A real-world look at the practice of dentistry from the perspective of Dr. Clary...
In my last post, I laid the groundwork for more effectively commuicating with patients about their dental insurance. As much as we may like to take an "it's-not-my-job" approach to talking about benefits, it is in our best interest to help our patients maximize the use of their dental insurance. To that end, here's more from my perspective...
Our office does not determine a given patient's dental benefits. The type of plan chosen by the employer determines program benefits. In other words, the amount a plan pays is determined by how much an employer is willing or able to pay for the plan. The insurance carrier then tailors the plan to the employer and specifies what services will be covered and what benefits will be paid to fit that premium payment.
I know, I know. I can actually HEAR you shouting at the computer screen. Sure, patients THINK DENTISTS DETERMINE THE BENEFITS. Which is just one more reason why we need to talk about these things with them.
In many cases, the office is not involved with dental plan carriers in any way. And since dental services are rendered directly to the patient, it follows that the patient is ultimately responsible for payment. The dental plan carrier is responsible to the patient.
And here's when that comes into play: As dentists, our responsibility is to provide patients with an accurate assessment of the current dental condition and offer treatment recommendations. Our treatment recommendations, however, are not based on whether the patient has dental insurance. Our responsibility is to provide the best possible treatment individualized for the particular situation – not the insurance carriers.
Within these parameters we can work to maximize your dental benefits. For example, we might stage treatment where dentally feasible in order to maximize benefits. We will provide the insurance carrier with the information it needs to accurately determine benefits due. As a service to our patients, we can also file insurance claim forms. Usually there is no charge for this service. However, if the insurance carrier requests more extensive narratives or duplication of x-rays, we should feel comfortable charging for that, whether the insurance company will pay or pass it on to the patient.
We should also set the expectation up front with the patient:
In order for us to file claim forms, the patient must be responsible for providing us with all of the necessary policy and plan information at the first dental visit. In addition, they must be responsible for informing us of any change in insurance status (i.e. dual coverage with spouse’s insurance, change of insurance carrier, or change of plan features) at each subsequent appointment. Processing dental claims is an expensive and time-consuming activity for a dental office. Our efforts at controlling dental costs rely on the patient being a partner.
And for patients, being a partner means having a full understanding of their benefits. Dental practicies often have members of the staff who who are familiar with dental insurance and who may be able to answer many patient questions. But since individual plans offer special coverage and restrictions, it's unreasonable to expect the staff can provide all of the answers. Patients often need to look to their employer or benefits provider to find the answers. And it's okay to tell them that's where they need to go.
If we fail to communicate these things, we set ourselves up for dissatisfied patients. Seems trivial, but it's often a lack of clear understanding of benefits that will turn a patient against you. Being able to talk matters. And an investment in a little bit of clear communications up front can serve to save you TONS of time unravelling a situation down the road.
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