#7 – Makes financial arrangements

Financial Arrangements

Continuing the Perfect Beginning

Did you know that 39% of Americans say that cost is the reason for not having dental care?  Worse that this, many of the new areas of dentistry are expensive (perio surgery, crowns/bridges, implants).  In fact, only 23% of Americans can afford to pay $500 out of pocket immediately for any thing.  The average American keeps his or her credit cards within $300-$400 of the available credit limit.

Don’t expect much help from traditional banks.  Banks try to make 1% profit.  That means that if only one loan is defaulted for each 100, the bank makes no profit and if two loans fail they lose money.  For this reason, they are very careful in screening who they will lend to.  Other problems with banks are

  1. Lots of paper work
  2. Clients must go to the bank for the loan
  3. The loans are “recourse” which means we must make good on the loan if the client defaults.
  4. Often won’t loan less than $2000

So, should we loan money to our clients?  The numbers don’t look very good.  On average, about 20% of our average monthly production is not collected at time of service. We average 98% collected every month.  That means that 2% of the 20% we loan out is not collected at time of service and that’s 10% of the money that’s not collected at the time of service!  Now, add the cost of running our billing program, and you can see how very expensive it actually is!

The better you understand this section and apply our principles the higher the rate of collections we’ll achieve and that means fewer collection problems and upset clients. Often, clinical staff are uncomfortable talking about money, so whenever a client wants to schedule for treatment, the chairside assistant , hygienist, and even the dentist will:

  1. Think “ I’m not sure what the fee is, the secretary will take care of it.”
  2.  They know, but say “ our secretary can help with the cost.”

Your ability to provide our client with a smooth, intelligent, professional financial arrangement will be one of the keys to our success. This section is very detailed. You will need practice before you learn the techniques.  A good financial arrangement will:

  1. prevent financial surprises to the client
  2. prevent collection problems
  3. allow us to provide more comprehensive care through firm but flexible financial policies
  4. reconfirm office policies
  5. reaffirm your control of providing access to dental care for the client and their responsibilities to us

Our Financial Policy

  1. For personal portion amounts less than $200, the patient must pay for all treatment before or at the first treatment appointment. (No discount for this.) “Fine John, then I’ll expect $150 when you come in for your appointment.”
  2. For personal portion amounts over $200, there are choices:
    1. Pay in full to schedule with cash or check (at least 1 week in advance of appointment) and receive 5% discount on the patient portion.
    2. Pay in full to schedule with credit card (at least 1 week in advance of appointment) and receive 3% discount on the patient portion.
    3. Pay as you go – patient can make payments in advance and when they have paid 2/3rds of their treatment fee, we will schedule the appointment. This way we will only have 1/3rd of the treatment fee at risk.
  3. For personal portion we also can offer our same as cash plans:
    1. Care Credit 6 months same as cash plan – must apply for this & if denied, then    (one thing to remember is that if the balance is not paid off in the 6 or 12 months the interest in charged from the beginning balance)

b.  Universal One (This is a loan with interest)

Financial Policy for Implants

$2000 for the surgery

Then a delay of 5-6 months for healing & uncovering the implant

$2000 for the crown

  1. Make a financial arrangement for the entire $4000 at one time, not 2 separate discussions.
    1. They can pay $4k by check now & get 5% discount
    2. They can pay $4k by credit card now & get 3% discount
    3. They can make monthly payments of $4000 / 6 months = $667/month
    4. They can do CareCredit or Universal One – once they are approved, we will charge out the $4000 total treatment fee on the day of the surgery
  2. Signed formal treatment plan must be saved in the patient’s chart & copy to patient

You have already experienced asking for money when clients are brought to you at the desk who want treatment. You greet the clients, state the cost, and ask how they would like to pay, if the client pays, you schedule. If the client can’t pay, then you refer the client to a senior secretary.

Now it’s time for you to learn this skill. Begin by making financial arrangements (F.A.) after your dentist makes a formal case presentation. Here is your responsibility:

Checklist for the Consult: (Adult)

1.   Introduce my role- organize, knowledgeable, facilitator

2.   Review treatment & answer questions – – discuss warranty

3.    Compliment the doctor’s work

4.   Ask about the patient’s schedule – do they prefer a certain day for appointments? Is there a deadline they want treatment completed by?

5.  FA’s

  1. Review dental and medical insurance coverage
  2. Set financial arrangement – Ask: How would you like to take care of your portion?
  3. If cannot afford – Ask: What is your budget per month? Then schedule as paid monthly.

