Strategies to Reduce Insurance Dependancy
Reduce or eliminate your insurance frustration

Gary Takacs' passion is helping dentists develop a more profitable and enjoyable practice. He has more than 20 years of experience coaching dental offices to higher levels of success. Gary is a frequent speaker at dental society meetings, study clubs, and other educational forums. His presentations are designed for the entire team and he guarantees your office will have a great time and you will learn a great deal that can be immediately applied to strengthen your practice. For more information about having Gary speak to your group, please contact him at (480) 951-1652 or e-mail garytakacs@prodigy.net.

Dealing with dental insurance is a sore subject for most dental offices. Even with the benefits of computers and electronic claims processing, most offices spend an inordinate amount of time sorting and following up on insurance claims. The fact is, dealing with dental insurance companies can be difficult. As if delaying payment wasn't enough, to add further insult many companies are reducing coverage, creating more contract limitations, and not making any progress in covering services that represent modern dental care.

It's impossible to discuss the topic of payment today in dentistry and ignore the insurance component. The reality is that dental insurance is an important part of the payment mix in most offices. However, you have choices regarding how you handle insurance in your office.

Dental Insurance Independence
Perhaps the most radical way to reduce insurance dependency is to not accept assignment of benefits. In one fell swoop you can eliminate all insurance dependency by not accepting it! Many dentists don't realize they have a choice, having been conditioned to think that they absolutely must accept assignment of benefits in order to remain competitive. The truth is the choice is yours. Either accept assignment of benefits or don't. It's up to you.

If you do not accept assignment of benefits, the patient pays your office in full and receives any reimbursement directly from the insurance company. Before you cast judgment that this approach is entirely unrealistic, I would like to point out that a small number of dental offices in every community do just this. I have personally consulted with more than 200 dental offices in the country (in all regions) that do not accept assignment of benefits. In the right circumstances this approach can work very well, if it is done properly. Here's how it's done.

First, obtain a copy of the ADA superbill and scan it into your computer. While the patient is receiving treatment, the dental assistant enters the treatment codes into the computer and makes a copy of the radiographs. The payment coordinator then prepares a walk-out statement of all procedures done that day and attaches a copy of the radiographs if appropriate. When the patient is dismissed, the financial coordinator hands the patient a copy of the walk-out statement, collects payment in full, and says something like this:

Financial coordinator: “Mrs. Jones, here is a copy of everything you will need to receive reimbursement from your insurance company. You can mail this to your insurance company for reimbursement of any benefit and they will mail you a check directly.”

Would this approach work for you? It depends. Here's some encouragement.

I recently presented a seminar in Santa Fe, New Mexico and asked the audience if there were any doctors that did not accept assignment of benefits. One lone doctor (out of more than 70) raised his hand. During the break, I spoke with this doctor about why he came to that decision and how it affected his practice. In a quiet and soft-spoken manner he told me about his frustrations in dealing with insurance companies (which I've heard a thousand times). Delays in receiving payment, eligibility problems, “lost” claims, requests for information already provided, unreasonably low UCR levels, and arguments over preexisting clauses were just a few of the litany of complaints this doctor relayed to me.

However, about a year ago, the doctor got fed up with the insurance game and decided to no longer accept assignment of benefits. I asked him how it has been going since he made this decision. He said things were great and that his office had since grown by more than 22%. I asked him if he lost any patients because of the decision. He said, “Yes...six!” He kept detailed records of any patient lost and, after almost an entire year, the total was just six. The doctor went on to tell me that although he personally valued every one of his patients, the truth was that these six were not really good patients. They had often canceled or no-showed for appointments, were slow to pay, and rarely accepted his treatment recommendations. The doctor's only regret was not making the decision to stop accepting assignment of benefits sooner!

But this approach doesn't work for everyone. A couple of months ago I received a call from a dentist in Houston, Texas. I could tell from his tone that he was rather depressed. He said that four months earlier he had attended a seminar by a popular speaker who'd indicated that because dental insurance was such a hassle, every dentist should stop accepting assignment of benefits. This sounded so good that he immediately went back to his office and mailed a letter to all his patients announcing that he was no longer going to accept their dental insurance. However, in the four months since he had mailed this letter, he'd lost 85% of his patients! No wonder he sounded depressed!

So, here we have the same strategy with completely different results. Two dental offices made the decision to no longer accept assignment of benefits; one only lost six patients while the other lost 85% of his patient base. What was the difference?

The answer is really quite simple: The Santa Fe office provides so many benefits that patients choose to keep coming, even though they have to pay in full at the time of service. The benefits of receiving care in this office more than offsets any inconvenience of paying up front. This leads me to my first recommendation to reduce insurance dependency: work on providing tangible, measurable benefits that reinforce the patient's decision to visit your office for dental care. These must be benefits your patients can truly appreciate. Incidentally, providing appreciable benefits will help to enhance your practice whether you accept assignment of benefits or not. This is an excellent business strategy that is sure to strengthen your practice regardless of how you handle insurance.

