Chris Lassiter
Forum Replies Created
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This seems to be a current trend in many states – We are hearing from a lot of members that they are inundated with calls from state funded plans that they are NOT participating in.
This patient population can be hard to reach – Oftentimes, they only want to be seen by a participating provider. But I do think it is worth explaining that they can be seen as a patient in your office but their insurance will not cover any of the cost. I think providing a waiver is dependent on the state you are in. If a patient decides to be seen in your office, a financial agreement of some kind should be discussed and signed.
We are not insurance experts. If you feel you need additional information, feel free to reach out to Colleen Huff, who is an insurance expert and coach. You can easily find her on Facebook.
Good luck!
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Great question! I highly recommend reaching out to CEDR – office manuals are something they specialize in; they will not only create one but they will also keep it updated for you!
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This depends on what type of plan the patient has. If it is a self insured dental plan then the credit could be due to the patient. I would investigate the type of plan so you know who is due the refund.
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Thank you for starting this discussion. Was this person given a detailed job description when hired? If so, that will help as you move forward and discuss her performance with her. I would set aside time to speak with her. Ask her how she thinks she is doing. Provide positive feedback and then give examples of where she may not be meeting expectations. Maybe she is not completely aware of what is expected of her. Ask her if she needs additional training/support and if so, in what areas.
Don’t come from a place of “fear”; Sometimes we hire people that turn out not to be a good fit for the practice. Speak with her, allow her a chance to voice her opinion and then give her a timeline for improvement and determine next steps.
I think it is important to remind the rest of the team to focus on their own roles. No one should be asking what someone else’s job is – That is creating a situation where sides are being taken and that is unfair. Everyone has a role in the practice and each of those is different, but all are important. If there is a question of division of responsibilities, that is something that can be worked on together to be sure everyone is on the same page.
If you need a job description for your meeting, check the DOCUMENT LIBRARY for resources.
Hope this helps…..
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I am happy to share this resource with you! We are always updating our DOCUMENT LIBRARY and this is on the list to be added ASAP. It is currently with the compliance department; as soon as it is released back as approved, I will send it to you. Thank you for your patience.
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Front Office Rocks provides training for these types of conversations. Watching the videos will provide verbal skills examples for answering patient questions and overcoming objections. Be cautious when creating scripts – They can often come across as inauthentic and can actually make those conversations with patients more difficult/confusing.
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Thank you for your question. If you are utilizing a third party like Practice By Numbers, Curve or Dentalintel, they provide online forms and compliance with standards is guaranteed. Depending on your software, forms may be available that way as well; You will need to be sure that whomever handles IT for the practice is familiar with compliance standards for the industry and has properly established those within your network.
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From our insurance expert and coach, Colleen Huff:
“They need to send a copy of the clinical notes regarding this. Insurance companies do not want narratives anymore. I would suggest she/he speak to the dentist as to the clinical reasons for the procedure which should be in their notes.
……that is the best way to get it paid”.
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Heather- I am not sure which insurance companies are rejecting this or what the reason is but that is the correct code.
Page 107 of the ADA Coding companion #13 addresses this specifically. So unfortunetly it may be something specific to that patients plan but I would try sending a copy of the ADA book with an appeal.
I hope this helps
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Great question! The RECEPETIONIST AND PHONE SKILLS COURSE has a lesson called “Answering Dental PPO Questions” – That discusses how to handle questions from patients. My best advice is to have a consistent message when handling insurance conversations – “We do everything we can to maximize your benefits. We are considered out of network with your insurance which means we can absolutely treat you in our office; the difference will be that you will pay when you are here, we will submit the insurance claim for you and the insurance company will reimburse you directly.” There are a lot of different ways to get this message across; As long as the entire team is consistent and confident in the delivery it should be a fairly simple conversation. If you have nay other questions or want to discuss this further feel free to email me at [email protected]! Have a great day!
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Heather – Thank you for posting your question! Colleen has reviewed it and is working on a response. She is currently traveling and will provide more information as soon as possible!
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From Colleen Huff:
“….You do need to keep a copy of the EOB as it is part of the patient’s chart. Now if you are getting an ERA downloaded into your account then you do not need the EOB also as they are the same.”
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CONGRATULATIONS on taking the steps to go out of network! I don’t think it needs to be complicated. Be up front with patients about why you are making this change and explain what this looks like for them moving forward. If you are concerned about patients not accepting treatment because of the cost, you can provide financial relief options like CareCredit, or you can split their payments – half at scheduling and the remainder on the day of treatment. When patients understand the reasoning behind a change like this, they will be fine. You want to be able to provide an exceptional standard of care and you cannot do that as an in network provider. So, they will be getting the care they need and utilizing the benefits they pay for; The only change is they will pay at the time of service and then be reimbursed directly. Make sure your team has the proper verbiage for explaining the process. I hope this helps! If you want to discuss this further, feel free to send me an email to [email protected] and we can continue the conversation.
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Yes you will need to bill both in whatever way they process. So if they pay 1 time/12 months then that is how you bill it. If they require monthly than that is what you do. It can get very confusing so I would have good notes on how to bill them
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I think that would make the most sense, yes.