As a practice management coach, I have spent the last decade reading provider agreements and manuals, CMS guidelines, denials, and appeals, and I’ve found that dental insurance participation is at the core of dentistry burnout.
It is felt on every level. Your team does not feel valued as wage increases become more and more difficult, competing with DSO benefit packages and a shortage of dental professionals for years, which was then exasperated by COVID-19. Even in my coaching role, I have felt burnt out fighting for my clients.
As such, I took to social media to call out the insurance companies because doctors cannot. Combined with my successes in bringing my client’s fee for service and coaching to educate the patient to fight for you, this has called the attention of the largest dental insurance company in America, Delta Dental. In March of 2023, I was served a cease and desist from Delta Dental, referencing my social media posts and letters I have shared.
So, if you were looking for credibility for the guidance in this article, I hope that biting back at Delta Dental and winning gives you that.
In this article, I hope to illuminate my successful processes transitioning to a fee for service model. It shouldn’t go without emphasizing that you need to thoroughly assess your practice before making the switch. Many practices, because of their demographics, low over-the-counter collection rates, and overall operations, are not able to successfully transition.
What Your Patients Want to Know
First things first, your patient will not read a 2-page letter. Thanks to social media, doctors nationwide are dropping insurance at an accelerated rate, and patients are not nearly as surprised as they were ten years ago. Even so, they barely read the bold font, all-in-caps line that states, “YOU CAN STILL USE YOUR BENEFITS HERE.” Most do not even know their dental insurance differs from their medical and will completely dismiss the letter, thinking it does not pertain to them. Others will briefly scan it and call in a panic.
Your letter should be direct, to the point, and highlight what is vital to your patient; after all, they already think you own a yacht.
- What is the change?
- Yes, you can still see them.
- Yes, you will take care of all claims processing
- Why is this change necessary for their oral health?
- Encourage them to call with questions.
I strongly recommend mailing your letter on the last business day of your week. This allows the patient to return to the letter rather than just scanning over it, and they will call the following week a bit calmer.
Review Insurance Benefits with Your Patients Ahead of Services
Many insurance companies provide access to view benefits online, so we can send patients exactly what their insurance reports are for in and out-of-network coverage. Simply telling the patient is not enough; they need to see it with their own eyes and from their plan benefits company. You should email this to them and save it in their patient record for future reference. Trust me, you will need to.
For all patients with appointments before the change, you need the benefits printed along with a copy of the letter sent to them. Only at checkout should this be reviewed with the patient. If your team presents this information at check-in, guess who will be asked questions? Your checkout team should inquire with the patient to see if they received the letter and if the patient has questions. Present the benefits page and briefly review it with them
Utilize Codes to Understand Actual Patient Losses
Track patients you have had conversations with by creating “dummy codes” such as Delta+ for patients indicating they would stay and Delta- for those requesting their records to be transferred. For those patients who do leave, always remind them they are welcome back should they change their mind. These codes must be added to every patient, not just the subscriber because you will want to review reports for actual patient losses.
Do Not Let Money Walk Out the Door!
You must collect at check-in, and you cannot trust that patients will pay you back when their reimbursement comes in. This is not just for dishonest patients; the check could be passed and forgotten about. You can always adjust the payment if their treatment has changed.
The Call About Their Misleading Benefits Breakdown
Two things can happen when a patient receives their reimbursement: They either deposit the check and don’t think twice about it being less than they paid, or they call you and get mad. In this case, the benefits previously reviewed and saved will be used again.
Ask the patient to review the benefits with you; this is when you can provide them with the hard truths. Most Delta dental plans not only refuse to pay the provider directly, but they also reduce their reimbursement. Educating the patient that most dental plans do not inconvenience them by forcing the member to pay the day of service; they also accept the provider fee as usual and customary or within a smaller margin.
Get Your Patients to Fight for You, Not Against You
Provide the patient with all contact information for that insurance company in member services. Encourage them to call, write letters, and submit grievances to their broker and HR departments. Also, provide the patient with your state insurance ombudsman, Department of Insurance & Financial Services, and state representative.
Patients fighting with us is the key to our success with insurance companies to provide fair reimbursements that increase with the inflation rate and stop providing medical advice by arbitrary denials, downgrades, and bundling. There is power in numbers; dental plan benefit holders deserve more than the same maximum from 50 years ago and should allow their doctor to provide the care they need, not what an insurance company dictates.
