Dental office manager training to resolve perio maintenance vs. prophy patient upsets

Resolve patient upsets | Dental office manager training

I talked with an upset patient last week. She was checking out at the front desk and I could hear her becoming agitated. She had been coming to the practice for the last couple years for perio maintenance visits. At this particular visit, she saw a new hygienist – who provided the same perio maintenance service and charged her out the same way she had been in the past. The problem arose when the patient was asked to pay for the visit in full.Dental Patient Complaints

Dental insurance problems

Turns out that this patient had a PPO plan that only covered preventive care – and in fact, she didn’t realize it had any dental coverage at all! So, for years she had been paying in full for her perio maintenance visits, but today she wanted to make sure that her dental insurance would cover the cost. You know what’s coming right? She said that she had just completed a cleaning – NOT a perio maintenance. And, she now knew that her insurance covered two cleanings a year.

This is where I stepped in. This woman was explaining all this to my front desk team member (who has been working in the practice just 4 weeks) and I could overhear the exchange. I introduced myself and offered to help. I brought this woman into my office to talk through the situation to make sure I understood her concerns properly. Next, I asked the hygienist to come in to my office to be part of the clinical discussion.

Hygienist’s Responsibility

I asked the hygienist to give her clinical opinion on whether this patient could be taken care of as a prophy or if she required a perio maintenance instead. The hygienist confirmed that the patient had gum surgery 20 years ago and although some of the teeth were more mobile than she would prefer, this patient was stable. She did recommend that even if we did make the change to providing a prophy, that the patient needed to come in three times a year.

Office Manager’s Responsibility

With this clinical recommendation, I was free to clarify the financial situation for this woman. On a blank sheet of paper, I wrote down the full fee of a dental cleaning and then (just like in math class long ago), I showed my work to multiply this fee times 3. Then I added a periodic exam fee (once a year was deemed acceptable by the hygienist). Now, my patient can see exactly the cost to come to the dentist for a year – as long as she continues to remain stable clinically.

For Dentrix users, you can quickly compare the fees for a prophy vs. periodontal maintenance visit by running a report in the Office manager, Reference, Fee schedule. If you have entered your PPO fees into your Dentrix software, then you can also run the report to show 5 fee schedules in one report. This helps you to see the fees between the different insurance plans against your standard fees. If you run this and highlight the prophy vs. perio maintenance codes, you’ll be ready for this type of discussion with patients.

All’s Well that Ends Well

In the end, we charged out a prophy that day. The patient shared with me that she expected to lose her dental insurance at year end anyway (only 2 months away) and appreciated my taking the time to help her see the total cost of her dental care. She also paid me a past due balance on her account! She left the office smiling.

After this incident, I added this topic to our staff meeting agenda. We discussed that the hygienists have the authority to determine the proper treatment plan for the patients – whether prophy or perio maintenance. We also confirmed that just like the assistant team, when a patient is seated, the hygienist will review what is planned for that visit, “Today I’m going to do a perio maintenance treatment for you.” Since some patients may have had root planing and scaling a few years ago, they most likely have forgotten that they are still being treated differently due to their gum disease. By reviewing their treatment plan at the beginning of the appointment, the hygienist can point out what specific services she is providing this patient (such as reprobing and reviewing perio charting) so that the patient understands that this is not a regular cleaning. A good hygienist will also be coaching their patient on what she can do to improve her oral health so that she can be categorized as a regular prophy in the future.

I am looking forward to eliminating all upsets regarding perio maintenance vs. cleanings at the front desk. I also anticipate that our hygienists will be having more detailed discussions with patients about their gum disease, their perio pockets and their oral health. Sounds like a win-win!

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Keeping current with industry information is just one way to run a successful dental practice. If you’re interested in new ideas on running a dental practice, please subscribe to my weekly blog. One of the biggest challenges to managing a dental practice is managing dental insurance. With dental insurance handled, then dental marketing for new patients becomes a primary focus. In today’s day of online reviews, handling patient complaints well is essential. As your practice grows, hiring dental staff becomes more important. With 18+ years of dental practice management experience, I’m open to your questions to help you run a successful dental office.


AUTHOR: Jill Nesbitt
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