6. Client signs the treatment plan

7. Document consult in the ledger & clinical & guarantor notes

8. Scan all signed documents & save in the patient’s chart.

In summary – from the time you spent in this consult, you should know:

  1. Why your patient wants dentistry done?
  2. When they want it completed?

To prep for the consult:

1. Make sure you are going to be present to make F.A. after the dentist’s presentation

2. Type the treatment plan into a Word document that uses patient friendly language and explains the dentistry as well as includes the fees and insurance estimate. You will be reviewing this with the patient, so the better you have prepared, the easier for your patient to understand and be willing to set up a financial arrangement, which you will write on this treatment plan and have the patient sign.

3. Confirm all fees and the fee total with the dentist.

4. Now check your client’s insurance, “use the dental plan maximum”

a. What has the client used so far this year?

b. What is the annual maximum?

c. Is there any waiting period for any of the major treatment we are recommending?

5. Pull all appropriate brochures, print 2 copies of the treatment plan and put all these papers in a case presentation folder.

6. Offer to the dentist to review the folder.

Prepare yourself for the conference:

1. Keep your schedule open when you expect to be needed. Do not expect the dentist to come get you when she has completed her part of the consult, you keep an eye on your watch and go into the conference room after about 30 minutes.

2. Review the treatment plan so you’ll be knowledgeable while talking with the client

3. Take with you:

a. Notepad

b. Your business card

c. Calculator

d. A copy of our F.A. choices

f. Your checklist for the consult

Prepare yourself mentally. Your attitude and how you present yourself determines your success. Remember:

  1. You have reviewed the client’s plan with your dentist. You understand it completely. It meets the needs of your client and offers alternatives where/ if appropriate.
  2. The fees are appropriate. Your client will receive great value.
  3. You’ve already thought through all the financing options if they’re needed.
  4. Your task is not to sell dentistry. Your task is to facilitate your client to clarify what they want and then find a way to help afford it.

Sample Consult Conversation

1.   Introduce my role- organize, knowledgeable, facilitator

Enter quiet area – conference room or Doctors office “Hello (last name) I’m Heather. My role is to answer any questions you have about treatment, schedule your appointments and make sure everything goes smoothly for you. Here’s my card if you have any questions, just call me. I’ll take care of them.”

2.   Review treatment & answer questions – – discuss warranty

Now, open up the folder and take out the treatment plan for the patient – “So, do you have any questions about the treatment that Dr. Pierson has recommended?”

(If yes- answer them or get Dr. Pierson to answer any questions that you can’t.)

“I can see you are planning to have ___________ (extractions, crowns, bridge, implants, sedation, etc) treatment done. Can I answer any questions for you about any of this?”

Often, this is where the patient’s start to talk with you. Most people don’t want to appear uninformed in front of the dentist (who may also speak in terms they don’t understand), and, when you are going through their personal treatment plan

3.    Compliment the doctor’s work

While you’re discussing the treatment plan, its easy to work in compliments about the dentist’s work in the past. “I have worked with Dr. Pierson for several years and he does an excellent job with dental implants. Patients have been really pleased with how well he listens to them and how well the implant crown matches their teeth. I think you’ll be very happy with Dr. Pierson for your treatment also.”

4.   Ask about the patient’s schedule – do they prefer a certain day for appointments? Is there a deadline they want treatment completed by?

“So you will  be having _______ (number of) appointments with Dr. Pierson – is there a certain deadline you would like to have all your treatment completed by?”

Often patients who are completing large treatment plans have a major life event they want their smile to be beautiful for- perhaps their daughter’s wedding or graduation, maybe a high school or college reunion or perhaps they have been promoted at work and now will be in a more visible role and need to give a presentation. If you can focus your patient on a date when treatment will be completed, you will have more success at getting your patient to come in for all his appointments and finish treatment quickly.

As you ask each question, be sure to write down what the patient says in your notebook – so you should have the deadline noted, as well as the following:

a. Are there certain days that are better for you? (document)

b. Is there a time of the day that’s better for you? (document)

c. Since we’re scheduling in advance, please give us at least 1 day’s notice if you need to reschedule an  appointment.

 5.  FA’s

  1. Review dental and medical insurance coverage
  2. Set financial arrangement – Ask: How would you like to take care of your portion?
  3. If cannot afford – Ask: What is your budget per month? Then schedule as paid monthly.

“The total fee for your treatment is $______. I expect your insurance to pay $______, leaving  $________ as your portion.”  While you’re saying this – you’re pointing at this information typed clearly on the treatment plan. “So, how would you like to take care of this amount?”

Now – you are silent. Even if your patient needs a few minutes (which will feel like hours) to speak, you must be quiet. At this time, the patient is thinking through their personal budget and trying to figure out how badly he wants this dental treatment because he has to figure out where he’s going to get the money.

