Benefit From Insurance – Even If You’re FFS

By April 2, 2019 May 10th, 2019 Podcast
Benefit from Dental Insurance

Episode 009 – Benefit From Insurance – Even If You’re FFS

We invited Tonya from MDFC to speak with us today because most of our listeners are FFS practices and one of the most commonly asked questions from their new patients is “Do you take my insurance?” Tonya is here today to let our listeners know that you don’t have to turn these patients away.

There are ways to get these new patients through the doors and still be a FFS practice.

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S1: 00:16[music] Hi, everyone, and welcome to the My Dental Agency podcast with your hosts Jackie and Sean.
S2: 00:21Just in case you guys are not aware, we're a dental marketing company. We eat, breathe, and sleep dental. All right, maybe it's not our whole lives but it's pretty close. We believe in thinking differently from other mass marketing groups that you're probably used to and we help you stand up against corporate dentistry. Yes, you heard me say it, we help the little guys. We do this by helping independent practices like yourself build genuine relationships with patients, create and manage positive reputations by utilizing online resources and retain your current patients. And you're probably thinking, "How the heck do you do that?" We do all this by creating custom, relatable, personalized and distinctly different campaigns that reflect the needs and personalities of each individual practice. It's as simple as that.
S1: 01:12So providing just valuable education to the dental community is a really big focus here for us and this podcast just serves as one way that we do that. So in this episode and in episodes to come, we'll be talking a lot about common frustrations dental practices have with marketing, big marketing wins we've seen, have been a part of and even some really big failures. [music] We'll also be sure to share as many tips and tricks as we can to make sure you're staying up to date on how you can really just best market your dental practice.
S1: 01:44So today we're joined by a very special guest, Tonya Evers, from Medical-Dental Financial Corporation. And in today's episodes, Tanya's going to share some tips for maximizing patient insurance benefits that it will allow you to take advantage of more financial and new patient opportunities in your practice. I know a lot of our listeners are fee-for-service practices and probably don't have much interest in taking insurance, but please I urge you to hear us out. A lot of these tips are going to apply to you as well.
S2: 02:12So we invited Tonya to speak with us today because most of our listeners as Sean just said are fee-for-service practices and one of the most commonly asked questions from their new patients is do you take my insurance. Tonya is here today to let our listeners know they don't have to turn these patients away, there are ways to get these patients through the doors and still be a fee-for-service practice which is huge for a lot of our listeners and a lot of our clients honestly. So you might be thinking, "Jackie, what does this have to do with marketing and what are we going to learn today?" And it, honestly, is a great question. I do want to say, first of all, ourselves, as My Dental Agency, we see ourselves as partners to our dental practices and not just a marketing agency which truly means that we want to provide as much value to you guys as possible. And secondly, more selfishly, we're driving these great, quality leads through our marketing that have the marketing and are ready to pay but are turned away by a lot of our clients and a lot of listeners in this similar scenario they get turned away because there are no financial options for them, and then these leads from the marketing campaigns - whether they're from us or from your marketing company - they end up being a waste. And most practices today are losing thousands and thousands of dollars with unaccepted treatment plans. We know this from our end but after Sean and I have obviously chatted with Tonya multiple times prior to this recording and she's telling us the same things. So we're happy to tell you there is a way.
S1: 03:45So Tonya, tell us how these practices are losing new patients and revenue by not tapping into their patients' benefits, specifically for things like oral surgery or cone beam CT, sleep apnea, dental implants, things of that nature?
S3: 03:59Yeah. Absolutely. So a lot of patients price matters and if they don't have the funds, they're going to walk away from the treatment plans. That being said, by tapping into benefits that they're already paying premiums on you're going to be able to market it to more of your clients or even clients that have, in the past, declined treatment because they couldn't afford it. So the different procedures that can be billed up are multiple different oral surgeries but not just by an oral surgeon - general dentist, periodontist, implants, [inaudible] grafting, sinus augmentations, alveolectomies, gingivectomies. Wisdom teeth are covered on a lot of policies. There are stipulations such as age requirements on certain policies but that's something we find out for when we're checking benefits on patients. Sleep apnea, TMJ orthotics or appliances as low as exams or imaging. And the great thing with imaging, the medical side, is unlike dental where it's one in every 60 months for a CT or one in every six months for a [inaudible], there's no frequency. Now, that's with the tone being CT because the only way FMXs or [inaudible] are covered through medical is if it's trauma but the CT scans are covered -again, no frequencies and exams any time you see the patient. There's a diagnosis to go along with it you're able to go out your exams and you're able to use your UCRs, your usual customary rates rather than contract [inaudible] that most dentists have with dental insurance companies.
