would be coming to me as a non-preferred-provider option, and paying a premium to do it. I shared this with her yesterday, and now I will share it with you:

“Mrs. _______, I completely understand why you would be hesitant to consider our practice for your treatment needs; after all, you can save a thousand dollars by staying in your network.

However, there are three reasons why I would encourage you to come here.

First of all, unlike most other in-network services, with orthodontics what you are paying for primarily is a cosmetic result, not a medical necessity. For that reason alone, your main decision driver should be where you are going to get the best cosmetic result, not who is in your network.

Second, this is a once-in-a-lifetime procedure, with one opportunity to have it done right. By staying in your network, your choices are limited to only those doctors who are participating, regardless of skill level or quality of care. We encourage you to compare our doctor(s), staff, and facility to your in-network options, and weigh these factors against the cost difference. Our success with patients shows time and again that we are worth the additional investment.

Finally, we allow you to finance paying for our services over the time of your treatment. What this means to you is that over a twenty-four-month period, that thousand-dollar cost to you for going out of network is a difference of only forty-one dollars a month, interest free. So the question really becomes not whether or not to stay in your network, but rather whether having treatment with Dr. _______ is worth an additional forty-one dollars to you a month. My job is to show you why it is.”

These points set the stage; by combining them in the consult with the support documentation covered in my training program, there is no reason why you can’t win a substantial number of these out-of-network cases. The key, as always, lies in helping your visitor to make a well-informed business decision. That’s not only your job; it’s your obligation.