Often, patients say, “Well, I don’t know. What are my choices?”

If that happens to you, then you can offer: “If you can pay in full by cash or check, you receive a 5% discount – that would save you $____. ”  (Its important for you to get your calculator out and show them what their portion x 5% looks like – this may motivate them to pay in full so they can save this money!)  “Or, if you can pay in full on a credit card, you receive a 3% discount – and that saves you $____. Do you think either of these options will work for you?”

If they say, “No, I can’t pay in full. Do you take payments?”

Now, you can offer, “Yes we do – my favorite way to do this is to have you apply for CareCredit which is our patient financing program, and when you’re approved you will make payments to them and we can schedule your treatment as if you have paid us in full. Would you like to go ahead and I can see if you can get approved right now? It only takes a few minutes.”

As long as you’re doing your consult in a room with a computer that can connect online, you can log into the CareCredit website and within a few minutes you can get your patient approved or denied. If your patient is denied, then you know that money is a real challenge for this person and you are left with a couple options. First, you can ask the patient if they have someone who would be willing to co-sign with them to try again to be approved for CareCredit. Second, you can offer for them to make payments, and when they have paid 2/3rds down they will have their appointment. Here’s how that sounds:

“I’m sorry that CareCredit didn’t work out. One other option that has worked for lots of people is to find someone who is willing to co-sign for you on CareCredit. Do you think you know someone who would be willing to help you with this?”

If yes – then give them the paper application and ask them to bring it back filled out. Then you can run it online again. If no, then continue:

“No problem. You are still welcome to make payments. Tell me, how much money each month could you pay me?”  Often a patient will say, I can pay you $100/month – but no matter what number they pick, we can work with it.

“Okay, so your full treatment plan is $_____ and you can pay $100/month so we’ll be working together over ____ months. Let’s look at your first visit (prepare for this situation in advance by noting how much the personal portion of the first visit will be, and maybe the second visit as well) – it will be $400 for your first visit.  Our guidelines are that you need to pay 2/3rds of the fee and then you can have the appointment. So, if you can pay $100/mo – that means you’ll make a payment in January, February and March – then we can schedule your first visit in March and make your last payment in April. Does that make sense?”

Often, patients are disappointed that you’re going to make them wait to get their treatment started until you receive 2/3rds of the fee – but if this patient has been denied for CareCredit, they have money problems and you don’t want to make them YOUR money problems next. Plus, remember, patients that owe you money don’t like you! So, the more they can pay you without getting into a bad situation, the better your relationship will be. If a patient seems upset or frustrated, just redirect them back to another option – perhaps they can find a friend/family member who will co-sign for CareCredit or simply pay for their treatment in another way.

If you end up setting your patient up with payments, be sure to set them up for the entire treatment plan amount (their portion) – not just one visit. You can enter this into your Dentrix or EagleSoft and print a schedule of payments for your patient. Be sure to ask which day of the month works best for them because the computer needs a specific date.

6. Client signs the treatment plan

Once you have decided on a financial arrangement, write on the treatment plan what you’ve agreed and ask the patient to sign. If the patient is hesitant, say, “By signing this, you are confirming that we have reviewed the treatment and made a plan for how you want to pay for it. – this doesn’t tie you into having the treatment done.”

You’ve done it. So – collect a payment or the entire amount, schedule the first visit and make a copy of the treatment plan the patient signed. Walk them to the door and shake their hand.

7. Document consult in the ledger & clinical & guarantor notes

Now, sit down quietly and take all your notes and document them in the computer. Charge out your consult in the ledger. Enter any financial notes in the Dentrix Guarantor note and create a clinical note that documents all other notes as well.

8. Scan all signed documents & save in the patient’s chart.

Be sure to scan the patient’s signed treatment plan and any other documents. Just for fun, you might want to go find the dentist and let her know how your consult turned out – especially if you were successful in getting payment and scheduling the next visit.

Dental Insurance

  1. Never say the insurance company has to “preauthorize.”  This says that they control whether the client has the treatment or not.  Only the client makes this decision.  The insurance company will send us a “predetermination” of what they will pay.
  2. We will estimate what insurance will pay, working out financial arrangements and explain that we will either give them a refund or send them a statement if our insurance estimate is off. It’s smart to edit our insurance estimates on the low side to make sure we are safe in case they pay slightly less than we estimated.
  3. Patients love to get money back and hate to pay extra.
  4. Stress the role of insurance as financial assistance, not determiner of treatment.

If the client and spouse have two separate dental insurance policies, in theory this “co-insurance” should cover almost all cost for the treatment. If one company covers 50 %(or more), the second company should pay the remaining 50%. Today many companies “co-ordinate” their benefits so that if one company has paid as much as they have paid the entire bill, then they wont pay anything since the client has received the benefit they stated s/he would receive-even though they paid nothing.

