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How to Ban a Plan

You may retain patients after dropping a plan by avoiding this pitfall.

GARY GERBER, O.D.

First, let me tell you what this article is not about. It's not about advocating you drop third-party plans. Dropping (or adding) a health plan requires you to carefully analyze each plan and its affect on your practice's staff and income.

Instead, this article educates you about what not to do after you've decided that dropping a particuar plan is in your practice's best interest.

Don't focus on you

Even if your analysis reveals that dropping a particular plan is the right decision for your staff and practice, you don't want to lose affected patients as a result if you don't have to. You have an excellent chance of retaining these patients by not focusing on the plan's affect on you, when notifying them of your decision to drop their plan.

After dropping a plan, a client of ours sent a letter to affected patients, which listed the three main reasons he chose to do so:

► The insurance company had ignored the practice's complaints regarding coverage for the use of certain diagnostic instruments.

► The staff was frustrated in dealing with the company.

► The level of reimbursement wasn't enough to compensate him for his services.

While any of us who've worked with a substandard plan can readily relate to the three issues this O.D. raised, patients don't care (or even believe) that you're frustrated and underpaid. The fact is their personal issues are more important to them than your inability to receive coverage every time you use your new opto-gadget. And, as far as your staffs' frustration in dealing with the big, bad insurance company, from a patient's perspective, your staff is just doing their jobs.

Focus on WIIFTP

Instead of appearing selfish and whiny to patients by airing your grievances, focus on WIIFTP ("what's in it for the patient"). Do this by remaining positive in your notification letter. Applaud and thank the patient for his support and loyalty up to this point. Then, let him know that although you're dropping his insurance, you'd be honored if he chose to remain with your practice, as getting to know him and provide him with the best eye care has been a pleasure.

If the plan you're dropping has an out-of-network benefit, explain the details of how it works. Also, if you offer payment plans or discounts, educate the patient about the terms.

The point of this letter is to make the patient feel valued and welcome despite the fact that you'll no longer be accepting his insurance. This, in turn, may enable you to retain some of these patients.

If you feel compelled to "bash the plan" on some level, do so productively. You can do this by determining whether many of the patients who belong to the plan are employed by the same company. If this is the case, attempt to set up a meeting with the company's human resources director to explain how the plan has negatively affected the company's employees and not you. You want to show this person that their company is paying a lot of money for a service that is delivering a high level of angst and inconvenience to their employees.

Remember: Although third-party plans can be frustrating, focusing on the impact the plan has had on your practice will not enable you to retain affected patients or prompt the company that belongs to the plan to investigate other options. So, stay positive and focus your energies on keeping patients, not bashing the plan. OM