Patients Will Always Need To Be Educated
In college, one of the first things we are taught as hygienists is how to educate our patients on the skills of brushing, flossing, and other oral hygiene aids that will help increase the overall health of their mouth. This is great information that we will take into our practices and utilize every day for the rest of our careers. However, the education of our patients does not stop with oral hygiene instruction. It also involves educating the patients about their restorative needs, periodontal disease, and preventative care needs. We also have to continually educate our patients about the constant changes to their insurance benefits (or should I say lack of benefits), because employers continue to cut costs by offering insurance plans that provide less and less benefit to the patient.
Are we going to lower our standards of care because of changes in insurance coverage? I hope not. We need to help our patients with utilizing their insurance benefits to the maximum possible, but it is our ethical responsibility to the patients to educate them about their specific dental needs, and provide them with all the information needed to make an informed decision.
There are two codes that are used on a regular basis when billing out root planing, and they specifically state that root planing procedures are not prophylactic in nature. So, for those of you that are doing a cleaning after root planning, the new trend for many insurance companies is to deny this procedure if it is not more than 90 days after the root planing. So when is the hygienist supposed to clean the areas of the mouth that are within normal limits and not periodontally involved, which need prophylactic care and not periodontal therapy/treatment? Three months from the root planing should be the first periodontal maintenance appointment. Not a prophylaxis, according to the codes.
The example of a cleaning after root planing is just one example of procedures that may not be covered by insurance. Adult fluoride, placement of chemotherapeutic agents, more than two cleanings, more than two periodontal maintenances, and night guards are a few more. This doesn’t mean that the patient does not need the treatment. It does mean that the patient needs to be educated about why they need and want to not only have the treatment completed, but pay for it out of their own pocket.
Educating patients about insurance benefit limitations is crucial and needs to be done by the entire staff. Of course, the financial coordinator is the person that will go over specifics when it comes to the patients treatment plan and out of pocket expenses. It is also the financial coordinator that will help in educating the staff about the constant changes and challenges that are happening when it comes to billing and getting paid by insurance companies. There are thousands of plans and there is no way to know all of the limitations. However, it is important to know how the majority of insurance companies are handling payment and even more importantly, non-payment for services rendered.
The perfect time to educate the patient about areas that are not covered by insurance and reiterate the need for the treatment regardless of insurance limitations, is while doing the treatment that is covered by insurance and that the patient has committed to do. This may be as easy as telling the patient at the last root planing appointment:
“Sandy, your next treatment is a (fine scale, prophylaxis, or whatever name your staff is calling a cleaning). We have finished the active phase of the periodontal treatment, but we still need to treat the teeth that are not infected. Unfortunately your insurance may not cover this, but it is the one time that I will be able to work on the areas of your mouth that are not infected and return to site-specific areas that still need some more attention now that there has been some healing.”
The main thing is for the assistant, hygienist, and doctor to help inform the patients about what treatment is needed, and why it is recommended regardless of the insurance limitations. It is the responsibility of the financial coordinator to inform the patient if the insurance is going to cover all or none of the treatment.
The more the patient is educated about their needs, the more likely they are to accept not only the treatment that is covered, but the treatment that they have to pay for out of pocket.
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