Orthodontics: Minding Your Own Business - Keeping Your Money

One of the best books in print about dental practice management is Michael E. Gerber's "The E-Myth Dentist." 

Dr Chris practices orthodontics in both the USA and in Abu Dhabi, United Arab Emirates (above). 

Written for parents, Dr Chris' book, Your Child's Smile, is also used as a dental school textbook for its thorough, well-researched information. 

Great advice for people in every profession can be found in Jim Rohn's "Twelve Pillars." 

Another photo of downtown Abu Dhabi, where Dr Chris practices. 

A fun fact from Dr Chris: Lucy Hobbs Taylor (1833-1910) was the first female dentist in the USA.  Today, slightly more than half of all American dental students are women. Without a doubt, Dr Taylor had no headaches from working with insurance companies!

So how can you enjoy your practice more?  How can you begin to take control of the business of your practice?  The answer lies in working ON your practice, as well as IN your practice.  One place to begin is to wrest control of your income from the insurance companies. 

Contemplate the fact that insurance companies in today’s world really function as managers of most of the dental practices into which they are allowed. How can you become the real entrepreneur and manager of your own business?

Remember, as Jim Rohn explains, ”if you don't have a plan for your life, you fall into somebody else's plan.”  Know what they have planned for you – taking as much money from your practice as possible.

You’ve got to begin minding your own business. You’ve got to start somewhere.  Here’s a suggestion.

Review all insurance companies with whom you work.  Categorize them into:

1. Managed care plans (HMO, PPO, EPO, POS, Medicaid and Medicare) that you have contracted with to pay you for the patient care
2. insurance companies from whom you accept payment directly, but have no contract with them.

Then review each to discover:

1. Which reimburses at the lowest rates for your typical billed procedures. And, then, which is next lowest, and so forth.
2. Which uses the most amount of staff time (and staff numbers) for filing, paperwork, appeals, etc.  You may be paying 5 or 6 staff members just to do paperwork to get low reimbursements.  This may be a loss-center for your practice that is masquerading as income.
3. How much total income each brought into your practice over the last year.

Once you have done the reviews and have a clear idea of which are sucking the most money from your practice, there will decisions to be made.  Decisions may include:

1. Reassign the patients in one or more plans to associates, as you prepare to transition the practice to free-market dentistry (no insurance participation) as soon as is feasible. 
2. Spend your time minding your own business, prioritizing all managed care and government health insurance strategem, Medicaid and Medicare, and then study your contracts to see when you can release them or opt out.  Your goal is to get out of the insurance business and stop letting the insurance companies take your money.
3. Study the insurance plans that you accept direct payment for the insurance portion.  Even if you’re not a participating member of the PPO or other plan, you will be waiting longer for your money, spending more on staff to prepare and file claims, log in payments, and communicate with the insurance companies.  For orthodontics, you may be waiting for quarterly payments or even every six months payments. You’re working for free for a long time.  That means the insurance companies are the ones collecting interest on your money. And that interest is not in your practice or family’s bank account and will not ever be!

How often do you:

1. Pay a staffer to sit for 1/2 to 1 or more hours on the phone trying to facilitate payment of an insurance amount?  It is somewhat typical for a staff member to be on the phone with an insurance company representative who is located out of the country - typically India or the Philippines, for 30 to 60 minutes at a time, concerning one claim which still may not be paid.  Ever.  And - how much do you pay that staff member per hour?  
2. Write a “by report” for an insurance billing - after it’s already been returned for ‘more info’, and you spend time explaining the ‘medical necessity’, only to be rejected for payment.  How much should you be making per hour?  You just cost yourself twice that by a) not treating another patient during that time, and b) wasting your time writing such nonsense that the insurance company may or may not accept.  
3. Think of communicative tools that are as manipulative as “usual and customary fee?”  Whose usual?  Whose customary?  What on earth does that mean?  Let me translate:  It means, “These words make the patient think if you are over the ‘usual and customary’ fee, your fee is somehow exorbitant and improper. “  Several recent legal cases have shown that the UCR utilized by insurance companies was neither valid, accurate nor reliable.  (Davekos v Liberty Mutual Ins. Co, NY Atty General and Ingenix UCR database, “which was shown to downwardly manipulate the data,” McCoy et al. v Health Net et al and others.)
4. Wait amazing amounts of time while the insurance gathers interest on YOUR money?  
5. Have patients who carry two insurances, one for the husband and one for the wife, and find that the “secondary” insurance company denies any payment because the “primary” insurance company has already paid some of the billing, and the secondary insurance company’s small print in the contract pays nothing further.  (Even if the patients pay for 2 insurance coverages.)  And you’ve waited for your payment, never to come, then have to bill the patient and wait some more - possibly never to come.
6. Accept a credit card payment for which you pay a percentage 

Stop it.  Now.

Once your patient has consented to treatment, it is their responsibility to pay on the day of service. It is the responsibility of the dental insurance carrier (a third party) to directly reimburse the patient for the portion of the procedure that is covered. The actual contract is between the patient, usually as an employee and the insurance company.

Even if the patient makes the mistake of believing that the contract is between the dentist and the insurance company, it is not.  You must be clear on that and let the patient know your expectations BEFORE treatment is begun.  A written contract between you and the patient or parent is recommended.

Assignment of benefits to you costs you a heavy financial and most undesirable burden in your practice, most especially when you multiply it by hundreds of patients.  

Outstanding over-the-top dental and orthodontic care, is your privilege, honor, and responsibility.  It is based on a relationship between you and the patient, without interference from third parties. 

​When the payment is made by the patient, it is a clear statement that they are taking an active interest in their dental health,  their loyalty is to you, and that they value your service.  

Stay out of the relationship between the patient and their insurance carrier and employer.  Make your relationship with the patient fantastic, based on outstanding, over-the-top dental and orthodontic care.