by Carol Tekavec, RDH
Many dentists would like to eliminate insurance in their practices. The intrusive nature of some insurance plans, the predeterminations, the requests for information, the follow-up phone calls, and the payment delays can make working with a patient's insurance difficult and irritating. Treating patients in an "insurance free" format sounds like a completely desirable situation. However, before taking that step, consider these facts:
- An ADA poll taken during 2000 demonstrated that a lack of insurance was the top reason most respondents listed for not visiting the dentist. While many dentists may feel that patients' discretionary income is simply being spent on nondental expenses, it appears that money continues to be a major obstacle to treatment. Young adults and the elderly typically are greatly underserved by the dental community. These are two of the largest groups in the United States that frequently do not have access to dental insurance.
- Patients with insurance generally received more treatment than those without insurance. The same ADA poll also indicated that patients who had access to insurance were more inclined to accept complete treatment plans.
- Inability to pay is not the only reason patients want their dentists to work with their insurance plans. Even patients with more than enough income want their insurance to pay the maximum allowed.
- Dentists who drop plans usually must be prepared to lose a certain percentage of their patients. Before you consider eliminating insurance from your practice, first determine how many patients in your practice use insurance.
Assignment vs. nonassignment
While eliminating insurance from their practices is what dentists talk about, what they actually may want to do is to greatly reduce the hassles and paperwork associated with these plans. They know that many of their patients are relying on their insurance plans, but the dentists want to quit functioning as the intermediary.
Changing from an "assignment of benefits" status to "nonassignment of benefits" means that a dentist can still file patients' completed insurance paper claims or e-claims, but the patient receives whatever benefit is allowed directly. (In the case of plans like Delta, it also can mean that the patient will receive a somewhat reduced benefit). The dentist bills the patient and the patient pays the bills. Then, the patient files a claim with his/her insurance carrier for reimbursement.
Sometimes dentists worry about allowing patients to receive a lump sum from an insurance carrier following treatment. What is to prevent the patient from keeping the money the insurer pays and not paying the dentist? The answer is — nothing! There are problems associated with nonassignment of benefits, just as there are problems with dealing with insurers directly. To mediate this, it may be possible to utilize a combination of methods. Plans that are easier to work with can be maintained as assignment-of-benefit plans. Plans that are more difficult to work with can be moved to the nonassignment system.
What will patients say?
In general, most patients will not be happy with any changes that the office makes regarding insurance. Careful oral and written communications are a must in this situation. Provide patients with a complete, written treatment plan and estimate (signed by the patient) prior to beginning any dental care. This is even more important with nonassignment patients.
The signed estimate form retained in the patient's record can eliminate future problems and questions about billing. Patients in the nonassignment system can be assured that the office still will complete their claim forms, but they will be receiving the benefit check. By not accepting payment from the insurance carrier, the practice puts the onus on the patient to follow up on problem claims.
Carol Tekavec, RDH, is the author of a new insurance-coding manual, co-designer of a dental chart, and a national lecturer with the ADA Seminar Series. Contact her at (800) 548-2164 or visit her Web site at www.steppingstonetosuccess.com.