Monday, August 15, 2011

Dental Heroin!

I don't know about you guys and gals, but without accepting dental insurance, we would be struggling. We only accept PPO insurance, no HMOs. We are only in network with a few, but will file and accept assignment for most PPOs because the insurance companies are easy to deal with. They pay the claim on time and do not give us the run-around for a one surface composite and so on. However, almost without a doubt, 95 percent of our patient problems are related to insurance payments and the patients’ perception of what dental insurance is.

We go out of our way to help the patient understand THEIR policy and communicate with THEIR insurance company. Of course, it always seems to come back to an angry patient yelling at our staff about why the insurance did not pay and why they are responsible for the balance. We have all sorts of paperwork that informs them that they are responsible if the insurance does not pay. After all, it is their policy, not ours, and we are just the middle person trying to help them understand the policy, but that rarely seems to help. I would love to get rid of all insurance in our practice, but it seems like someone addicted to heroin; you cannot get away from it easily.

I understand insurance does allow patients to receive some care that they might not be able to afford otherwise, but many people feel it should cover all of their care. If we get a denial, they look at us like we did something wrong.

We have had patients come in and say they called the insurance company and were told that we should not have done that procedure or that we coded it wrong. In fact, we did not, and who are these people answering the phones (dentists or flunked-out dentists?) telling us we did the wrong treatment. Too bad we cannot get them for practicing dentistry without a license for giving dental advice.

What’s also frustrating is that the insurance plans seem to constantly change. We have more than 600 different plans we deal with and we just cannot stay up-to-date with all of them. We are using Eaglesoft to help try and head off problems, but there are still holes in the info.

Some might say I am looking a gift horse in the mouth, but most of the time that I have an irate patient, it has nothing to do with the dental work but something with the insurance policy.

I am hoping one day I will be in the position to have a dental insurance intervention and go to "fee for service" rehab, but with the economy, that might be a while. Maybe it will be called retirement.


1 comment:

Anonymous said...

An excellent synopsis on an everyday problem.


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.