Are Your Patients Accountable Anymore?

By Natalie Lucken, Account Manager

Many practices will tell you right away that they have a signed financial policy on file for every patient. But, have any of the patients actually read it? I often ask myself this when I called them and asked try to explain to them that their insurance has paid all that they’re going to pay, and there is nothing more forthcoming.  It’s not a Terms & Conditions for your TV service, this is a promise to pay the office, if the insurance carrier decides they don’t want to cover what was estimated in a timely manner.

Our patients need to be held accountable for their own insurance policies. Our relationship as a dental office is not with their insurance company, because “we” are not the policy holders. I have often wished that we could have a giant sign, right above the front desk, that says ESTIMATE in very large letters! Too many people have no idea what this word really means. I would say that in all the time I have been working in dental billing, I have met less than 10 patients at each office who really understood their policy and what their responsibility was in paying for dental services. There is no dental benefits/insurance plan that will cover everything at 100%.

Medical insurances would never go to the lengths that we do, trying to secure payment on behalf of our patients. Would a medical practice ever help you write an appeal letter? Or call the insurance company every week for months and months trying to get a claim to go through processing?  Most people would much rather have teeth pulled then call their insurance company and try to navigate through all the customer service reps to see what happened to their claim, and why it paid so little.

Why can’t we call an insurance company and speak with a well trained person, who has the ability to break down what the coverage means for their subscriber/policyholder, so that they can understand? This is an issue that needs to be addressed, along with all the healthcare reform discussion happening today. No one can be on the phone, speaking privately, for 30-60 minutes, waiting for such an answer from the carrier’s Customer Service.  I have also seen too many times when an insurance company has blamed the dentist for having higher fees than anyone else in their area, insinuating that this is the reason there is a leftover balance for patients to pay. This instantly infuriates the patient, who turns their anger away from the insurance company, and toward their own dentist. That’ s a damaging situation for the practice to find itself in.

There are a few offices, of course, that are fee-for-service, which makes sense financially, when you consider that it is merely a courtesy (not a right) that a dental office files your insurance claim for you. People have come to expect it, and it’s hurting the bottom line.

When crafting your new financial policy, consider the following:

• How many times are you willing to submit a claim before the patient becomes 100% responsible for payment?
• Will you collect a set/estimated copay or a percentage of the full fee on the date of service (this may require refunds to be issued when insurance payment is received)?
• How many calls to the insurance, on their behalf, to check on the claim?
• Does the office feel obligated to also check eligibility for patients?
• Are Pre-Authorizations going to be filed? Pre-Authorizations are only valid for a limited time, and some offices do not want to cover the cost of filing a determination in advance, when there is no guarantee the work will ever be started or completed.

Every dental office needs to introduce a financial policy effective for all patients, those who are new this week, and the ones who have been coming there for 25 years. Your version of a new financial policy needs to spell out that the amount collected on the date of service is our ‘best estimate’, and insurances are free to change their mind, seemingly at any time. Ultimately, the patient is the person who owns the benefits policy, and they should not be afraid to call the carrier and demand an explanation for the amounts covered, non-covered, and denied. Easier said than done, I know, but dental practices cannot allow themselves to become a “bank”, which loans money (interest-free, no less!) to someone, and then spends time and money to try to recover that money from someone other than the loan holder.

A good financial policy and being transparent about what you know and don’t know help but, in the long run, if we want to get paid and keep patients happy we have to do what we can do reasonably to get paid.

eAssist Helpful News and Billing Tips; Edition #123