“That leaves $______as your responsibility. How would you like to pay this?”

You know our financial  arrangement policies. Guide your client through facilitation to choose an acceptable arrangement.

Sec “That leaves $1600 as your responsibility. How would you like to take care of this amount?”

Client “I could pay $200 each month.”

Sec “Ok let’s see. (using calculator). That would take about 8 months. Since we don’t charge any interest, that’s a little too long. We have a few choices:

1. “If you pay all now we can reduce the fee by 5% or 3% if you pay by credit card” (1 week before the appointment.).

We accept Visa, MasterCard and Discover. The bank charges us about 2% on every transaction, so we would prefer cash.  However, we would rather have them use their credit card rather than charge it and force us to send a statement. However, if a client prepays in full with a charge card we will give them a 3% discount of the difference between our cost to process a charge and the 5% cash discount. We authorize all credit card charges by running the card through the terminal.  You will receive an authorization number on each transaction.

2. “We could spread it out 3 months at no interest at $534/mo”

3. “We could use our extended payment plan for 6 months at $267/month with outside                   financing”

Sec “I’m sorry they’ve denied you for this program. Since you were comfortable with $200/month. I can have Dr. Pierson see what he believes is the most important treatment. Then I can make a financial arrangement for the amount that we could do in 3 months and the rest of your treatment could be done later. Would that be ok?” (1st of the month to start)

 

Flexible Spending Account

Many companies have developed these tax free plans. Most major dentistry can be postponed into the next calendar year so the client can set aside enough money to cover the procedures. Or, you can find out how much the patient has left now and make the most of both calendar years.

Colored folders

We identify long term clients by the color of their folders:

Green – 5 year client

Purple – 10 year client

Gold – 15 year client

For any of these colored folder clients, we want to encourage them to follow the above policies, however if a colored folder client mentions that they want special treatment or are uncomfortable with external financing, it is okay to allow them to pay us later. Just make a note of when we should expect the payment so we can follow up. If they want to spread out their payments but don’t want to use the external financing payment plan, they can pay us directly over 3 months – go ahead and enter a payment agreement in Dentrix to set this up. If they want more than 3 months to pay, then they must work with the Care Credit Financing program.

This should be presented to the client only on a Financial Arrangements form, the Dentrix itemized sheet never goes to the client for large cases with lots of procedures because we don’t want to confuse our patients. The itemized sheet is for your use. In tracking treatment completion and to assign fees for daily production. When clients see the itemization sheet they begin to think in terms of why does this filling cost more than that one? And “My aunts root canal was less than that!”  Your task is to keep the client thinking in terms of total treatment. “You mean I can solve all my problems and improve my appearance for only $3,487?”

It doesn’t take a “certain kind of person” or a special temperament to help people make and keep their financial arrangement.  It does take a certain professional mindset.  Take a deep breath and assume these characteristics of a financial counselor.

  1. Your doctor is the best both technically and personally.
  2. You have the knowledge and experience to solve your client’s problems and to smooth the way a “hassle free” experience that meets their goals.
  3. You like your clients.  You’ll be their friend and confidant through this experience.
  4. Their doctor has organized the treatment plan to meet their needs.  It is cost effective.  It will result in the most functional cosmetic result they can expect ‑ for the level of finances they are willing to commit.
  5. You understand economics and financing.  You can make the treatment your clients desire to be financially affordable. You can deal with insurance companies and banks as needed. You are firm but fair.  You won’t allow them to get over extended financially.  This is in their best interests.
  6. You’ll continue to work with them until their problems are solved.  You won’t feel pestered by small problems or questions.  Your job is to serve them.
  7. You’ll become their coach, cheering section, best friend in the office.  If something is a problem you not only can find a solution, you want to find the solution.  You take pride in smoothing the way for all your clients.
  8.  Thinking about ‘facilitating’- how do you know when you are facilitating vs. telling people what they have to do?

 

Signs You Are Facilitating:                  Signs You Are Telling:

– You are asking questions                             –  You say ‘ you have to’

-You and your client are seated            –  You are standing at the front desk with you client

in a quiet area                                   –  You are telling them choices and not asking questions

 

Remember, the key is to deal with your problems BEFORE they occur, no matter how unpleasant, than to ignore it and let it happen and THEN try to deal with it.

After the treatment has been discussed with the client, the staff person giving the conference will have you come in and meet the client and tell you what will be done at the next appt., how much time will be needed, and the total fee for the required treatment.  Be sure to review treatment plan BEFORE the conference so you know what’s going on!