S2: 05:33Okay. So I mean I know this is probably an obvious question but can you articulate how adding this medical billing can increase the revenue for the practice? I mean I know it's obvious, right, but let's spell it out for our listeners.
S3: 05:49So a lot of times-- and I'll give you a scenario. I had a periodontist that we started billing for that used all these free consults to get the patients in, and I asked him for one month to set that aside and let us bill out the exams. We collect $7,000 in exams in one month.
S2: 06:06Wow!
S1: 06:07Just one month?
S3: 06:08And it was a $49-- yeah, he made it a $49 consult. So they're losing money because they're giving away free treatment. Their time is money. So that's one way of increasing it. Another way of increasing it is those case closures that patients with four kids or with kids in general or that are financially on a budget will look at the treatment plan and not want to spend that money on them even if it's going to better their life and better their health. And it kind of helps give them other options to where it lessens their out-of-pocket where you're still able to access their medical and you can bill out their dental as a secondary if you wanted to lessen it even more. So it would definitely help with treatment closures and increase the revenues on that side of it.
S1: 06:58And then I think you know, obviously, from Jackie and I speaking with you quite a few times in the past we're aware of some of these things but tell the listeners about things like dental implants, right. I know a lot of practices we work with and just a lot of people in the industry really believe that that's not something that's typically covered by insurance and I know that you know a little bit differently. So can you talk a little bit about that?
S3: 07:21Yeah. Absolutely. So the difference between dental billing and medical billing is dental's pertaining to the actual tooth structure and medical billing's pertaining to the tissue and the bone. So if you were extracting a tooth because there's an abscess or an infection underneath it and ended up [inaudible] the area doing the bone graft and then doing the implant, that's all covered because you're returning the patient back to a normal function such as feeding which is obviously a daily activity [laughter].
S1: 07:48You would hope.
S3: 07:49And with that, a lot of-- yeah [laughter]. Unless you want an NG tube going down your throat. But a lot of insurances cover these-- again, they have to have underlying systemic issues - so diabetes, AIDS too, lowering your immune system to fight off infection, patients with high blood pressure 95% of the medications that MD's prescribe for them cause dry mouth. Obviously, dry mouth creates a bacteria that increases and can deteriorate and can [inaudible]. So all of it we connect the dots for the insurance companies to prove that it's a medical case to get the medical coverage. And then there's certain insurances that-- so Blue Cross Blue Shield of Texas, Illinois, and Michigan don't allow implant coverage - they're contract exclusions. However, with medical, it's not always do or die. There's a way around it. So if you're placing bone the same time you're doing the implant you're able to bundle that as one procedure and the reason you're able to do that is if you don't place the implant which in medical terminology is called a bone stabilizer, if you don't place that implant, the bone's gone atrophy and you're going to have to redo that procedure. So they work together for the future.
S1: 09:06Right. So I think the biggest thing-- for me, I think the biggest takeaway here is that obviously a company like MDFC, like yours, really, obviously, by working very closely with all these insurance providers really knew the ins and outs of, obviously, what the benefits are, how to maximize them and how to take advantage of them and really utilize them. Obviously, to get these patients healthy and get them the treatment that they need but obviously, that's a big benefit to all these dental practices as well who I think are probably not seeing the entire picture when they're kind of making a wholesale decision not to take insurance at all.
S2: 09:45And I mean, correct me if I'm wrong, Tonya, but it seems to me it's a win-win. So all these practices that are fee-for-service they can still be fee-for-service essentially, right? And all these patients that we're saying today they're qualified patients. They're patients with money, they're patients with the intent to get these procedures, they now can take advantage of this. So win-win. We're not saying that these fee-for-service practices now have to turn into insurance driven. I'm correct in stating that, correct?
S3: 10:19Absolutely. Most dentists are not in network with medical insurances depending on the area and what they want but they are able to access their out of network benefits. So the doctor is still able to use their usual and customary fees and get paid in doing it and it's helping the patient pay for it on their end or get reimbursed for those fee-for-service offices. So it is a win-win. It's a win for the patient because they're able to access the benefits that they've already paid for, and it's a win for the doctor because they're able to close procedures or treatment plans that were too expensive for the patient to handle on their own out of pocket on their own.
S2: 10:56Okay. And I'm sure a lot of our listeners are at the point thinking, "That's great. That sounds great. I can still be fee-for-service. I could take advantage of this, but I do not want to deal with this." This is probably one of the reasons that they get away from it is because it's such a headache, right? And I think that's where your company comes into play. So why don't you tell us a bit about how you're helping your practices today and what that looks like - the benefit of using a company like yours?
