1042: Metric Mondays: The Hidden Cost of Letting Insurance Set Your Fees - Robyn Theisen

Letting insurance fee schedules become your “real” fees creates bad data, bad decisions, and an unnecessary production treadmill. In this episode, Kirk Behrendt coaches with Robyn Theisen on why every practice — even PPO-heavy practices — must use a master fee schedule, bill full fees, and track adjustments correctly so you can see the true gap between UCR and contracted rates.

You’ll learn how insurance-driven fees distort write-offs, inflate gross production, hide profitability, and anchor patients to allowance instead of clinical value — plus what to do today to start fixing it. Listen to Episode 1042 of The Best Practices Show!

Main Takeaways:

• If your practice management system uses insurance fee schedules instead of a master fee schedule, your production, adjustments, and write-offs become inaccurate.
• Without regularly comparing UCR to contracted fees, you can’t see the true adjustment gap or make good plan-by-plan decisions.
• When practices bill contracted fees, gross production may look strong while net production tells a very different story.
• Insurance-driven fees can force doctors to produce more volume to reach the same results, creating scheduling and profitability challenges.
• Billing full fees and categorizing adjustments by insurance plan allows you to identify where discounts are coming from and how large they are.
• Getting granular with adjustment categories can reveal hidden issues, like different doctors operating under different insurance fee schedules.
• Auditing a small sample of EOBs weekly helps you validate whether adjustments and payments match what you think is happening.

Snippets:

00:01 What “the hidden cost of letting insurance set your fees” actually means.

03:00 What it looks like when practices get this wrong: distorted adjustments, write-offs, and inflated gross production.

05:40 Why not using a master fee schedule creates “fake news” everywhere in the practice.

06:30 What it looks like when practices get it right: billing full fees and tracking adjustments by plan.

08:50 How granular write-off categories reveal deeper problems — including huge write-offs and mismatched fee schedules.

11:10 What you can do today: check how adjustments are entered and get more specific by insurance company.

12:20 Why anchoring patients to allowances instead of clinical value hurts your practice long-term.

Guest Bio/Guest Resources:

Robyn Theisen brings an entire life and legacy of dental experience to the team and every team with which she works as the daughter and sister of dentists. With almost 20 years of experience in dentistry, her roles ranged from practice management to operations at Patterson Dental to coaching teams. Robyn’s passion is empowering teams to realize that they can dramatically impact the lives of the people they serve by implementing skills and systems to remove barriers to life-changing dental treatment. She has done it for decades and does it every day with dental teams.

Outside of coaching, she enjoys time with her husband, Rob, and two daughters, Emerson and Ruby. She loves traveling, music, fitness, and cheering on the Michigan State Spartans.

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