MORE THOUGHTS AND DIALOGUE REGARDING FINANCE

The most important consideration is to avoid the client coming out to the front desk at the end of each appointment asking “How much was it today?”  We don’t sell silver, gold, plastic, porcelain, etc.  We sell high quality skill, care, and judgment that often involves these and many other materials.

With a good financial arrangement this hassle will be reduced.

Rec. ‑ A molar root canal is $652

Client ‑ $652 for one tooth!

Rec. ‑ I’m so glad the Dr. was able to save the tooth!  (Don’t defend‑ accentuate the positive).

 

If the client says he wants to “pay as we go”.  Don’t offer resistance, say ‑ Yes, this is possible, Mrs. Jones.  You will have 5 appointments in your treatment sequence and your total fee is $2000.That would be $400 at each appointment. The first payment will be due now for us to schedule your appointment.

Client says – “Chuck knows me, I’m good for it”.  Don’t lose control!  Say – “I’m sure Dr. Smith has confidence in your ability to meet this obligation.  However, any extended payment plan has to go through our outside bank that has a formal written agreement.   Would you like for me to set this up for you?”

Client says ‑ “I’ll need to go home and discuss this with my husband/wife.” –  “Fine, would you like me to arrange for me to review this with both you and your husband?”  If no, then “Okay, I’ll give you a call in a week if I haven’t heard from you.”

Client says – “My insurance company says you must send a PTE before my treatment.”  Sec: “It’s always best to get an idea of what your insurance coverage will be, however, it will slow your treatment by 3-4 weeks. If you want to begin now, I can make an arrangement on your portion and we can schedule right now.”

Client says – “Don’t you trust me?  How come so much interest in money?”   – “The Dr. has placed me in charge of paying OUR bills and I need these arrangements so this will be possible.”

Client says ‑ “Bill me!”   – “I’d be happy to do that. You should expect that in about ______. so I should expect your check in ________ days. Does that sound right?”  As soon as the patient walks out, print the statement and put it in the mail.

If client doesn’t pay initial amount ‑ forgot checkbook, etc. ‑ say “As soon as I receive your check I’ll call you to schedule your next appointment.”

Whenever you have to discipline a client, begin with “I know that you would prefer. . .”

Client says – “I don’t want to make regular paying arrangements”.  Sec. – “Well, for us to meet our financial obligations we need a financial arrangement. Why don’t you call me when you’ve decided.”  (Get them out of your hair and my practice.)

Try to use professional language when discussing arrangements (not “contracts” or “notes”).  “Initial payment” not “down payment”.  “Statements” not “bills”.

  1. Client says, “In the office I used to go to, they just accepted my insurance for everything and I didn’t have to pay anything more.”  Your response should be “Gosh, Mr. __________, I’m sure you didn’t realize it, but that’s illegal.  I’m sure your previous dentist didn’t realize he was breaking the law.”
  2. Client says, “I’ll pay what’s left after the insurance pays you.”  Secretary says “By paying us your estimated portion now, it reduces our billing expenses and helps keep out expenses down.  The lower our expenses, the lower our fees.  I’m sure you’d like us to keep your fees as low as possible”

HOW TO DEAL WITH LOW INCOME FAMILIES

If the client can’t meet any of the standard agreements, and you feel they are in financial trouble, thank them for being honest with you and say – “Dr. ____ doesn’t believe that money should be the reason that anyone has pain or loses teeth.  Let’s spread out your treatment.  We can help you keep your teeth, stay pain free, and have a healthy mouth in 5 years!  Let us give you information on how to save your teeth and we can do one appt. at a time and arrange for you to pay for that before we schedule your next appt.  I’ll tell Dr. and he’ll plan this out step by step.  How much would you like to spend at each appointment (or how much would you like to pay each month)?”  Then, go back to the dentist and see what he will accept.

Due to many new regulations imposed on the savings and loan industry, we can’t charge interest on overdue accounts.  These same federal regulations state that billing fees are not the same as interest payments.

 

Red flags for bad credit risks:

1.  No income or employed less than 6 months

2.  Sporadic employment or none longer than 6 months

3.  Lives in apartment or transient area

4.  Single, just moved in area

5.  No business phone or address

6.  No home phone, P.O. Box for mailing address

7.  Reluctant to assign insurance to us

8.  Prior history of slow pay or sent to collections in our office

9.  Don’t own a car

10. Recently divorced or separated

You may be able to place some of our clients that are having significant problems in touch with agencies that could help them.

 

Our Philosophy

I have found that people or families who only get emergency care have much unnecessary pain and usually end up with dentures.  Many times our clients tell us they want emergency care because that’s   all they can afford.  We respect people trying to live within their budgets, and this lower cost might be true for that one appointment, but it isn’t true over a lifetime or even a few years of emergencies.

