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Insurance Questions—A little knowledge about an awkward topic

March 1, 2003
During your next team meeting, discuss payment options that are offered to patients.

by Janice E. Hurley

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"Will my insurance cover this?"
"I don't know"
"Do you take payments?
"I don't know"

Patients will ask and tell their hygienists almost anything. Why not? Who else do you know who gets that close and sounds that smart? I can't think of anyone. Certainly not anyone you have to see at least twice a year lying down.

Patients consider their hygienist to be a very accurate source of information. Most hygienists can handle the questions posed to them without problem. There are just a few that tend to "stump the stooge" as we say — the dreaded questions about insurance and money — and rightly so. Those questions are hard to answer because the correct answers keep changing.

Insurance benefits will be different for each insurance carrier; each specific plan with that carrier; and each employer with that plan. They also will be different for each job ranking and benefits for that position. For some patients, their eligibility will be determined in terms of work hours met that month. For others, their benefits will differ depending on their enrollment date and the benefit calendar year for that plan.

No wonder our offices have team members specifically assigned to understand the daily change in insurance benefits and services. Each patient has a different plan, has used a different level of benefits, and they want their hygienist to know the answers.

For those questions the best answer, of course, is, "I don't know." That's my answer and I'm sticking to it — right? Well, we can also be a little more helpful by saying, "I don't know the answer, but Pam is our insurance expert and she would be glad to answer those questions for you."

Some hygienists may work in an office that does not accept assignment of benefits from insurance companies. Their practice is "insurance free" or their practice sees hygiene patients within a "capitation plan." The office with a capitation plan is paid monthly based on the patients assigned to that practice in their area. Capitation insurance plans pay their contracted doctors the same amount whether they see the patient or not, and many plans have no "out of pocket expense" to the patient for those hygiene visits.

But for the vast majority of hygienists working in the United States, the patients in their chairs do have dental insurance with a pre-described list of benefits and services that will be paid for in a calendar year. Actually, the hygiene department usually has a larger dependency on insurance benefits than does the restorative side of the doctor's schedule. People with dental insurance are more likely to receive the services of their hygienist.

Here's a suggestion: conduct an office fact-finding mission. Run a report to see what percentage of patients in your hygiene schedule have dental insurance. Then conduct a similar comparison of your patients on the doctor's schedule. The majority of the time, hygiene runs about 15 percent to 20 percent higher. All that means is that the hygienist often will be faced with the question, "Will my insurance cover this?" to which you can respond, "I don't know, but ask Pam; she is very knowledgeable."

The second dreaded question is often, "Can I make payments?" The doctor has come in for the hygiene exam, diagnosed needed treatment and after leaving the patient consults his/her trusted hygienist by asking, "Do you really think I need this?" or "Can it wait?" You give those questions your very best answer only to have the follow up questions be: "Can I make payments?"

Your reply: "Absolutely." Hopefully, that's the correct answer.

I have been a dental consultant for 16 years, and in the past we worked very hard to get our offices away from "in-house financing." It was clear that dental offices were not set up to be lending institutions. So we went from being bankers to offering no payments outside of "cash, check, or credit card." So much has changed in the last five years. Outside financing or payments through a lending partner is a necessity for our patients.

Hygiene patients might be diagnosed with periodontal disease that would require four to five visits with their hygienist. Perio therapy to get their mouth healthy might cost as much, if not more, than the office's full coverage crown or endodontic treatment. Patients should not have to put off this much-needed treatment due to finances. But many people would if they had to rely on their savings or available money in their checking account.

The biggest changes I have seen in dentistry in the last five years have been:

• More patients accepting periodontal therapy
• More men having cosmetic services
• More night guards being treatment planned and accepted for grinding or bruxism
• More treatment being financed through an outside financial partner

Your patients view you as a wealth of information, as they should. Make a point in your next team meeting to discuss just what payment options you have to offer your patients. Being knowledgeable enough to speak on this subject helps remove some of the discomfort when the questions about payments arise.

Today in dentistry we should be able to confidently offer:

• Three-month interest-free plans
• Six-month interest-free plans
• Extended payment plans for those treatment plans greater than $1,500

I have recommended and worked with numerous outside finance companies. I lived through the terrible rating system that one company put our patients through when they gave them a Gold or Silver rating. I have watched local institutions get very excited about partnering with our offices to extend simplified loans for our patients only to have them lose interest as it soon became obvious we weren't their largest source of revenue.

Since then I have encouraged my offices to sign up with CareCredit ( because of its quick and thorough response rate to our questions and its on-site training. I recently challenged an office to a small contest. They had brought CareCredit on board one year ago and complained that they had only two patients approved. I was surprised. I looked into the number of applications that had been sent to CareCredit for review and found out the number was only four. Four applications, with two of those approved. A 50 percent approval rate is nothing to sneeze at, but four applicants over a 12-month period was hardly an honest effort at offering this service to their patients.

So we made a deal. I would be back in three weeks. I would pay them $2 for every application they even sent to CareCredit and $10 for every one approved. We role played and laughed and practiced just how best to describe this service to our patients. We laughed because I told them that based on their last 12-month track record I was hardly at risk for losing any money.

I came back in three months, when they proudly showed me their tally sheet and we chuckled some more. They had filled out 13 applications, and seven had been approved for a grand total of $21,000 — $21,000 worth of treatment had been scheduled that would not otherwise have been put on the books. They divided up my $80 among the three of them and we tabulated that if they continued at that rate there could well be another $336,000 on the books in the upcoming 12 months.

CareCredit, of course, is an example of a company that I'm familiar with through my work. I encourage readers to examine options offered by all finance companies servicing their area.

It was fun to challenge ourselves, and it was fun reporting the results at the team meeting. But most importantly we answered the question for the rest of the team members, "Do you take payments?"


Janice E. Hurley is the president of Janice Hurley & Associates, located in Visalia, Calif. She has been a practice-management consultant for 16 years. She has been a featured speaker at dental meetings, including the California Dental Association and The Holiday Dental Convention. For more information on her speaking or consulting services, call (559) 635-4843 or fax her at (559) 635-7190.