Estimating Your Patientsí Portions
Do some of you remember the days before insurance? Patients simply “paid” for their services. There were no terms such as out-of-pocket, co-pay, deductible, maximum, not allowed, not covered, missing tooth clause, waiting periods and all the other terms that your Business Coordinator has to deal with now. It would appear that you need to be an “insurance expert” to simply ask the patient for the anticipated portion. And even then, with all the technology and tools that your Business Coordinator has, it is still an educated guess. This article is a brief overview of one way to approach the patient regarding their benefits.
Where Does Benefit Information Come From?
How Accurate is the Information?
1. Who you speak with at the insurance company. You may get a different response from two different agents at the same company for the same plan!
Honestly, it seems that patients think your computer is somehow connected to their dental plan. They assume you have “instant access” to accurate information and can tell them exactly how much their plan is going to pay. We only wish it was that easy, right?
Discussing Benefits with Your Patient
I always start by telling the patient with a sincere and sympathetic smile on my face: “Mrs. Jones, we don't know how much your insurance is going to pay. Based on our experience, I can estimate that your portion will be about $125. (Always “guestimate” on the high side). After we hear from your insurance company, we will contact you if there is any difference. How does that sound?”
Often I get a glare from front office staff when I suggest they admit that they don't know how much the insurance is going to pay. Some want to project to the patient that they are “insurance experts”. We find that patients will not hold you as responsible if you are honest and tell them that you don't know – because we don't know! The more we project to know, the more the patient expects us to know.
When estimating the patient’s portion, it’s important to round off so it doesn’t appear to be precise. I have not worked with a dentist yet who prefers to send a statement and try to collect the unpaid portion from the patient opposed to sending a refund check.
Are there situations where your Business Coordinator knows exactly what the patient’s plan will pay barring no unforeseen circumstances? Of course. And it is fine to request the exact amount from the patient. The goal in collecting “patient portions” is to avoid having to send a statement after the fact and then manage patient calls explaining why the insurance didn’t pay what was expected.
Ideally, your patients are so informed and "sold" on their treatment recommendations that they want the treatment regardless of out-of-pocket cost, and they understand your office team will do everything in their power to maximize the benefits. “Mrs. Jones, we will do our best to maximize your benefits, but please understand that we have no control over how they will handle your claim.” Maybe a simple way of stating this is to “under-promise and over-deliver”. I have never seen a patient who was upset that the insurance company paid more than anticipated, just like they are not upset when you didn’t need to perform a buildup, thereby reducing the fee they were initially quoted.
Avoid being an insurance benefits “expert”. Patients just want to know how much you want them to pay at their appointment. Keep it simple!
McKenzie Newsletter Information:
To unsubscribe: To discontinue receiving the Sally McKenzie eManagment newsletter,
click on the link at the very bottom of this page for instant removal,
To report technical problems with this newsletter or to request technical help,
please send a descriptive email to: email@example.com
To request services, products or general inquires about The McKenzie Company activities
please send a descriptive email to: firstname.lastname@example.org
If you would like to have any of your dental practice concerns answered personally by Sally McKenzie,
please send a descriptive email to her at: email@example.com
Copyrights 1980-Present The McKenzie Company - All Rights Reserved.