Emergency care only stops pain, usually by pulling teeth. Eventually it becomes difficult to chew and the smile shows “gaps” of missing teeth.  It’s not long then until their appearance bothers them and they decide on dentures.  I don’t believe anyone should be caught in this bind and I care enough to try another way.

The alternative isn’t dental fillings and other repairs.  They are only expensive ways to put off dentures for a few years.  If the client can’t afford dental repair, then it would be better if he learned how not to need to be repaired.  This will keep his teeth for a lifetime at the least possible cost.

Our doctors would be glad to work with the client at no immediate cost so he can learn to avoid emergencies.  Then the secretary can arrange a program of regular care so the client will be able to fit it into his budget.  Soon the client will be able to chew better and look healthier and more attractive without pain or loss of time from work.

HARDSHIP ACCOUNT

Periodically one of our clients will undergo some financial hardship.  When this happens, let me know and we’ll discuss whether or not to place them in our hardship account.

Once placed on hardship, the client will need to make a minimum payment weekly.  They should be told to call us if they will not be able to pay something each week or the balance will be sent to collections.

 

WELFARE (Medicaid)

The client pays nothing.  Check to make sure their welfare card is current monthly.  For new welfare clients, make a copy of their welfare card.  Each time they return for treatment in subsequent months, mark in pencil on the copy that they are covered for the current month.  All welfare clients are entered into the computer as a family account and each claim is billed individually to the Welfare Dept.  Dr.’s standard charges are used.  It takes several weeks for the Welfare Dept. to pay us, so we want to send claims as soon as possible after the work is completed.  Any service covered by welfare, we must accept their payment, no matter how much less than our standard fee, as total payment.  We cannot bill this client for the difference between what welfare pays and our fees are.

However, some procedures aren’t covered by welfare.  These procedures are billed directly to the client at our regular fees.

Some examples of these services are:

1. Preventive Care appointments for adults

2. Diagnostic models

3. Fluoride gel for adults

4. Fluoride water test

5. STM – I recommend a PC appointment followed by one cleaning appointment (ultrasonic whole mouth).  Each 6 months we’ll do more.

These are to be paid at time of service only.  If can’t pay ‑ don’t give fluoride or bottle for fluoride water test.  For any service which requires another appointment, they must pay before the appointment is even scheduled.

 

Success depends on developing a friendly, cooperative relationship.  Objectives of this relationship are:

1. The role their mouths play in their lifestyle

2. That they can become healthy and stay that way

 

It’s best to work with whole families and particularly with Mom.  DON’T GIVE ADVICE UNLESS IT IS ASKED FOR.  Remember, allow people to be themselves and have their own values.  Over time, we can develop their desire to be healthy.  If you try to teach what they aren’t ready to learn, offer advice, or allow them to feel they have failed, then they will feel bitter, pushed around, and will disappear from our practice.  Other than this, we would offer them exactly the same treatment as any other client.

On some occasions, we may decide to refer them to the county dental clinic for extensive or non-covered care.

Often, if patient is pregnant and in pain, no FA’s needed- just let the doctor know the money situation and he will do treatment anyway.

 

EMERGENCIES

“Mr. Pain, the fee for today was $34”.  If he has no money with him today – “Here is an envelope (stamped and self‑addressed).  This will save you a trip.  I’ll make a note that we can expect your $34 by Friday.  Dr. has indicated you would like another appt. for _____.  Once I receive your payment, I’ll call you to schedule your next appointment.”

 

GOOD CLIENTS, BUT. . .

They can’t seem to get their balance caught up and now it’s time for recall.  “Hello, Mrs. Slow Pay.  This is _____ from HeathPark.  When you were in last you asked me to contact you when it was time for your recall examination.  However, you still have a balance on your account.  How would you like to handle this balance?  (This will have to be paid before I can schedule further treatment for you.)”

 

YOUR FEES ARE TOO HIGH

No matter how reasonable our fees, some clients will complain. Here is the response:

“I’m sorry you feel that way.  We are always looking for ways to reduce our overhead and keep our fees down.  If you notice anything, please let me know”

 

Spouse is responsible for payment and wants to schedule child, but there’s an unpaid balance.

Don’t schedule any further appointments for treatment until the finances are straightened out.  The parent who brings the child in must have the ex‑spouse call us to set up financial arrangements directly.  Don’t schedule any appt. until we talk to the other spouse.

