Thoughts on handling a patient that says “I want to know exactly what my insurance will pay before I schedule this treatment.”
Patient No. But I do need to know what my insurance will cover.
Secretary Great, I’d be happy to help you with that. It looks like the total fee for all your treatment is $1500. My estimate for your insurance is that they will pay $750. That would leave your portion at $750. How would you like to take care of that?
Patient Well, I need to know exactly what my insurance will pay before I can figure out how I’m going to pay you.
Secretary No problem. The best way to do that would be to send a pre-treatment estimate to your insurance company. I can send this to your insurance company for you. It will show each procedure Dr. _____ recommends listed by dental code and after about 4-6 weeks, your insurance company will send us what they plan to pay for your treatment. This is our best way to confirm what your insurance intends to pay, however, you do need to understand that your insurance will not guarantee this amount – since no one actually signs this pre-treatment estimate from the insurance company, they still consider this an estimate. In our experience, insurance companies almost always pay according to pre-treatment estimates, but this is not a guarantee. Would you like me to send this for you?
Secretary Okay. So, I will send that out for you today. Now, have you been thinking about when you would like to get this treatment done?
Patient Not really, sometime next month would be fine.
Secretary You know, one thing you might like to do is to get a discount for paying in full on your portion. If you pay me the $750 of your portion by check you can receive a 5% discount and if you pay it with a credit card, you can receive a 3% discount. Then, what we can do, is to simply confirm our arrangement when we get your pre-treatment estimate back. How does that sound to you? (Be sure to check with your insurance company for approval on giving discounts on patient portion only)
Patient Well, I don’t know.
Secretary That’s okay. I just want you to know about our discounts so you can take advantage of them if that works out for you. We have several ways to work out payment arrangements, if you’re thinking of making a monthly payment. Does that sound like what you were thinking?
Patient Yes, I would rather just pay like $100/month.
Secretary You know, I could get close to that with our 6 month same as cash option. The way that works is that you would apply for our All Care financing program and once you are approved, you get 6 months to pay off your portion with no interest. Now, if you go beyond 6 months, you will pay interest. For the $750 that’s your portion, that would mean payments of $125/month – how does that sound to you?
Patient Sounds fine, let’s do that.
Secretary Great – let me just ask you a few questions and I’ll process this online, should only take about 10 minutes & we can get this done right now. Then I can schedule your root canal – sound good?
— So, you have worked out the financial arrangements and you still send the PTE to confirm our insurance estimate. If you want, you can schedule the first visit in about 3 -4 weeks (we usually get our PTEs back in 3-4 weeks) and then the calls you make when the PTE comes back in are simply a confirmation of the financial arrangements you have already discussed.
Sometimes, the patient or patient’s parents will want to schedule for the treatment before the PTE is received in our office. That is fine – go ahead and schedule the appointment but make a note on the treatment sheet and in the system G notes that they wanted to schedule before the return of the PTE from the insurance company.
For this section, we saved a handful of pre-treatment estimates in a binder and then created these type of questions for training;
To get signed off on this section, you must be able to:
Team Leader Date