Dental Insurance Reality Check
It begins innocently enough. You diagnose necessary treatment for the patient. It’s consistent with your standards. You recommend to patients the treatment that you would advise your own family to receive. You don’t make your diagnosis based on what you perceive the patient can afford or what you think insurance will cover, rather it’s rooted firmly in appropriate standards of care and based upon what you consider to be the best course of treatment for the patient.
And then one day those standards backfire. Insurance won’t cover the crown you’ve recommended. Suddenly, the patient sitting before you is quietly questioning your integrity. It’s as if they view the insurance company as the police, and you have been busted! In other cases, the patient perceives that the staff is incompetent, reasoning that if the practice had filed the claim correctly, it would have been paid. Or perhaps the patient wants to “help everyone out,” so they take it upon themselves to research the matter and explain to your business staff how to handle it.
“The insurance representative I talked to said all you have to do is code it as an ‘XYZ’ and the insurance company will pay the claim.” If the employee handling this patient doesn’t know better, s/he may take their “advice,” thereby putting the practice in a position in which the doctor could, in fact, get busted for insurance fraud.
Dealing with insurance can be nothing short of exasperating for many practices. Patients may have excellent medical insurance that covers the care they need until they are well, yet they have severely restrictive dental insurance that provides a mere $1,000 in dental benefits annually, which further fuels the perception that dental care is not all that important. Worse yet, the patient may not be allowed to use the dental benefit as s/he chooses. The insurance company may dictate percentages, perhaps paying 50% on crowns, 20% on amalgams, and requiring the patient to meet an annual deductible.
How do you tell the patient that his/her dental coverage is horrible? How do you explain that the company’s understanding of dental care is stuck somewhere in the mid-twentieth century, completely out of touch with modern dental procedures and standards? How do you communicate to the patient that they have a choice: their dental insurance or their teeth - what’s it going to be?
It all begins with managing patient expectations. And that begins with education. “But Sally, isn’t it the patient’s responsibility to know and understand what their dental insurance covers?” Yes, of course it is. But if you and your team are not proactive in educating patients, you will be far more likely to find yourself in situations like those above where the staff and even the doctor have to defend or justify treatment recommendations, or they have to tap dance around awkward and potentially illegal requests. Better to be proactive. It’s important for every patient to understand that dental insurance is severely limited, and the insurance company is not the dental expert.
Your financial coordinator should sit down with the patient and review what’s covered in their dental plan according to a prepared script in which the situation and options are clearly articulated and the coordinator is ready with the answers to those frequently asked patient questions and concerns. Discuss the calendar year cap, deductibles, co-pays, coverage for preventive care, etc. The greatest benefit of a script is that you know precisely how to respond and you are well prepared. Doctor and team can better manage the messages to ensure they are clear and professional. Specifically, patients need to understand that they have a limited dental benefit; however, that doesn’t mean that you, the dentist, will ignore infections of the mouth. One of the most common areas of insurance frustration is the lack of understanding of periodontal disease.
Insurance companies commonly pay for two professional cleanings a year. The patient believes this is all that they need because additional prophys are paid out of pocket . Consequently, many dental practices do not have active “interceptive periodontal programs” for fear of losing patients. These offices let the insurance companies dictate treatment to the detriment of the patient’s dental health. However, if a patient had an infection or disease in their heart or lungs or any other part of their body, they would not expect their physician to ignore it because insurance wasn’t expected to cover the treatment. The same should hold true for their dentist.
For more information on this topic, visit my blog: The Lighter Side
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Five Ways to Improve Hygiene Production Now
In the past, the hygienist in a dental practice functioned as a “cleaning lady”. The faster she could get patients in and out was the measure of her successful contribution to the office. Restorative treatment has always been important, with sustainable health and perio concerns somewhat on the back-burner. In that practice model, the hygiene department is thought of in the old-fashioned way of “loss leader”.
For many years now we have known that this is just not the case in a profitable and patient centered practice. Patients rely on their hygienists for more than just “cleanings”. They rely on their hygienists to provide them with general knowledge, specific home care instructions for their individual needs, appropriate treatment, and on-going continuity with the office. Often a patient will look to the hygienist for confirmation when the dentist suggests restorative treatment. The relationship is important. Therefore, the hygienist is in a powerful position to help identify and support necessary patient care, as well as functioning as one of the backbones to production in the office.
The hygienist should not be on a treadmill of appointments that consist of only prophys and bitewings. Her appointments should not be rushed to simply force in more of the same. Hygiene services are a separate production and income center, and as such deserve careful attention as to how these services are being delivered. Here are five ideas to improve hygiene production right now:
1. Review patient records to determine when the last complete radiographic review was performed. This should be done before the daily morning meeting. ADA recommendations for prescribing dental radiographs were updated in 2012 (complete information available at ADA.org). Guidelines for all age groups and with complete, partial, or edentulous conditions are shown. While the guidelines are helpful, they do not infringe on the individual assessment and recommendation of the dentist as to when and how many radiographs should be exposed. Many dentists recommend a full mouth series at a minimum of every five years. More frequently if the patient has had a history of dental disease. Many dentists also recommend bitewings at least annually. The ADA guidelines show bitewing radiographs being recommended at 6-12 months for children and adolescents with clinical caries or at risk for caries if proximal surfaces cannot be examined visually or with a probe. For adults, under the same circumstances, the guideline suggests 6-18 month intervals. Children and adults with no clinical caries and not at risk for caries have bitewings recommended at 12-24 month intervals, even going as long as 36 months for some adults. The prime directive is the dentist’s assessment; therefore his assessment should determine when radiographs must be taken. Also of concern to most patients is insurance coverage. Most plans cover bitewings once per year and a full mouth series or panograph every three to five years.
