The Patient That Continually Refuses Treatment
In the past, we have discussed how to develop your hygiene department into the profit-making department that you want. One of the industry standards is to have periodontal treatment and ancillary products at 33% or above total hygiene production. This is extremely doable with a continuous effort from the hygiene department and truly benefits the periodontal patient as much as the practice. Those patients that have gone to the periodontist and have refused surgical treatment, but are willing to have non-surgical therapy, will benefit from the more aggressive non-surgical treatment. However, they should be reminded that the surgical treatment recommended by the periodontist is still to their advantage.
We have just looked at one reality of working as a hygienist in a general dentist office. Not every patient is going to have the same priorities as ourselves or as other patients we see.
What do we do with the patient that will only do treatment based on what the insurance will pay? What about the existing patient that refused to have periodontal maintenance appointments? What about the patient that refuses the 3month recall they so desperately need? These are just a few of the realities that happen when practicing chair side. Yes, in the perfect world of hygiene, every patient would floss, stay on schedule, make every appointment, do all restorative treatment, have surgery when diagnosed, and not care at all about how much insurance pays.
Those patients that refuse to do only what the insurance will cover need to be educated about their insurance benefit provided by their employer. What does this mean to the dental hygienist? It means she should be made aware of insurance benefits, limitations, and insurances that have unusual benefit limitations. Not because the hygienist will be going over financials, but because she does need to help the Financial Coordinator when it comes to educating the patient about insurance. This may be as simple as explaining to the patient the different limitations that different insurances have. Thus, making the patient aware that insurance companies are not there to keep the dentist from doing unnecessary work, but that their benefits are based on what their employer was willing to pay for their dental insurance. The pamphlet, My Insurance Covers This Right?, is another great way to help with educating not only the hygienist about insurance but also the patient.
Then there will be those patients that refuse to have periodontal maintenance appointments. These patients need to be educated about the difference between a periodontal maintenance appointment and a prophylaxis. This education needs to be not only verbal but also in the treatment that is actually done. Yes, we know that a periodontal maintenance appointment requires more work by the hygienist but does the patient perceive that there is something else or more being done compared to a prophylaxis? The hygiene department should be doing additional therapy specific to the patient’s individual needs at every appointment. Also, if the patient refuses to have a periodontal maintenance appointment, then office policy will need to be developed. Do you continue to see that patient? Does the hygienist only treat the patient with a prophylaxis? Why should the dental hygienist do the work of a periodontal maintenance appointment if the patient is not willing to pay for it? When I go to the grocery store, they do not sell me a steak at hamburger price just because I don’t want to pay for it.
This brings us to the patient that refuses to come in every 3 months because of insurance limitations or they just don’t want to pay for more than two professional hygiene appointments a year. Again this is a matter of educating the patient about the importance of coming in every 3 months. It is not just to get their teeth cleaned. It is to prevent them from developing periodontal disease. Possibly the patient needs to reevaluated and may need root planing. A bloody cleaning with 4 mm or more pocketing is not a healthy cleaning.
If the patient has already had root planing, and is on a 3 month periodontal maintenance appointment, it is in order to help slow down a disease process that cannot be cured.
Is the hygienist aware that some insurance companies pay for four periodontal maintenance appointments, but will only pay for two prophylaxis? Of course this varies from insurance company to insurance company.
It is recommended that the patients receive the treatment that is needed. However, the patient retention in the office may increase if you do everything you can to utilize their insurance 100%.
Educating ourselves as hygienists, not only about the disease process, but also about insurance limitations may help with treatment acceptance. It will also help us educate our patients and support us in patient compliance. The doctor should develop office policy and the entire team should work on verbiages to be used for these particular patients.
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