Office Magic Online

January 2007
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In This Issue
-- Question of the Month
-- Testimonial of the Month
-- Response of the Month
-- Stay Tuned!

Greetings!

This month, we thought a client's question and our response would make a great newsetter with useful information. Are we right? Read on and you decide ... And do stick around for next month's announcement ... our most important announcement ever!!

Question of the Month
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have a patient that was recently seen for a New Patient exam. I treatment planned two cracked teeth to be crowned with porcelain to metal crowns.

"The patient called the office the next day. He told us that his insurance company told him that he should have a resin crown because his policy would pay 100% and that he wouldn't know the difference. He commented that he was concerned that I didn't present this option to him in the first place and he is concerned that I am trying to upsell him on a more expensive and unnecessary procedure.

"I can handle the patient thanks to your training and scripts. What can I do about the insurance company? I would really appreciate your reply in this matter. Thanks.
-- Ricky Cornish, DDS, West Plains, Missouri".

Testimonial of the Month
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I recently purchased your complete package of Office Magic training materials at your meeting in Springfield, Missouri in September. Thanks so much. I especially appreciate the Book of Scripts. I have been telling other dentists about it and how to contact you. Every dentist needs this information!"
-- Ricky Cornish, DDS, West Plains, Missouri

Response of the Month
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Tnanks for writing, Dr. Cornish. We are not sure what is meant by the term "resin crown." We would agree with you that a cracked tooth is most reliably treated with full coverage, whether the insurance company pays or not.

You mention that the patient called you "the next day," having been told by the insurance company something about a "resin crown." Sounds like whatever the patient was told, it must have been on the phone, probably by someone who had not reviewed the case. So ... do not give up hope. Actually submitting the claim may lead to a different -- and more enlightened -- response.

Alas, if the insurance company does deny the claim, there is probably NOTHING you can do. Oh, you can debate with them, send them studies and the like. But all you can really do is to know the plan's limitations and perhaps explain such limitations to the patient in advance when possible.

That is to say, you can attempt to explain the clinical situation to the insurance company, but its coverage or lack of coverage is determined by what the patient or the employer purchased, and not by the patient's dental needs
.
In addition to all the value our materials have helped you instill, you might also mention to the patient that he is lucky to have any insurance, particularly one which allows him to choose his own dentist.

You might add that while it is impossible for your office to know the ever-changing and confusing limitations of hundreds of insurance plans, you are always happy to assist the patient in maximizing that coverage. Regardless, your recommendation of what is most appropriate is not influenced by insurance limitations.

Whenever you suspect that an insurance plan may not cover a crown for any reason, it is of course desirable to explain this fact to the patient beforehand. You can also take the opportunity to mention to the patient that these situations are exactly why you have other payment options (e.g., 5% courtesy or payment plan) to keep dentistry affordable.

Finally, the patient will certainly know the difference if the "resin crown" is not really a crown and the tooth is later lost!

Best of luck, Dr. Cornish, keep fighting the good fight, and don't take any wooden nickels!.

Stay Tuned!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Next Month:

Our Most Important Announcement Ever!

Really.

Love,

Pat, Ginny & Lorraine