Fight Truth Decay With Options

Feb. 1, 2000
Want to stop taking insurance assignment? The solution is to provide the patient with financial options. Here`s how!

Want to stop taking insurance assignment? The solution is to provide the patient with financial options. Here`s how!

Ronald E. Groba, DDS, and

Beverly Mentzel

How often have you heard a patient say, "I just can`t afford your prices," or "My insurance company says you charge too much," or "You`re way over the `reasonable and customary charge ... I`m going to find another dentist!" And how many times have you threatened to stop taking insurance and become a cash-only practice?

Dental offices have battled with insurance companies for years. As the battle continues with DMOs, PPOs, etc., offices continue to get the bad rap from patients.

The fallacy that dentists are the ones who overcharge has come from years of insurance-company representatives who evaluate a claim. They often have little or no experience in the dental-office setting. Let`s face it - the insurance company is in it for the money. Insurance carriers rarely deal with the actual patient - they leave that to us! If the patient knew the real truth about who is actually responsible for reducing their benefit, we might have a better chance of treating our patients with the best recommended treatment. This would save our patients time, money, and inconvenience in the future.

Our office decided to stop taking insurance assignments in October 1998. At the same time, we stopped taking Delta Dental and Blue Cross insurance, the only two plans in which we were considered to be a preferred provider.

We`re not the problem!

After some understandable apprehension, we informed our patients about the way insurance companies function and the fact that their employers also have input into their benefits. We told them that their employers actually negotiated with the insurance company for the amount of premium payments and which services would be covered at what amount. They then realized that there was a lot more to this problem and that it wasn`t about charging too much!

We also pointed out that maximum benefits per year on most insurance policies have not increased at the same rate as the cost of living index - in fact, most haven`t increased at all. With the "missing tooth" clauses, waiting periods, and other restrictions in insurance policies - as well as the delays in receiving pre-estimates and claim checks - our patients began to see how impossible it was for the dental office to be precise about anything regarding their dental insurance!

After 10 months, our receivables decreased 46 percent and we went from sending out 600-plus statements to sending out less than 150. The benefits of this change in our collections policy have also contributed to an increase in our net profit.

We did not send out a blanket letter to our patients stating that we no longer take insurance assignment. Making a major change like this required a lot of thought. What we did do was present our patients with an alternative that they could not refuse!

What`s in it for the patient?

Most people today are looking for a bargain - i.e., a discount, a savings. They do not want to be bothered with the paperwork that comes with filing their own insurance. We file the insurance for the patient, with the request that the check be sent to the patient`s home address. If the patient comes into the office and prepays the entire cost of treatment to be performed at the next visit, we offer a bookkeeping courtesy discount of 10 percent. If the patient prepays with a credit card, the discount is 7 percent.

Conditions for discounts

The patient must prepay at least 24 hours in advance of the next scheduled appointment to receive the discount. We have found that patients who prepay almost never cancel.

The verbiage used when dealing one-on-one with the patient probably is the key to the patient accepting treatment. A typical dialogue might be:

"Do you understand the treatment that Dr. Groba has recommended for you?" (A full explanation of the necessity of the treatment and the patient being sold on the treatment is of primary importance. When patients want to have the work done, they almost always find a way to finance it.)

"The best option for payment and the one that will save you the most money, Mr. Patient, is this. If you prepay the full amount due with a check or cash, we will write off 10 percent of the charge as a bookkeeping courtesy. Prepayment means anytime between now and up to 24 hours before your scheduled appointment. If you prefer using a credit card, the same prepayment policy applies, but we will give you a 7 percent bookkeeping-courtesy discount. We will be glad to file your insurance for you and the check from your insurer will come directly to your home address."

When we request the check be sent to the patient, it comes back much more quickly - the insurance companies only have to issue one check instead of a "bulk" check that creates more possibilities for delays. We send all X-ray copies and narratives needed to give the patient the maximum benefit insurance will allow. We find that most of our patients want to save money in any way they can, and are very accepting of this option.

`Same-as-cash` financing

We also provide "same-as-cash" financing for qualified patients for three, six, and 12-month periods from an outside financing source. We currently are using a service called the OHelpCard.O The HelpCard can be used to charge up to 100 percent of the treatment plan for patients who qualify for the company?s GOLD Plan. Our office absorbs a percentage of the fee charged by the bank; therefore, we do not allow any discounts when the HelpCard is used. There is no application fee, no annual fee, and no downpayment required.

This is a great way for patients to pay for treatment that is not covered by insurance. The approval process takes only 30-60 minutes. We have experienced a very high approval rate with this company. Many other good companies, such as CareCredit and Norwest, are also out there. Look for the one that will work best for you.

Jumping the financial hurdle

One of the biggest OhurdlesO a patient faces when treatment has been diagnosed is making a comfortable financial arrangement. With outside financing, our patients are able to have more high quality work done in a lot less time. This proves to be a win-win situation for everyone! Performing multiple units of permanent dentistry is the secret of every top-producing prosthodontic or general dentistry practice that exists today!

You will have patients who want to know absolutely how much insurance will reimburse them. We all know there is no OabsoluteO when dealing with insurance companies. Even pre-estimates are not a Oguarantee of benefits.O

The insurance companies have made this clear from the beginning. We do pre-estimates when a patient requests it, but the patient is informed that it may take from four to six weeks to get the paperwork back and treatment may be required before this occurs. The patient needs to know the urgency of the treatment needed to make the best informed decision.

You must have a plan in place to eliminate insurance from your practice Be sure your staff is totally in agreement with your plan. Then, implement your plan following the action steps I have outlined in this article.

For more information about this article, contact the author by phone at (281) 482-1275 or by fax at (281) 482-0270.