February 13, 2018
by Lois Banta
“I’m sorry… we have not received your claim.” “Why did I get a statement? I have already paid your office my co-payment!” Ah, the wonderful effects of non-communication. Nothing is more frustrating for a dental office than a patient or insurance company who misunderstands what we are trying to communicate to them.
The most important aspect of dentistry today is not what you say to patients and insurance companies, but how you say it. How many times have you called the insurance company to track a past due claim only to be told you have to re-submit it? I can almost hear your silent screams now! There is a definite connection between making the phone call and getting the results from the insurance company the first time. One of the most effective tools in communicating with insurance companies and getting speedy payments isn’t necessarily the content of the claim, but in talking to the insurance customer service representative. You catch so many more flies with honey…make a friend at the insurance company! Yes, that’s right; I said make a friend at the insurance company. You have to be prepared to plead your case while at the same time getting results now. My suggestion is to call the insurance company with this conversation in mind….”Hello, this is Lois from Dr. Smith’s office. I’m calling to check status on an outstanding dental claim”. Never say past due claim…it puts the insurance rep on the defense. Always write down today’s date, the insurance rep’s full name, and any notes pertaining to the conversation. Some insurance companies train their staff to respond to your first phone call by telling you they have not received the claim. What I suggest as a response to that is to ask the rep to put you on hold and check the pending or in-processing claims. This gives the insurance rep the opportunity to put you on hold and now tell you…”Oh, there it is, I don’t know why this wasn’t processed yet!” If they still insist they have not received the claim, ask for the FAX number and resubmit the claim by FAX, not “snail mail”, or re-send it by electronic claims if that is how it was originally sent.
Communication with your patients can be equally frustrating if you assume they know the financial policies of your practice. The first thing every dental office needs is to have a financial policy. The second thing is to put it in writing. Always, and with no exceptions, explain all treatment recommendations to your patients before dental treatment is performed. There are many ways of discussing financial arrangements with patients because there are many types of treatment consultations.
1) If the patient is in your office for an emergency and there is time to do the permanent treatment that day, the financial coordinator should come back to the treatment room to answer any questions the patient may have regarding fees and insurance so that the patient can make an informed decision. The doctor and clinical team member must leave the room at this time to allow for privacy. Discussing financial arrangements chair side allows for proper communication to take place regarding patient’s financial responsibility.
2) If the patient has a continuing care appointment with the hygienist, and dental treatment was recommended that is not too involved, the financial coordinator can make financial arrangements at the front desk if it is a private enough area. All financial arrangements should be made before the patient comes in for the next treatment appointment to avoid negative surprises.
3) If there is major treatment to do there should be a formal consultation privately for the patient and the financially responsible party (if different from the patient). In all cases, a written plan for treatment and estimate of financial responsibility should be available for every patient. All patients have a right to know what they are agreeing to…It’s called truth in lending.
The importance of communication also comes into play for patients paying their “estimated portion” after insurance payment at the end of their dental appointment. You give patients the potential bad news before they get it on their statement. To avoid any repercussions from getting a statement after insurance pays and the patient has already paid their “estimated portion”, I tell the patient “If insurance pays less than we estimate, we will send you a final statement and it will be highlighted in orange at the bottom of your statement with the phrase…We have received final payment from your insurance”. This absolutely prevents an angry phone call from the patient because they just got a statement with a balance due after insurance has paid and the patient has already paid their previous in-office payment. Give your patients the potential bad news before they get the “bad news” and you have just diffused a potential angry situation! It works like a charm.
Another effective communication technique I use with patients is when we change the payment rules in the office. I find this the most difficult transition for patients because they were used to “making payments”. First of all, you should never have to be the “bank” for your patients. This is where we have become our own worst enemies. In order to change the rules effectively you need to be excited about the change. The conversation should go like this…” Mr. Jones, today’s visit was $700. We estimate insurance will pay approximately $350…therefore; we estimate you portion to be $350. Will you be taking care of that by cash, check or credit card today?” The patient usually responds by saying, “Just send me a statement like you usually do.” This is where the magic conversation must happen. You say “Actually, we are so excited, the accountant was just in our office recently and we are now prepared to handle your payment in office today…so…which would you prefer… cash, check or credit card?” If the patient still objects, give him/her a courtesy statement with an envelope, and a stamp in instruct them to send you the estimated in the next 5 days.
Say that you will follow-up with a phone call if for any reason a payment is not received.
The important thing to remember in the “art of communication” is to speak to patients and/or insurance companies the way you would want them to speak to you. Remember the Golden Rule… “Do unto others as you would have them do unto you!”
About the Author
Lois Banta is CEO, President and Founder of Banta Consulting, Inc., a company that specializes in all aspects of dental practice management. Lois has over 40 years of dental experience and consults and speaks nationally and internationally. www.bantaconsulting.com