Dealing with the eccentric uncle

Oct. 1, 2000
Do you want to break free from the stranglehold of insurance? Here are some tips to change the philosophy of your practice.

Do you want to break free from the stranglehold of insurance? Here are some tips to change the philosophy of your practice.

Gary Takacs

Dealing with dental insurance is a sore subject for most dental offices. Even with the benefits of computers and electronic claims processing, most offices spend an inordinate amount of time sorting and following up on insurance claims. And - as if delaying payment wasn`t enough - to add further insult, many companies are reducing coverage, creating more contract limitations, and making little or no progress in covering services that represent modern dental care.

It`s impossible to discuss the topic of payment in dentistry and ignore the insurance component. The reality is that insurance is an important part of the payment mix in most offices. However, you have choices regarding how you handle insurance in your office.

Independence from dental insurance

Perhaps the most radical way to reduce insurance dependency is to not accept assignment of benefits. In one fell swoop, you can eliminate all insurance dependency by not accepting it! Many dentists don`t realize they have a choice because they are conditioned to think they absolutely must accept assignment of benefits to remain competitive. But the choice is yours.

If you do not accept assignment of benefits, the patient pays your office in full and receives any reimbursement directly from the insurance company. Before you cast judgment that this approach is entirely unrealistic, remember that a small number of dental offices in every community do just this. I have personally consulted with more than 200 dental offices throughout the country that do not accept assignment of benefits. In the right circumstances, this approach can work very well - if it is done properly. Here`s how:

Obtain a copy of the ADA superbill and scan it into your computer. While the patient is receiving treatment, the dental assistant enters the treatment codes into the computer and makes a copy of the radiographs. The payment coordinator then prepares a walkout statement of that day`s procedures and attaches a copy of the radiographs, if appropriate. When the patient is dismissed, the financial coordinator hands the patient a copy of the walkout statement, collects payment in full, and says something like this:

Financial coordinator: "Mrs. Jones, here is a copy of everything you will need to receive reimbursement from your insurance company. You can mail this to your insurance company for reimbursement of any benefits and they will mail you a check directly."

Would this approach work for you? It depends. Here`s some encouragement.

I recently presented a seminar in Santa Fe, N.M., and asked if there were any doctors that did not accept assignment of benefits. Only one doctor - out of more than 70 - raised his hand. During the break, I spoke with this doctor about why he came to that decision and how it affected his practice. In a quiet and soft-spoken manner, he told me about his frustrations in dealing with insurance companies (which I`ve heard countless times). Delays in receiving payment, eligibility problems, "lost" claims, requests for information already provided, unreasonably low UCR levels, and arguments over preexisting clauses were just a few of the litany of complaints this doctor relayed to me.

About a year ago, the doctor became fed up with the insurance game and decided to stop accepting assignment of benefits. I asked him about the health of his practice since he made this decision, and he told me things were great. In fact, his office had since grown by more than 22 percent! I asked him if he had lost any patients because of the decision. He said, "Yes, six!" He kept detailed records of any patient lost and, after almost an entire year, the total was just six.

He went on to tell me that, although he personally valued every one of his patients, these six were not really good patients. They often had canceled or not shown up for appointments, were slow to pay, and rarely accepted his treatment recommendations. The doctor`s only regret was not making the decision to stop accepting assignment of benefits sooner!

But this approach doesn`t work for everyone. A couple of months ago, I received a call from a dentist in Houston. I could tell from his tone that he was rather depressed. He said that, four months earlier, he had attended a seminar by a popular speaker who indicated that, because insurance was such a hassle, every dentist should stop accepting assignment of benefits. This sounded so good that he immediately went back to his office and mailed a letter to all his patients announcing that he was no longer going to accept their dental insurance. However, in the four months since he had mailed this letter, he had lost 85 percent of his patients! No wonder he sounded depressed.

Here we have the same strategy with completely different results. Two dental offices made the decision to stop accepting assignment of benefits. One lost six patients, while the other lost 85 percent of his patient base. What was the difference?

The answer is really quite simple: The Santa Fe office provides so many benefits that patients choose to keep coming, even though they have to pay in full at the time of service. The benefits of receiving care in this office more than offsets any inconvenience of paying upfront. This leads me to my first recommendation to reduce insurance dependency: Work on providing tangible, measurable benefits that reinforce the patient`s decision to visit your office for dental care. These must be benefits that your patients truly can appreciate. Incidentally, providing appreciable benefits will help to enhance your practice whether you accept assignment of benefits or not. This is an excellent business strategy that is sure to strengthen your practice, regardless of how you handle insurance.

