It’s that time again. Football is in full swing, there’s a chill in the air, the final months of 2012 are upon us. Shore up production before the end of the year by giving patients the incentive to be in the chair now.

This is the perfect time to alert patients to unused dental insurance. It’s also the perfect opportunity to inform your patients about treatment financing plans like those offered through CareCredit. I readily advocate of the use of financing companies because you want to do everything within reason to make it easy for the patient to accept treatment and easy for the practice to receive payment.

Moreover, educating your patients about available insurance funds as well as interest-free financing options can be an essential means of helping the patient get past the financial barrier to receive the treatment they need.

Use scripts to guide financial conversations. Consider incorporating the following points: “Mrs. Patient, we want to do everything we can to ensure that you receive the care you need. We understand that in today’s economy financial options are very important. We can make arrangements that will enable you to make low monthly payments at no interest for a full year. We are able to do this with the help of CareCredit, which is a treatment financing company endorsed by the American Dental Association. If you would like those payments to be even lower, CareCredit offers fixed rate financing options for two, three, even four-year payment plans. More and more of our patients are taking advantage of the payment option these days. And the process takes just a couple of minutes.”

Provide options and make it easy for patients to get treatment.

Hi Sally,

I have a big problem with my front desk. For the last three years, it turns out the front office has mostly collected what insurance paid and did a lot of write offs, never bothering to bill patients when they were supposed to. So now patients are questioning their bills over 3 months. They don’t want to pay since it’s long overdue, although they do admit to getting the work done & how wonderful the dentistry is that the Dr. does. How do I resolve?

New Office Manager

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Dear New Manager,

Obviously the failure of the front office team to perform is a result of a lack of training, systems, protocol and MEASUREMENTS of performance of the system and the employee. With those things in place, you would know within 30 days if the employee was performing up to the standards of the protocol of the system.

To the patient: I would admit to the failure of the employees and systems to bill them in a timely fashion after the treatment was performed. Considering this failure, the practice could agree to allow patients to pay over 3 monthly payments to make it easier on their cash flow. However, you must be clear that moving forward, you will require them to pay for their portion at the time of treatment.

Let’s face it – the office dropped the ball. It’s not fair to reprimand the patients when they had no idea. Better to take all of the blame and make it easy for them to pay and retain them as a patient than to anger them and lose them.

Here to help,
Sally McKenzie

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Sally,

We have a huge number of patients that have had one of the PPO’s we are part of and now find themselves without insurance. (retired or unemployed or even new standard insurance) The problem we are having is that more and more patients are angry with us due to our fees. Patients with PPO’s have a much lower fee plan than that of our normal pay for service patients. Now without insurance they want us to still honor the fee of the PPO or they are leaving because we are so overpriced. We have not had this issue prior to the PPO and we just don’t know what to say to these patients. I looked at your archive and didn’t find anything directly referring to this. Thank you for any help/guidance you can give us.

Renee

Hi Renee,

There is no right or wrong answer here. Putting myself as the owner of the business, the business decisions I make have to be what is in the best interest of the business, always. In order to make an informed decision, I would want to know how many of my active patients were actually on this PPO plan and how many people it affected, i.e., retired and unemployed. I would then want to know how my fees ranked within the zip code for my practice. You can purchase this on my web-site here: http://www.mckenziemgmt.com/book-practice.htm#b11. From this, I should be able to tell if the patients are able to in fact, go to another dentist and that my fees might be too high. If I were to lose a lot of business then I might have to consider a “post PPO” courtesy adjustment. I would also need to work on lowering my overhead as much as possible in order to be profitable.

Hope this helps,

Sally

Sally

I am under the understanding that it is illegal to give or even offer discounts to patients that have dental insurance. I have a situation where a patient asked us to give him 10% discount after his insurance paid their portion on his bill. We explained to him that we are not allowed to do this. He still is insisting that he has done so in the past why can’t we do this now. Can you send me any article to show him that this would be considered fraud and we can get into trouble. I appreciate it.

Thanks, Patient Coordinator

Dear Patient Coordinator,

My guess is that an “article” is not going to be enough to convince this patient. If the insurance company in question and your dentist employer is a “provider” of this insurance company, then the doctor should have some signed agreement with the insurance company. I would locate this agreement and then extract from that agreement what has legally been agreed to.
The other option would be to contact the insurance commissioner of your state and ask for a statement from them.

Hope this helps,

Sally

Hello Sally,
I have a question, if we have a patient, that after he is seated, we discover he needs a buildup besides the crown, mind you that we did not originally discuss it or treatment plan it, and we do the buildup, can we bill the insurance and only accept what they in turn will pay and not charge the difference to the patient as long as we let the patient know that we are doing this? Will this be okay to do. We want to do what is right, but on the other hand charge for what we do. It takes time and money to just do the buildup and not charge it to the insurance. Please let me know how you would follow up on such a matter.
Thanks
Wanda

Hi Wanda,
Always include a build-up in the treatment plan as possible treatment.  It is safe to say, that if you are removing a large restoration or an existing crown, a build-up is necessary to retain a crown and is a separate procedure.  Also the patient will not get angry if you have to do the build-up and also think you are “wonderful” if it is not necessary.  Put a disclaimer on treatment plans that say, “This treatment is an estimate based on the condition of the teeth and tissue at the time of diagnosis. Should treatment change during the course of the service, you will be given an updated estimate.”
Delta Dental does not pay for a build-up because they consider that part of the crown service.  Other insurance companies will pay if the build-up is submitted at the time of the prep, not the seat date and some will pay with proper documentation at the prep.  It is usually covered at 50% of the contract or UCR fee whichever is applicable.  Document with an x-ray and a narrative.  Take an x-ray at the time that a build-up is found  to be necessary to show to the insurance company.  You can not bill the insurance and only accept what they will pay on a service that pays a percentage of the cost.  Insurance companies require collection of co-pays and deductibles as part of the contract of cos participation.  If you discount, they want to pay less on the claim.
Hope his helps,
Sally