Why Open Enrollment Changes Shouldn’t Dictate Your Fees, Contracts, or Revenue Starting January 1

Stop Accommodating Your Patients’ Employer Cost-Cutting Decisions.
Every fall, employers across the country make decisions about their employee benefits during open enrollment. Those decisions typically take place between October and November, sometimes extending into early December, with new plans becoming effective January 1.

On paper, that sounds orderly.In reality, those decisions create one of the most financially vulnerable periods of the year for dental practices.

Open Enrollment Ends in the Fall. The Pressure Starts Immediately.

While most new plans do not go into effect until January 1, dental practices often begin feeling the consequences weeks earlier.

During November and December, carriers start sending notices to offices stating that:

     · A large number of existing patients are moving into a new plan

     · An employer has changed carriers or benefit structures

     · Continued participation requires execution of a new application or fee schedule

These notices rarely arrive during a quiet period. They show up while practices are:

     · Fully booked

     · Managing year-end benefit utilization

     · Closing out production and collections

     · Navigating staff vacations and holiday schedules

The timing matters.  Practices are busy, distracted and under pressure to avoid disruption.

The Year-End Utilization Crush

November and December are already the most operationally intense months of the year for most dental offices.

Patients are:

     · Rushing to use remaining benefits

     · Scheduling larger restorative cases before annual maximums reset

     · Filling hygiene schedules to capacity

At the same time, carriers introduce participation pressure with language that suggests urgency:

     · “You have a lot of patients in this plan.”

     · “To continue seeing them, action is required.”

     · “This must be completed before January 1.”

The message is subtle but effective:  sign now or risk losing patients.

Employers Shift to Save Money for Themselves.

Employers reduce benefit costs by:

     · Switching insurance carriers

     · Narrowing networks

     · Choosing lower reimbursement structures

     · Modifying benefit designs

Those decisions reduce the employer’s expense. They do not reduce the insurer’s margin.

Instead, the financial impact is often passed directly to providers through:

     · Lower fee schedules

     · Reduced allowable amounts

     · Narrower participation requirements

     · Increased administrative friction

Dental practices are then expected to quietly absorb the difference.

Volume Is Used as Leverage, Not Information

Carrier communications during this period often emphasize patient volume:

     · “A significant portion of your patients are in this plan.”

     · “This is a popular employer selection in your area.”

What is rarely disclosed is far more important:

     · How many of those patients are actually profitable

     · Whether the plan is PPO, HMO, or a hybrid structure

     · Whether out-of-network benefits exist

     · Whether reimbursement relies on leased or umbrella networks

Volume is presented as a reason to sign, not a data point to evaluate.

The Most Expensive Decision Is the Fast One

Faced with time pressure and full schedules, many practices respond by:

     · Signing new agreements without analysis

     · Accepting reduced fee schedules “temporarily”

     · Assuming they can revisit the decision later

But January 1 locks in consequences:

     · Lower reimbursement becomes the new baseline

     · Contract leverage diminishes

     · Revenue loss compounds quietly over time

What feels like a short-term accommodation often turns into a long-term financial drag.

Patient Loyalty Is More Stable Than Practices Assume

One of the most persistent misconceptions in dentistry is that patients will leave simply because their employer changed insurance plans.

In practice:

     · Patients choose dentists based on trust, convenience, and experience

     · Most patients do not understand plan mechanics

     · Clear communication matters more than participation status

Practices consistently overestimate attrition risk and underestimate their own leverage when transitions are handled intentionally and transparently.

Employer Benefit Changes Are Not Your Financial Responsibility

There is no legal requirement to:

     · Accept new carrier contracts

     · Match employer benefit changes

     · Offset employer cost savings with provider revenue loss

Your responsibility is to:

     · Provide care

     · Communicate clearly

     · Operate a financially sustainable practice 

Accepting lower reimbursements to accommodate decisions you did not make is optional, not obligatory.

The Question Practices Should Be Asking in November and December

Instead of asking:

“How do we accommodate this plan change right now?”

A better question is:

“What does accepting this agreement do to our revenue starting January 1, and is it worth it?”

Answering that question requires:

     · Plan-level analysis

     · Real reimbursement data

     · Understanding network behavior 

     · Slowing the decision-making process during a deliberately compressed window

A More Intentional Approach Going Into the New Year

At Solutions-101, we work with practices to separate employer benefit decisions from provider obligations.

That means helping offices:

     · Evaluate year-end carrier pressure objectively

     · Understand the real financial impact of participation changes

     · Avoid reactive decisions made during the busiest weeks of the year

     · Maintain patient trust without sacrificing revenue

The goal is not disruption.

The goal is control.

Final Thought

Open enrollment happens every year.
Carrier pressure happens every year.
What does not need to happen every year is voluntary revenue loss.

Before signing another “routine” agreement during the holiday rush, make sure you understand what you are actually agreeing to — and what it will cost you long after January 1.