Oct282009 preisslbriggs

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  • Dental InsuranceOvercoming Challenges

    &Managing Effectively

    Debbie & PaddyVictoria, BC 2009

    The Rules Have Changed

    Our Dental ProfessionDeserves

    To Be Treated With Fairness&



    Dental Insurance difficulties & effective strategies Informing patients regarding the challenges the

    dental office faces Educating patients about their role & responsibility Utilizing verbal skills, forms & letters Diagnosis based on patient needs versus insurance The impact of AR and collections Consideration, planning steps, and anticipated

    outcome of transitioning from assignment to non assignment

    We Want To KnowWhat Insurance Challenges

    Are You Facing?

    Challenges Dental Practices Are Facing

    Patients not understanding their coverage Not being able to obtain adequate coverage

    information from the insurance company Pay patient only plans Pre-auths only being issued to the patient Pre-authorized treatment being declined Unusually slow payments or partial

    payments Limited re-submission time frames Claw back payments

  • Dental Insurance is Intended To

    Make Dentistry Affordable

    Never Intended to Cover Everything

    Dental Insurance Companies

    Are In the Business to:

    Sell Dental Premiums

    Not pay dental claims

    Explanation of This Statement

    Information regarding coverage not forthcoming

    Pre-authorizations issued by Dentist, are most often sent to the patient

    Not allowing coordination of benefits In some cases pre-authorized treatment

    is not paid Unreasonably short re-submission


    Dental Insurance Does Not Have:

    A relationship with the dental practice

  • Criticisms Aside

    We do earn money from dental insurance

    We have to strategize in order to survive

    If you are an assignment practice & get paid directly by the

    insurance companythen

    you have to learn how to play the game to win

    Accounts Receivable Facts

    &Financial Comparative Analysis

    Heres how youre A/R dollar is greatly reduced when its paid


    60 days past due - .61 cents

    90 days past due - .38 cents

    6 months past due - .18 cents

    This Strongly Affects Your Cash Flow

    Firstlets examine the bigger


  • Building a business&

    building relationships

    & providing healthcare services to patients

    What is your philosophy

    regarding dental insurance?Then & Now

    We are no longer able to do what we once did

    Costs far too much time & money

    Reduces quality time with patients & time spent in more valuable practice management areas

    Not able to communicate effectively with the insurance companies

    Lack of control = us looking incompetent


    We Must Change our Mind Set

    In order to be effectivethe entire dental team

    has to support the philosophy & approach to

    be taken with patients

    If the entire dental team does not support the philosophy and

    approach to be taken with patients regarding dental insurance

    It can

  • Cost you money!

    alienate staff membersconfuses patients

    poor Treatment Acceptance

    Are your administrative staff comfortable

    communicating with patients about

    Money?Fees, patient portions, amounts

    not covered, maximums reached

    We can offer solutions&

    strategies regarding dental insurance

    However, its up to the entire team every day


    1. Managing Expectations

    Yours & The Patients

    Dental Team Expectations

    Patients understand their responsibilities

    Patients understand the difficulties involved & appreciate your efforts

    Patients understand why they require treatment & the benefits of the treatment

    Patients dont assume everything is covered

    What Do Patients Expect Regarding Dental Insurance?

    Want to use their benefits to their advantage

    Informed of what will take place financially

    Given options

    Be involved in the process

    No unexpected occurrences

  • Can we meet those patient expectations?

    Not In Every Instance Because

    Dental practices dont have a relationship

    with the insurance company

    Privacy Act

    How do we manage patient expectations? Effective Communication

    Begin by:reviewing each team members

    role regarding dental insurance

    Dentists Role

    Dentists diagnose treatment according to the patients needs rather than their dental insurance coverage

    Routinely record in your diagnosis: the reason/rationale for treatment

    Our suggestion dont discuss money

  • Hygienists Role With Insurance

    Regardless of insurance coverage! Educate patients on the importance of

    periodontal health, its relevance to their current dental status & the correlation to their over all general health

    New Data a high% of infections in our body are directly related to periodontal disease lung & heart/cardiovascular

    Scaling and Root Planning

    Hygienist discusses and educates the patient regarding their need for any additional scaling / root planing

    Regardless of their dental insurance limit

    Have printed information available & use photography

    Hygienist Script

    Patient I am not covered for 3/ 6 month hygiene appointments ( Never say cleaning)

    Hygienist When you compare the cost to the benefits of this preventive treatment, you will find it quite affordable. Lets go see Paddy at the front desk and find out the cost.

    CDAs Role With InsuranceContinues the education process with patients on:

    The need & rationale for treatment

    Liaison with the receptionist regarding financial concerns the patient may have

    Supports the policies of the office

    Administrative Role Responsible for overseeing the collection of


    Communication & follow through of policies


    Perform insurance tasks

    Follow through

    If We Properly Manage Expectations Then Patients Will:

    Understand insurance challenges & : Pay their deductibles Pay their co-insurance Pay for uninsurable services Pay maximums when reached Pay differences in fee guides Pay any insurance shortfalls Pay for fees above the fee guide

  • How do we do this?

    Educate your patientsin advance of the


    Know who you are talking to

    Whats your approach

    Know yourself Know each other Personality Profiling

    Generational Differences


    Gold - needs to follow rules- respects authority /

    professional- organized, good with details- believe work comes before play

    - values home, family and tradition


    Green - cool, calm, self controlled- does not express emotion- information gatherers, research

    - excellent problem solvers- values intelligence - thinker

  • BluesBlue - people oriented, empathic,

    unstructured- people come first, appreciates feedback

    - values authenticity, honesty, team

    - good communicators, establishing rapport &keeping confidentiality


    Orange - determined, driven, decisive- competitive, thrives on variety- risk taker, courageous- good at managing multiple projects at once

    - values action, freedom, quick completion of tasks

    Differences Between the Four Generations


    Baby Boomers

    Generation X

    Generation Y

    Matures 1922 1943 (64 85 years old)

    Values Dedication and sacrifice Duty before pleasure Hard work Respect for authority Adherence to the rules

    Matures Contd

    Work Ethic Seniority and age directly correlated Tend to respond well to directive

    leadership Obedience and conformity over

    individualism Work is a priority

    Baby Boomers 1944 1964 (43 63 years old)

    Values Optimism Idealistic Team orientation Personal growth Personal gratification Health and wellness

  • Boomers Contd

    Work Ethic Service oriented Driven by the legacy of WWII Uncomfortable with conflict Can be overly sensitive to feedback Can be judgmental of those who see

    things differently

    Generation X 1965 1980 (27 42 years old)

    Characteristics / Values Accept diversity Think globally Latch key kids single families Balance work / life (family first) Grew up with recession Technologically literate Informal Self reliant Reject rules Practical Have multiple careers Involved in extreme sports

    Remember with Generation X

    The value of time is very important to them

    Generation Y - approx 1980 2000 (27 and younger)

    Characteristics / Values

    Technologically brilliant Optimistic Realists Individualistic Globally conscious /

    environmentally aware Street smart Sense of entitlement Irrelevance of institutions

    More about Yers

    Product of self esteem movement in the 1990s where all children were WINNERS

    Want constant open communication and positive reinforcement

    Want to reduce stress Believe age and experience are

    irrelevant, what matters is ability

    More about the Yers

    Because they have been overpraised and protected from feeling unsuccessful they often struggle with processing failure and criticism

    This generation frequently lacks the ability to internalize the lessons they need to learn

  • Latest Statistics Say

    Regarding Generation Y

    On the horizon of the workplace looms the bulk of Generation Y. At over 80