A major problem in many dental offices is that the financial coordinator is unable to provide an accurate estimate of insurance benefits. The patient asks, "How much is my insurance going to pay?" A fair enough question, but the patient really ought to be asking their benefits supervisor at work. However, in the real world they ask you. In many offices the answer is, in some form or another, "I really don't know." The patient then responds, "Go ahead and find out what my insurance pays, then send me a bill" thus setting up a 60-80 day (or even longer) wait for payment.

To avoid this game, your office must be able to provide an estimate of insurance benefits. By doing this, you can then determine the patient's portion of the fee and you can arrange to collect this at the time of service. When the patient asks, "How much will my insurance pay?" I suggest a response as follows:

Financial Coordinator: "Ultimately, you are responsible for all charges. However, I can do a good job of providing you with an insurance estimate. Let's see, the fee for the crown is $_____, and I estimate your insurance will be paying $_____. I'll go ahead and take care of filing all your insurance paperwork. Your portion of the fee then, is $_____ and you can take care of that at the time of service by cash, check or credit card." NOTE: This conversation takes place at the exam appointment.

Until now, providing the patient with an estimate of insurance benefits has been a haphazard process at best. With common insurance carriers and common procedures, some offices do a fairly good job of estimating coverage. However, mistakes are often made. You may not know if patients have met their deductibles. Patients may have maxed out their benefits for the year. Any number of other complications have made estimating the insurance benefits difficult. Soon there will be a better way!

Imagine if you will . . . Your patient shows up for his appointment with dental insurance card in hand. You take the insurance card, run it through a card reader attached to computer keyboard, and within seconds, very important information appears on your computer screen. If the patient doesn't have an insurance card, you type in his social security number to obtain the information. First you learn whether the patient is actually eligible for insurance coverage. Then you discover this patient's deductible amount and if he has already met it. Next you find out the year-end for his insurance. (As you are well aware, it's not always December 31.)

It gets even better. After you discover the year-end, you find out the dollar amount of the annual benefits. Next comes an extremely important bit of information -- you discover exactly how much of their benefits the patient has already used this year. For example, you might discover your patient has $1,200 of dental benefits coverage and she has already used $482, leaving $718 in dental benefits remaining this year. Next you learn about common plan benefits. Finally you find out any plan exclusions and limitations. Keep in mind that you get all of this information within seconds of scanning the dental insurance card or typing in the social security number.

Now armed with all this information, it is very easy to have a specific financial discussion with your patient. You even print out a simple summary of the information to hand directly to your patient. The best part is that it allows you to do an excellent job of estimating the patient co- payment. There is no need to bill the patient "after insurance pays." You have this information immediately. You can (and should, I might add) collect the patient portion right at the time of service.

Lest you think this look into the future sounds too good to be true, I have some outstanding news. Not only is the system I just described going to be a reality, but it's happening right now! Don't get too excited though, it's not available just yet. This system is currently installed in some beta test sites and we are in the process of working out the bugs. All the technology is currently available. The challenge has been to link the technology in a seamless manner -- and to get the payors (the insurance companies) to support it. So far, so good. The early test results are extremely encouraging and this system should be operational and available in the near future. Stay turned for future developments. It's exciting! It's real and will be available soon.

As good as this system is, you still need to set up a system in your office to collect the patient co- payment. For this piece of the payment puzzle I don't need a crystal ball. We have the answer today. The solution regarding patient co-payment is to create a situation in your office where patients expect to pay their portion at the time of service.

Now, not only is it possible to set up a situation where patients expect to pay at the time of service, but if it is done properly they will do so happily! I can say this with confidence, because I have helped hundreds of dental practices in every part of the country do just that, and I've seen the terrific results.

Some offices that I've helped set up successful payment systems had been using systems that were downright dysfunctional! I can think of no more accurate way to describe it. For example, I visited a practice in the Pacific Northwest (who will remain anonymous) because the doctor thought something was amiss in his payment system and he wanted some help making changes. He had a rather high amount of outstanding accounts and wanted to reduce his accounts receivable. Within about five minutes of stepping foot in his office I discovered that his office manager had not mailed a billing statement in eight years. I am not exaggerating -- eight years! I asked her why, and she said, "Oh Gary, you don't understand. Our patients would not appreciate receiving a bill." Remembering the high amount of outstanding accounts, I asked her how she handled payment if she doesn't send out statements. She said, "I just keep track of it in my head and remember to ask the patient for payment the next time they come in." She was right -- I didn't understand!

Needless to say, we made changes. It took some transition time, about 8 - 10 months, but we completely transformed this practice. The patient co-payment is now collected at the time of service. Incidentally, we tracked how many patients were lost because of our new payment policy. After a year of tracking this information, we figured we had lost only three patients! Better yet, when the doctor looked at this list of three patients, he was relieved. He told me that while he appreciated every patient in his practice, the truth was these three patients caused nothing but grief. He was happy they had left.

I tell this story because no matter what the current state of affairs in your payment system, it couldn't be as bad as this office. If this practice can succeed, so can you! It's not easy. After all, no worthwhile project is ever easy. The end result -- your patient expecting to pay at the time of service and doing so with a smile -- is worth the effort.