Working with insurance

In our office, we choose to accept insurance assignment. The reason? Good old competition.

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By Louis Malmacher, DDS

In our office, we choose to accept insurance assignment. The reason? Good old competition.

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The debate about whether dental offices should accept insurance assignment is an ongoing one. I believe that whatever is successful for a particular office is just fine.

In our office, we choose to accept insurance assignment. The reason? Good old competition. Most of the dentists in our area accept insurance assignment; we view it a service we provide to patients. Patients generally have three main objections to dental treatment - time, pain, and money. I would venture to say that for many people money is the main obstacle. For that reason, accepting insurance assignment is beneficial. Our patients' out of pocket investment is not as great and they view this as an added value from our practice.

Accepting insurance assignment by no means affects our treatment plan for the patient. We examine and diagnose the patient as if the insurance doesn't exist. We base our treatment suggestions on the patient's needs and wants regardless of insurance benefits. We will then work with our patients to structure a plan that ensures they get the treatment they need in the way that is affordable. We investigate the patient's insurance coverage and figure that into the total package of treatment costs and out of pocket expenses.

Once our office manager has the patients treatment plan and insurance information, she can then prepare an estimate - or, as we call it in our office, a predetermination. This predetermination is a break down of our fees, the expected insurance benefit, and the out of pocket expense to the patient. At this point, we generally underestimate the amount the dental insurance company will pay. We do this for a number of reasons. First, most dental insurance companies will use a UCR fee that is below our current fee, even though we know our fees are well within the UCR range for our area. Secondly, the insurance company may deny certain items in the treatment plan, which will lower their payment. As we all know, there are many other reasons an insurance company will not pay the full percentage of a treatment plan.

Underestimating the amount the insurance company will pay by approximately 10 percent prepares us for any of these situations. If the insurance company pays more that what we estimate, then both our office and the insurance company look good in the eyes of the patient. The patient always pays the out of pocket expense by the time treatment is finished, even though, in most cases, the insurance company has yet to pay their portion.

In cases where the both the insurance company and the patient have paid in full, a refund may be due. We will then send the patient a refund check at the end of the month. Patients love getting refund checks - a nice alternative to their credit card statements! Patients usually expect bills or other notices from the average medical or dental office and are pleased to open an envelope and find a surprise. We love sending refund checks too because everybody ends up happy - the patient because they feel it is "found money," and our office because we know our full fee was paid and our patients are happy.

Working with dental insurance can be challenging. Using common sense and a consistent system can make handling our patients' insurance predictable and rewarding.

Dr. Louis Malcmacher is an internationally known lecturer and author, and maintains a general and cosmetic private practice in Cleveland, Ohio. Dr. Malcmacher can be reached at (440) 892-1810 or via email at dry owza@iname.com.

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