Reducing insurance woes

The processing of dental insurance causes significant administrative problems in many dental offices today. Delays in receiving payment, eligibility problems, `lost` claims, requests for information (radiographs and narratives) already supplied, unreasonably low UCR levels and arguments over preexisting clauses are but a few of the woes dental offices experience in dealing with insurance companies. One way to eliminate this frustration is to not accept assignment of insurance benefits. The patie

Gary Takacs

The processing of dental insurance causes significant administrative problems in many dental offices today. Delays in receiving payment, eligibility problems, `lost` claims, requests for information (radiographs and narratives) already supplied, unreasonably low UCR levels and arguments over preexisting clauses are but a few of the woes dental offices experience in dealing with insurance companies. One way to eliminate this frustration is to not accept assignment of insurance benefits. The patient pays you if he/she has dental insurance; then, the insurance reimburses the patient.

A transition that works

If this concept sounds interesting, but you are concerned about how this decision might impact you, I would like to suggest a way to transition your office with success. My solution is to no longer accept assignment of insurance benefits for hygiene visits.

From this day forward, require your hygiene patients to pay for their dental services in full at the time of service. I suggest that you continue to produce an insurance form for your patient, because he/she does not have the expertise to do so. At the end of the hygiene visit, your front-desk team member can provide the patient with a walk-out statement itemizing all charges. Your front-desk person then will collect this amount from the patient, hand the patient the completed insurance form and tell the patient to mail this form to his/her dental-insurance company for reimbursement. Be sure to check the box on the insurance form that assigns the benefits directly to the patient. The insurance company then will mail a check directly to the patient.

Think about what we accomplish with this shift. By collecting payment at the time of service for hygiene visits, you will reduce significantly the number of billing statements your office sends out. Many of the statements that your office sends out each month are related to hygiene visits. Sometimes it is necessary to send out two and three statements until the balance is settled in full-all at a cost of somewhere between $7.26-$10 per billing statement!

Let`s not forget the indirect costs of the time value of money. If you collect in full at the date of service, then this time value cost is zero. Insurance companies discovered the reverse of this trick a long time ago. They learned that if they just kept your money for a few extra days, they could make a ton off the `float.` If you think the money they earn off the float is inconsequential, then I challenge you to rethink! Insurance companies actually earn hundreds of millions of dollars each year by hanging on to your money a few extra days.

Can you actually do this?

Let me be painfully direct. Your patients will not be thrilled with this new approach. They would rather you bill their insurance and wait for payment. Who wouldn`t??? How-ever, the question is not whether your patients will like this change, but whether you will lose patients due to this decision. My experience is that if your payment coordinator is polite and diplomatic and if your office provides exceptional patient service, then this decision will provide minimal upset to your patients.

If the patient objects, your financial coordinator should be prepared to overcome these objections. One positive approach is to suggest that the patient could charge the visit on a credit card. Credit cards provide a billing cycle and grace period of 25-30 days. Indicate that patients can charge today`s visit on their credit card and they probably will receive reimbursement from their insurance carrier before their credit card bill is due. As a sidebar, please note that most insurance companies will reimburse the patient much quicker than they provide payment to your office. This is because insurance companies prioritize payments to policyholders before providing reimbursement to providers.

The bottom line is that most patients are able to comfortably handle payment of the hygiene visit. If this payment represents a financial hardship for a particular patient, then you can make an exception. However, it is my experience that the vast majority of patients are able to pay for this visit out of pocket.

For now, I suggest that your office continue to accept assignment of benefits for treatment other than hygiene services. For restorative or operative dentistry, I suggest collecting the patient copayment at the time of service and accepting assignment of benefits on the insured portion. Later, once you have successfully completed the payment transition in your hygiene department, you may wish to take the plunge and create an entirely insurance-free practice. Or, you may decide that this decision is just too radical and stick to accepting insurance assignment for any treatment other than hygiene services.

If you are concerned about negative patient reaction, then focus on increasing the level of patient service you provide. Together with your team members, determine how you can strengthen your relationship with your patients and increase patient service. Ultimately, if you provide your patients with distinct reasons why they should continue visiting your office, even when they are required to pay for hygiene visits out of pocket, then they will not leave the practice.

Gary Takacs is a noted authority and frequent speaker on payment issues in dentistry. He can be reached at (602) 951-1652.

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