Use the morning meeting to look over the patient’s clinical history and determine the need for the dentist to examine and assess the patient’s condition concerning radiographs. In many cases a patient may have been receiving bitewings only for a period of several years. This may not be proper and should be corrected by a full mouth series being exposed today. Be sure to also document the need for any radiographs taken in the patient’s record.
2. Note the patient’s last complete periodontal charting and probing. While a perio assessment is considered a part of any dental exam, sometimes it may be overlooked in favor of other pressing concerns. Perio charting should document probing depths, bleeding areas, recession, furcations, and mobility. According to the American Academy of Periodontology, probing depths of 4mm or deeper may be indicative of the need for active periodontal treatment. If the patient shows these results, it is not appropriate to continue to use standard prophys every six months as their “treatment”. The hygienist should explain all readings and recommend scaling and root planing where necessary. The dentist and hygienist need to coordinate their message on this. “Watching” and waiting are typically not in the patient’s best interests.
3. The use of intraoral photographs should be a part of every hygiene visit. Identifying and explaining restorative needs are expedited with photos, and showing a periodontal probe disappearing into a pocket easily demonstrates the patient’s perio issues.
4. Hygiene appointment times should not be too brief. If the hygienist does not have the time to perform a complete perio assessment, take photos, expose radiographs and explain the patient’s condition, then the patient and the practice may be short-changed. Less than an hour is typically too little time to provide what is needed. Appropriate perio identification and subsequent treatment is better for the patient and the office. Taking the time to make this happen improves hygiene production in the long run.
5. Make products available to help patients sustain their home care efforts. These might be home fluorides and toothpastes, prescription mouth rinses, xylitol items such as sprays and candies, and dry-mouth remedies. “Selling” items is not unprofessional. Our patients appreciate being able to obtain the products that can support their success.
Because patients see the hygienist on a regular basis, anything that can be done to improve their care and treatment helps them and helps the office. Small changes can improve hygiene production now.
Carol Tekavec RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email firstname.lastname@example.org.
Influence: A Picture’s Worth a 1,000 Words
You’ve probably heard this quote hundreds of times, but have you ever stopped to consider what it means? The phrase has actually been attributed to several sources throughout the years but refers to the power of visual (nonverbal) cues to communicate large amounts of data.
Humans are sensitive to things like body language, facial expression, posture, movement, and tone of voice. We have the ability to communicate many emotions without saying a word. Is there ever any doubt in your mind as to the mood of an employee when they walk into the office? Or the ability to get children to behave by simply giving them “T-H-E eye”? Research shows that verbal communication – the actual words – accounts for approximately 10% of the message. This is the “surface” of communication. Science tells us that the “nonverbals” account for up to 90% of the real meaning in what is communicated.
Being a successful dental leader requires you to influence people just about all of the time. You need to persuade your patients and your employees to take action based on what you say. To deliver the full intention of your messages, use the following nonverbal behaviors to raise the impact of your communication.
Facial Expressions. When you smile, you convey approachability. Your employees and your patients will feel more comfortable around you and they will listen more attentively. Be careful, however, to avoid smiling when the message is serious.
Voice. The volume, rate, tone, pitch, and inflections of your speech are major factors in communication. When you use a soft voice, you may be seen as lacking confidence. On the other hand, using a slower, quieter voice in stressful circumstances signals strength and control. A strong voice shows confidence. Yet in matters of disagreement, a booming voice often escalates the conflict.
Body Language. The way you stand, walk and move speaks volumes. If you are too fast-paced, you convey tension much more than efficiency. A relaxed, calm posture signals confidence and receptivity. Your posture also influences whether you are seen as competent. Slumped shoulders undermine credibility. Stiffness conveys nervousness. Unfold your arms and uncross your legs when engaged in important conversations.
Gestures. When gestures are natural and flow with your words, they enhance the impact of your message. But be careful of distracting gestures - fiddling with pens and clothing, foot-tapping and fingernail clicking. These are seen as signals of discomfort. They show a lack of confidence and diminish your credibility.Photographers and artists try to influence us by choosing the setting, the subject and even the light conditions in which they ‘paint’ their pictures. All of those choices influence how we see what the photographer wants us to see. Increase your influence in business and personal relationships by adjusting the ‘picture’ you give others through your nonverbal communication. Over the next week, practice one aspect of your body language or facial expression or voice. Be mindful and deliberate. It may feel awkward but with consistency it will become more natural over time.
Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at email@example.com
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