 

DIVORCES

Watch out!  Sometimes a spouse will try to run up a big dental bill to punish an ex.  Be sure to check with the party who will be paying the bill before treatment.  Get these questions answered:

  1. Which parent is responsible for making the child’s dental care decisions?
  2. Has the court restricted either parent from access to the child’s dental record?  (We must see copy of court order.)
  3. Which parent is responsible for paying for the child’s treatment?
  4. Address/telephone number of non-resident spouse so we can inform of treatment.

This person must understand and accept treatment before we begin! The parent who brings the child for treatment is ultimately responsible for payment if we can’t talk to the ex‑spouse.  He or she can get reimbursed from their ex‑spouse or attorney.  We do not get in the middle.

Previous Write Off/ Financial problem

  1. Chairside will recognize the problem and refer the client to you.
  2. Escort client to a private office.
  3. Tone: professional, stern
  4. Review past treatment, fees, collection efforts
  5. Accept the client’s excuses
  6. Reaffirm that “our accountant” has established a “no credit” policy for anyone who has been a collection problem in the past.
  7. The client wishes to continue treatment with us, they must:
    1. Pay off past due balance
    2. Pay the non-insurance estimated portion before the next appointment can be scheduled
  8. If client has insurance, verify the coverage we can expect so the client “won’t be surprised if their insurance company pays less than expected.”

 

IV Sedation Consult- for Children

Same as outlined for adults with these additions:

“I have reviewed Kyle’s treatment that you and Dr. Dajani agreed upon.  I have seen Dr. Dajani do this type of treatment many times.  She is wonderful. First of all there is a lot of great things about having treatment done with IV sedation. This brochure walks you through some of the benefits. (Open brochure) The anesthesiologist will be Dr. DeVaney.  Here is some information about Dr. DeVaney and her phone number, so if you have questions for her, feel free call her.  (I usually put a star next to her name on the brochure).  Be sure you read this brochure and follow the instructions carefully.  Do you have any questions on the sedation part of the appointment?

Do you have any questions regarding Kyle’s treatment plan?

( Yes) – Get Dr. Dajani to answer them

(No)

For this treatment, Dr. Dajani will need about 1.5 hours.  The total fee is $2,500 and the cost for the anesthesia is $550.  I like to think of the cost in two groups – one for the dentistry and one for the IV sedation (I usually use hand gestures to communicate this also).  Let’s go through each.

For the dental treatment, the total cost is $2,500 and we estimate your insurance will cover $1,000.  Often, your coverage is a little different from what we estimate.

For the IV sedation the fee is $550.  Medical insurance may reimburse you for some of the IV sedation fee.  Most of the time, health insurance does not cover this fee – but sometimes they do – it’s worth the call.  Follow the script that we have in this handout (refer to brochure- I usually read this section & have them follow along).  You have all the information that your medical insurance needs to make a decision – you have the list of treatment, the length of the sedation appointment and our total fees.  If you call them, be sure to have them talk to you in terms of dollars, not percentages- and be sure to get the name & direct number of the person you talk to so you can follow up.  Since it’s your insurance company, often you get a better response than we do.

If they will pay part of the fee, they usually will give you a confirmation number.  We ask that you pay the total amount to Dr. DeVaney/Dr. Dajani.  We will fill out a form for you to submit to your health insurance and they will reimburse you.

Do you have any questions on your dental or medical insurance?

(No)

Good!  We expect that your insurance will cover about $1,000, so, your portion will be $1,500 for the dental treatment and $550 for the sedation; that will be $2,050.  How would you like to take care of that?

Then, follow the regular financial arrangements guidelines.

Once that is complete, write up the agreed upon financial arrangement on the form & have the parent sign.

Schedule the appointment.  As you can see, Dr. Dajani  and Dr. DeVaney schedule only one client at a time for IV procedures.  If, for any reason, you must cancel this appointment, please give us a minimum of 3 days notice to that another child can be given this time.  Also, it’s very important that you be here on time.  Dr. Dajani  has arranged enough time to complete all of Kyle’s treatment.  If you are late and Dr. Dajani  is not able to do Kyle’s treatment, the appointment will have to be rescheduled.  There will be a $175 rescheduling fee.

(Note in the appointment the financial arrangements.)  Note on the tx sheet that you did the consult & the result.  Give all paperwork to Mom to take home.

If Mom doesn’t make a financial arrangement, tell the parent the date you will call to follow up.  Put this note in your daybox.

You will pass this task when you have a tape that meets all the check list steps.  To explain to parents why you are taping the consult, say “I am training a staff member and would like to use our discussion to help make sure that everything is covered properly. Is it okay if I record our consultation for internal training?” Then, after you record it, you need to listen to your tape and make notes about how well you did on the sheet and give it to your team leader or dentist to approve.