I want to emphasize that making a decision to not accept assignment of benefits is not appropriate for all dental offices. There are risks associated with this decision as evidenced by the Houston dentist who lost 85% of his patients. While it can be very alluring to not accept insurance, for most offices the appropriate decision is to continue accepting assignment of benefits.

Educate Your Patients On Their Dental Coverage
You can reduce insurance dependency even if your office continues to accept insurance. My next recommendation is to use creative verbal skills to educate patients about their insurance benefits. For example, when you meet new patients for the first time, ask them the following question sometime during the initial exam.

Doctor: “Mrs. Jones, it's wonderful to meet you. We welcome new patients to our office. I'd like to start by conducting a very thorough exam. We like to be very thorough because we have found that it helps our patients to be as healthy as possible.

“I noticed that you have dental insurance. Let me ask you a question. If, in the process of doing our thorough dental exam, I discover something in your mouth that requires attention, that is not covered by your dental insurance, what would you like me to do?”

This is an extremely powerful question. Most patients will respond that they would want you to take care of the problem. I have found this question to be extremely effective at helping patients understand that some things are covered by their insurance and some things are not.

Most patients know very little about their insurance benefits. Without getting overly technical, here's a useful way to talk about it to your patients. Tell them to think about dental insurance as if it were an eccentric uncle who is giving them $1,000 (or whatever the amount of their annual coverage) per year to be used for dental care. However, there are two strings attached. The first is that any unused amount does not carry over to the next year. Use it or lose it. The second string is that he will pay for some things but not others (that's why he's eccentric).

This “eccentric uncle” communication technique has proven very effective. It helps take all the emotion out of the insurance issue and presents the limitations of their policy in a playful context. While this conversation may not be appropriate for all patients, I have found it to be very effective with most people. Plus, it gives you an opportunity to focus on the positive by pointing out that some people don't have this eccentric uncle to help them. You are glad that they do and more than happy to help them with it.

Increase Cosmetic Procedures
Another recommendation to help reduce insurance dependency is to make a strategic decision to do more cosmetic dentistry. This works for the simple reason that cosmetic dentistry is usually not covered by insurance, but many people still choose to have it done because they are concerned with their appearance.

You have likely heard the following saying, “People will pay for what they want long before they pay for what they need.” This is absolutely true when it comes to cosmetic dentistry. Understand that I am not talking about developing a cosmetic-exclusive practice. I'm suggesting developing a cosmetic component within your practice. Nearly every dental office could benefit by learning the clinical skills necessary to provide more cosmetic care.

If you are serious about developing the cosmetic component of your practice, I have three specific suggestions. The first is to join the American Academy of Cosmetic Dentistry (AACD). This is a fabulous association of dentists committed to sharing their knowledge of cosmetic dentistry. They hold an annual meeting that is world-class and offer a program packed with leaders in the field. If you have any interest in cosmetic dentistry, a membership in the AACD will prove invaluable.

I also recommend taking extensive continuing education courses on cosmetic dentistry. Lectures are great, but to really maximize your learning, a hands-on course is most beneficial. Dr. David Hornbrook's P.A.C. Live program at the University of the Pacific is one example. These are hands-on courses, where you bring a patient and actually complete a case under the guidance of instructors who are masters in the art of cosmetic dentistry. You will learn the skills to confidently diagnose and complete these cases in your practice. The P.A.C. Live program offers courses in anterior, posterior, and full mouth rehabilitation.

If you are interested in doing more cosmetic dentistry, I also recommend restoring each of your team members' mouths to cosmetic perfection. There is nothing like “show and tell” dentistry to get patients' attention. Your team members can show potential cosmetic patients their new smiles, which will help create enthusiasm and interest on the patients' part. Having seen firsthand what happens when my clients restore their team members' mouths, I can report that this is an excellent marketing strategy that will result in more cosmetic procedures.

Conclusion
This is a fabulous time to be in the profession of dentistry. If the 1960's are considered the “golden age” of dentistry, then I think the early years of this century will come to be known as the “platinum age” of dentistry. We have an aging population (the first wave of baby boomers turn 54 this year!) that is profoundly interested in good health and a youthful appearance. Quality dental care can provide these benefits to patients. While these are terrific times in the profession, it's also a fact that dealing with dental insurance can be a major frustration. While it is a very radical decision, you could decide to not accept insurance like the office from Santa Fe. However, this strategy is certainly not appropriate for all offices. Regardless of how you decide to handle insurance, every office can benefit by reducing insurance dependency.

In summary, here are my specific recommendations to reduce insurance dependency in your practice:

• Work on providing tangible, measurable benefits that reinforce the patient's decision to visit your office for their dental care

• Use creative verbal skills to educate patients about their insurance benefits

• Make a strategic decision to do more cosmetic dentistry

I encourage you to work on these things in your practice. The end result will be a practice that is more enjoyable!