How many times have you wanted to pull your hair out because insurance claims are getting denied, patients won’t pay the outstanding balance, and your collections are lower than the production? If this is you, please know that you have officially been fully entrenched in the most frustrating business aspect of managing a dental practice. The good news is that there are a few tips you can use to help alleviate these challenges.
Make sure the front desk position is dedicating enough time to do a true insurance verification prior to the patient’s visit. I know what you’re thinking…”what if the patient doesn’t give us the insurance information until they show up for their appointment?” Honestly, this does happen but if your front office team implements the proper verbiage on the initial call, this situation can be reduced dramatically.
The key is to handle the topic of insurance in a very specific manner on the new patient initial call. You never want to give your new patient the impression that the practice is insurance-driven. While insurance is nice to have, it definitely does not “insure” anything other than an annual maximum (which is usually less than the cost of a crown), a percentage of payment, and a very low usual and customary fee schedule.
Whomever is answering the phones in the practice should always wait until the end of the new patient conversation to mention insurance. Casually say, “Oh by the way, will we be using dental insurance for your appointment?” If the patient says no, explain that as a cash pay patient your practice will offset that cost with a 20% courtesy on all treatment. If the patient says yes, simply ask “Do you happen to have the insurance card handy? I’d like to get just a bit of information now so that you are able to maximize the time reserved for you during your appointment.” If the patient doesn’t have the card, you can still find their benefits by saying “Not a problem, I understand. Who is the policy holder? If you don’t mind me asking what is their date of birth? And last question so that I can verify everything prior to your appointment, what is their social security number?” Most every insurance verification can be done with those three items.
Once the verification is complete, make sure to note the account with specific stipulations such as: waiting period for major, xrays considered basic (which means the patient should pay their portion at check-out), missing tooth clause, or replacement clause. Knowing this information will allow you to calculate a more accurate estimate of cost on the treatment plan, reduce insurance appeals, and eliminate denials.
The treatment plan presentation is crucial to obtaining a collection percentage no less than 98%. Follow these steps and you will succeed most every time:
- Get on the same eye level as the patient
- Speak slow and soft
- Introduce yourself
- Let the patient know that you are there to discuss the financial portion of their treatment and ask permission to talk about money (Ex: “Doctor asked me to go over the cost of the treatment he/she recommends. Is that okay with you?”)
- Explain what each column represents but when you get to insurance, be specific in saying “This is what we estimate your insurance will take care of however because it is an agreement between you and them, we can’t guarantee payment. If insurance pays more than we estimate, you will receive a refund, if they pay less you will receive a bill. Is that okay with you?”
It is imperative that while the patient understands we will make every effort to work with insurance, we will not take responsibility for the cost of treatment. Insurance is a contract between the patient and their specific carrier. Dental offices verify benefits and file claims as a courtesy to the patient, not an obligation.
Statements should be send every 20 days. Wouldn’t it be nice if every patient would just pay the statement and never question the bill? That may be a stretch but we can definitely take the pressure off by handling the patient’s inquiring call appropriately.
Most of the time, the conversation begins with a patient saying, “I paid my portion on the day of treatment. Why am I getting another bill from you?” Your first response should be, “I’d be happy to assist you. Let me look at the EOB and find out. It looks like your insurance carrier downgraded that posterior filling resulting in them paying less than we estimated and leaving you with the balance.” Inevitably the patient asks, “What does that mean?” You explain, “You may have a clause in your specific insurance contract that states they have the option to pay less for treatment done on your back teeth, often referred to as posterior. Would you like to get on a three way call with your carrier and I can help you talk to them?”
At this point, you have turned the conversation around and it is now an “insurance” issue, not an issue with the billing at your practice. The patient will be so happy that you helped them that they will pay the balance with a smile, usually with a credit card at the end of the call.
If your dental front office team can master these techniques, you will be well on your way to a healthy A/R report every month!
Good luck and if you need anything, don’t hesitate to call or email. As always, I’m here to help you.
Cheers to Success,