_________________________                      _______________

Approved for financial arrangements                     Date

 

Financial Arrangements Quiz:

1)  Client is paying in full for tx, total fee is $985 and insurance is estimated to pay $358.  Give example for each discount.

a)  What is the discount for paying with a credit card?  ________%   $_________

b)  What is the discount for paying with cash or check?  ________%   $_________

2)  Client is paying for tx, in full, on day of apt.  Do you give any discount?

a)  If yes, what and why?

b)  If no, why?

3)  Senior Citizen is paying in full for tx, total fee is $1,589 and insurance is estimated to pay $469.  Give example of how to do the discount.  The discount is __________% $ _________

4)  If a client chooses Care Credit, do you give them a discount for paying in full?

a)  If yes, what and why?

b)  If no, why?

5)  When do you charge the clients Care Credit account if using Care Credit to pay for the whole tx plan?

 Checklist for the Consult: (Adult)

1.   My role- organize, knowledgeable, facilitator

2.   Review tx & answer questions – – discuss warranty

3.    Compliment doctor’s work

4. Schedule long/short- favorite day, be on time

5.  FA’s

  1. Review dental and medical insurance coverage
  2. Set financial arrangement – Ask: How would you like to take care of your portion?
  3. If cannot afford – Ask: What is your budget per month? Then schedule as paid monthly.

6. Client signs the Word treatment plan

7. Document consult on yellow treatment sheet

8. Organize the chart

In summary – from the time you spent in this consult, you should know:

  1. Why your patient wants dentistry done?
  2. When they want it completed?

To review your tape – write what you said for each:

1. Did you tell the patient your role? _______________________________

2. Words you used to describe your role: __________________________________________________

3. Did you review treatment and answer questions? __________________________________________

4. If the patient said no questions, did you review the handouts to make sure they can review them when they get back home? _________________________________________________________________

5. Did you discuss the number of visits and length? How many? were there for this patient? ________________________________

6. Did you ask about the patient’s schedule to find out when they would like all treatment completed? Is there an event coming up in their life that they are wanting to look good for? What is it? When? ____________________________________________________________________________________________________________________________________________________________________

7. Write the specific compliments you gave the dentist _______________________________________

8. Did you explain how the warranty works? When are they due for their next cleaning? __________________________

9. FAs – Did you review the total cost of treatment and clarify what is included? Write the total cost $______________

10. FAs – Did you review the dental/medical insurance coverage? Write it here $____________

11. Did you ask “How would you like to take care of your portion?” – Write the patient’s response here: _________________________________________________________________________________

12. If money was a concern, did you ask “What is your budget per month for dentistry?” _____________

13. Did you review the pay as you go form with the patient (only if $ is a problem)? _________________

14. Did the financial arrangement you established follow office guidelines? Write the FA you set up here: __________________________________________________________________________________

15. Did you have the patient sign the treatment plan?  _________________

16. Did you charge out “Case presentation” in Dentrix? _______________

17. If paying in full at a future date, did you note in your planner & the appointment to collect? ________

18. If using patient financing, did you put a copy of the checklist into the chart & start working down it? _________

19. If using pay as you go, did you get the form filled out, signed & to the proper person? _______________

20. Did you let the dentist know how this consult turned out? ____________________________

 

Checklist for the Consult: (Child)

  1. My role- organize, knowledgeable, facilitator
  2. Review tx & answer questions – – discuss warranty
  3. Compliment doctor’s work
  4. Schedule long/short- favorite day, be on time
  5. FA’s – Review dental and medical insurance coverage; Set financial arrangement – Ask: How would you like to take care of your portion?  If cannot afford – Ask: What is your budget per month? Then schedule as paid monthly.
  6. Client signs the Word treatment plan
  7. Document consult on yellow treatment sheet
  8. Organize the chart

 

Financial Arrangements Tape:

1. This is a difficult task to learn and apply to real clients. Once you feel you are ready, let your team leader know and she will role play a couple of financial arrangements with you. There is no acceptable “close enough” approach to financial arrangements. This is a major stumbling block to clients receiving the care they want as well as a major reason for complaints when treatment is complete.

2. The philosophical purpose of this appointment is to give your client as much control of the situation as possible. You’ll do this by asking questions, making notes, and then meeting the needs of the client. You’ll get them in the “control mode” with easy questions so that by the time you get to the financial arrangement she/he will be comfortable working with you.

3. Once you are comfortable with our approach you’ll be comfortable asking for payment at all appropriate times. Once your team leader says you’re ready, do as many financial arrangements as possible and tape record them all. Use the check off list at the end of this section to see steps required. Once you have a tape that has each step correct, give it to your team leader to review.