I want to emphasize that making a decision to not accept assignment of benefits is not appropriate for all offices. This decision involves risks, as evidenced by the dentist in Houston. While it can be very alluring to not accept insurance, the appropriate decision for most offices is to continue accepting assignment of benefits.

Educate your patients

You can reduce insurance dependency, even if your office continues to accept insurance. My next recommendation is to use creative verbal skills to educate patients about their insurance benefits. For example, when you meet new patients for the first time, ask them the following question sometime during the initial exam:

Doctor: "Mrs. Jones, it`s wonderful to meet you. We welcome new patients to our office. I`d like to start by conducting a very thorough exam. We like to be very thorough because we have found that it helps our patients to be as healthy as possible.

"I noticed that you have dental insurance. Let me ask you a question. If, in the process of doing our thorough dental exam, I discover something in your mouth that requires attention and it is not covered by your dental insurance, what would you like me to do?"

This is an extremely powerful question. Most patients will respond that they would want you to take care of the problem. I have found this question to be extremely effective at helping patients understand that some things are covered by their insurance and some things are not.

Most patients know very little about their insurance benefits. Without getting overly technical, here`s a useful way to talk about it with your patients. Tell them to think about insurance as if it were an eccentric uncle who is giving them $1,000 (or whatever the amount of their annual coverage) per year to be used for dental care. However, two strings are attached. The first is that any unused amount does not carry over to the next year (use it or lose it), and the second is that he will pay for some things but not others (that`s why he`s eccentric).

This "eccentric uncle" communication technique has proven very effective. It helps take all the emotion out of the insurance issue and presents the limitations of the patient`s policy in a playful context. While this conversation may not be appropriate for all patients, I have found it to be very effective with most people. Plus, it gives you an opportunity to focus on the positive by pointing out that some people don`t have this eccentric uncle to help them. You are glad that they do and more than happy to help them with it.

Increase cosmetic procedures

Another recommendation to help reduce insurance dependency is to make a strategic decision to do more cosmetic dentistry. This works because cosmetic dentistry usually is not covered by insurance, but many people still choose to have it done because they are concerned with their appearance.

You have likely heard the following saying, "People will pay for what they want long before they pay for what they need." This is absolutely true when it comes to cosmetic dentistry. I am not talking about developing a cosmetic-exclusive practice. I`m suggesting that you develop a cosmetic component within your practice. Nearly every office could benefit by learning the clinical skills necessary to provide more cosmetic care.

If you are serious about developing the cosmetic component of your practice, I have three specific suggestions. The first is to join the American Academy of Cosmetic Dentistry (AACD). This is a fabulous association of dentists committed to sharing their knowledge of cosmetic dentistry. They hold a world-class annual meeting that offers a program packed with leaders in the field. If you have any interest in cosmetic dentistry, a membership in the AACD will prove invaluable.

I also recommend taking extensive continuing-education courses on cosmetic dentistry. Lectures are great, but to really maximize your learning, a hands-on course - where you bring in a patient and actually complete a case under the guidance of instructors who are masters in the art of cosmetic dentistry - is most beneficial.

You will learn the skills to confidently diagnose and complete these cases in your practice.

If you are interested in doing more cosmetic dentistry, I also recommend restoring each of your team members? mouths to cosmetic perfection. There is nothing like Oshow and tellO dentistry to get patients? attention. Your team members can show potential cosmetic patients their new smiles, which will help create enthusiasm and interest on the patients? part. This is an excellent marketing strategy that will result in more cosmetic procedures.

If the 1960s are considered the Ogolden ageO of dentistry, then I think the early years of this century will come to be known as the Oplatinum ageO of dentistry. We have an aging population ? the first wave of baby boomers turns 54 this year! ? that is profoundly interested in good health and a youthful appearance. Quality dental care can provide these benefits to patients. While these are terrific times in the profession, dealing with dental insurance can be a major frustration. While it is a very radical decision, you could decide to not accept insurance like the office from Santa Fe, but this strategy is certainly not appropriate for all offices. Regardless of how you decide to handle insurance, every office can benefit by reducing insurance dependency.

Again, here are my specific recommendations to reduce insurance dependency in your practice:

Y Work on providing tangible, measurable benefits that reinforce the patient?s decision to visit your office for dental care.

Y Use creative verbal skills to educate patients about their insurance benefits.

Y Make a strategic decision to do more cosmetic dentistry.

I encourage you to work on these things in your practice. The end result will be a more enjoyable practice!

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