Carol Tekavec, RDH
Patients with insurance coverage want their insurance to cover the maximum allowed under their plans. They would be very happy if the dentist would wait until all recommended treatment was completed before filing their insurance claims. They also would like the dentist to wait until the insurance benefit is paid before billing them for the balance due. They would like to have as much time as possible to pay this balance off, preferably without any interest charges. In other words, most patients would like their dental treatment done as soon as possible without the financial burden of shouldering payment responsibilities. Who wouldn`t?
While it is not hard to understand why patients would like this type of treatment/payment scenario, it is not in the dentist`s best interests. My company, Stepping Stones to Success, operates by a simple philosophy that can apply to any business endeavor: "Success stems from a sincere desire to provide something of value to others, as well as to oneself." For a dental practice to operate successfully, we must be sure that the "something of value" that we provide to others also is provided to ourselves. Control of payments and insurance is central to office prosperity.
What follows are some guidelines for dealing with patient payments and insurance. (Keep in mind that we are talking about traditional indemnity insurance, not capitation or reduced-fee plans.)
The office philosophy concerning how the dentist views insurance - including whether or not to accept assignment of benefits - must be clearly defined.
If your office is not going to work with a patient`s insurance, this should be explained during the patient`s treatment conference. If your office is going to help patients file claims, a fair amount of paperwork problems and payment hassles are to be expected.
(1) If your office decides to accept assignment of insurance benefits, the insurance carrier will pay you directly for a portion of the total fee, with the balance to be paid by the patient. The amount to be charged should be presented during a treatment conference and detailed like a contract on an estimate form that is signed by the patient.
The estimate form/contract must contain the information that the entire balance is the patient`s respon-sibility, but that any payments made by the patient`s insurance will be credited to his or her account. If the insurance carrier does not pay its portion, the patient`s obligation is not then a surprise.
(2) A detailed treatment plan should be drawn up that shows what treatment should be accomplished for the patient at each appointment.
Treatment codes and fees to be charged that day should be included. The plan should show what needs to be done from the first appointment on through the very last crown cementation, but only one appointment at a time should be scheduled. For offices accepting assignment of benefits, a preset portion of the fee should be noted on the treatment plan and collected from the patient at the end of each and every visit.
Also, an insurance claim should be sent to the patient`s carrier immediately with the fee for the treatment completed that day. Under no circumstances should a dentist wait until the end of all treatment before filing a claim on behalf of the patient.
(3) The dentist should decide how long the office can wait for payment from a patient`s insurance carrier. When that time has passed, claim information should be given to the patient to deal with the insurance carrier directly.
It seldom is productive for the dentist to become involved in a monetary tug-of-war with carriers that are extremely slow. If the patient has no luck with the insurance company, he or she should complain to the company`s employee benefits coordinator. Often, a complaint to a carrier from an employer (the entity paying the insurance premiums) receives attention that would not be given to a dental office.
As always, a detailed treatment conference where all treatment and fees are explained in advance is the key to effective financial arrangements. Attempts to collect after all treatment has been completed can be extremely difficult.
Carol Tekavec, RDH, is the author of two insurance-coding manuals, co-designer of a dental chart, and a national lecturer with the ADA Seminar Series. Contact her at (800) 548-2164 or at www.steppingstonetosuccess.com.
