Insurance Wars: Dealing with Insurance Companies as a Dental Practice

Real World Insights from AADOM Authors - Amy Jones, FAADOM

Do you ever have days that seem hopelessly full of issues in dealing with insurance companies?

All too often, it feels like a battle as they question a doctor’s decision regarding a patient’s treatment plan, have frustratingly long wait times, and have difficulty in getting answers while being transferred to various representatives. Sometimes tension can build in your own office when trying to get payment for big cases if the patient notes, X-rays, or treatment plans are not detailed enough either from the hygienist, doctor, or dental assistant. Then you have to find the time to investigate the situation with the staff in hopes they remember the case in enough detail to get the claim paid. The frustrations can grow when sending in for a pre-authorization or claim for a crown prep and finding that the required X-ray was never taken, while the only explanation from staff is that one was taken last year or even three years ago, making my head want to explode, screaming, “WHY ME!!??”

That’s when I take a deep breath and remember that I am the team captain or frontline warrior, so to speak, and need to come up with a strong battle plan. Our practice members are all on the same team, but the insurance companies are in it for the bottom line; it’s business, yet it seems like war at times.

Make the insurance companies the focus of your displeasure, not your teammates. As leaders, we certainly see our share of tension in the office since we’re all only human, but by focusing on what sometimes seems like “the enemy,” we take the negative focus off of our position and requirements for very detailed information back on the other guys, insurance companies.

The frustrations of having to appeal a crown claim due to insurance saying that there isn’t enough evidence on the X-ray showing need for a crown… that there’s enough tooth structure for a filling, even though the whole back of the tooth structure is missing and you have called to appeal two or three times definitely makes the blood pressure rise. Again, not healthy, so I pull out all my weapons, the patient, and my team.

When I have done all I can, I will have the patient call their insurance company and talk with them. I have found that it definitely helps with processing the claims. The insurance companies always try to dictate treatment for patients. How many times a day does a patient come to you asking to help them understand their insurance benefits, call or come in upset because they have maxed out for the year due to a major dental treatment?

One of the ways I try to limit patient misunderstandings is that when we call to confirm their appointments, I will make a point to remind them of the amounts that they will owe and that their insurance is never a guarantee. I know that we all still have those patients who only hear what they want and get frustrated, but I just remind my employees to always make notes anytime they inform patients since documentation is the key. At the end of the day, it is about serving our patients, and since we are the area experts, it comes with the territory to inform and let them know that we are on their side of this insurance battle.

Handling Insurance with Your Staff

My most powerful weapon in these payout wars is my staff. Have I prepared them?

Through experience, I have found some battle-tested solutions to reduce stress and improve productivity. For instance, writing down daily issues that my staff or I have come across; as the saying goes related to the power of communication, “The pen is mightier than the sword.” I’ve made it a point to go over the scheduled treatments for the day during our morning huddles.

Communicate! Point out the patients needing detailed X-rays, periodontal charting, intro oral pictures, etc. There have been times that I’ve had to sit down with the hygienist, assistants, or even the doctors to remind them of the importance of detailed information and how it makes our jobs much easier when we all work together.

Share responsibility! This is not only helpful when dealing with insurance companies, but also if we were to ever get audited, or if we have to go to court for whatever reason. I’ve even had our hygienists and assistants watch online videos on patient documentation and its importance. Needless to say, they were not very happy about it, but in the end, they were more aware of making sure they got the needed information.

Train! On a positive note, it’s great to maintain humor in the office with thank-yous, like a “chocolate bomb” when an employee is seen diligently completing detailed insurance requirements in our battle for approvals. This could even include celebratory lunches for each month that the office has no treatment requests returned for lack of detail.

Celebrate success often! When we function efficiently as a team, we begin to win our battles.

I know dealing with insurance companies and patients can be exhausting and very time-consuming, but having a well-trained team and patiently answering customer insurance concerns with a smile on your face, is all part of your warrior’s shield. Convince them that you’re on “their side” in this battle. However, reminding them that coverage is only there to help keep them healthy and reduce some of the unexpected expenses, that the doctor does not let the insurance companies tell them how to treat their patients, and that the doctor and your team do the best they can to advocate for patients’ best interests, should help to calm some defensive nerves.

Regardless, the reality that insurance plans have complicated coverage limits, entail frustrating response times, and even question the doctor’s decisions can feel like you’re entering a war zone. So armor up!

About the Author

Headshot of Amy Jones, FAADOM

Amy Jones, FAADOM, has been in dentistry for almost eighteen years, having trained to be an office manager shortly after she started. Amy comes from the optometry industry, where she worked for nearly five years and then decided to pursue a different path. She started working as a dental receptionist and found that her passion is in dentistry and helping patients love their smiles again. Amy has also cross-trained to assist and help where needed. She loves learning all she can about dentistry and how to help run a successful dental practice. Amy received her AADOM Fellowship in 2019 and will be inducted in September as an AADOM Master (MAADOM).

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