S3: 11:30Absolutely. So my background - I'll tell you a little bit about me - I worked for an insurance company-- can't stand them but [laughter] I worked for one as a claims examiner and the training is minimal and they a really are trained to not pay out. So a lot of times I hear when dentists try to do start doing medical billings it's not successful it's because it's not being done right. Medical is very different from dental - much more detail-oriented, they require a lot more information. And what MDFC does is we take that off of your hands from start to finish. So for fee-for-service offices, what they do is-- and I have offices that are not fee-for-service but we're going to focus on the fee-for-service because that's what y'all specialize with in your practices that you have. So for fee-for-service offices, they get the insurance when the patient comes in and not prior to and that's because they don't want the patient to be insurance driven. So with that, they would be sending us their-- we remote into that practice. We'll pull their information based off of the [inaudible] letting us that their medical information is in there and depending on what kind of office the practice is would be what codes we check. So if it's surgery, we check surgery specific; if it's TMJ sleep, we check the TMJ. So you'll know right off the bat if the patient needs authorization or not. If the patient then decides to proceed with treatment, our clinical team will create what is a medical [inaudible] and send them to the office for their approval. It comes to them in an editable format where they can change whatever they want. Our team will not initiate the authorization until the doctor signs off on that [inaudible] and then from there we move forward.
S3: 13:14Once it's approved, we'll fill it out and we'll follow it all the way to closure. So we have three different departments here at MDFC and you get to utilize all of our department but it frees up your patients or it frees up your employees to focus on patient care rather than being on the phone with an insurance call for two hours just trying to get a [crosstalk].
S2: 13:36Sure. I'm sure that can be a huge headache.
S3: 13:38[crosstalk]. Oh yeah. And that's where they-- I mean the most-- I hear it all the time from offices that we don't bill for that prior to us taking over they would spend countless hours on phone calls and barely get anywhere. But insurance companies are trained to read from the screen and not give you information. We're trained to get around that [laughter].
S1: 13:59Sure. Sure. So I mean it really sounds like without really adding any additional labour or really any other additional resources at their practice that they can really start taking advantage of their patients' existing medical benefits to help complete more treatment plans and get their patients healthier and even getting in front of more new patients without really doing hardly anything different at their practice at all. It sounds like you guys really handle just about everything for them and they just kind of get the benefit from it.
S3: 14:33That's correct. So we do the four weeks of webinar training and when we're doing that webinar training with the office obviously there's certain things that need to be in the patients' chart for us to be able to do our job which we go over, but unlike most medical billing companies they have their process and that's their process, we understand that each office is different. So as we're training and we're going through everything, we tweak it to emulate what the office is already-- what their workflow already is because we don't want to make it harder on the office. Our whole point is to make it easier and to get the turnaround and the increased revenue that they're looking for.
S1: 15:15Yeah. That sounds really beneficial.
S2: 15:17Absolutely. And I'm going to take a gamble here and I bet we still have some practices that are listening that may be skeptical and hesitant to do something like this. So do you have any stories, Tonya, of practices that you talked to, didn't want to move forward, kind of pushed back, and then obviously ended up moving forward and found this to be extremely beneficial? Do you have any stories you could share with us?
S3: 15:49Yeah. Absolutely. I have one office in particular, they're a fee-for-service office so the doctor's question to me was, "I'm already getting my money. Why would I pay you to bill these or bill medical out for my patients when they're already paying in full?" And then he tried it and he said, "I tell the patients, hey, depends on your policy, depends on what they cover. You might not get anything back. So they already have a really low expectation of what they're going to get back from medical, but when they get a $4,000 cheque, they love me which makes me love you [laughter]." So there's that and then I have other scenarios where I have a patient that-- and I typically don't do dentures or [inaudible] natural teeth unless it's trauma-related because that's more dental but this patient had [inaudible] surgery and it caused [inaudible] and we were able to get the dentures covered for a patient and they were a fee-for-service office. So the patient wasn't willing to go forward with treatment and until we were able to get that covered. And we actually got it approved and they moved forward with treatment as soon as we got it approved. So there's a lot of different success stories whether it's TMJ sleep and or surgery, but it definitely helps with the patients. And when you have a happy patient they're going to tell, I don't know, tons of people. If you have a patient that wasn't happy because they couldn't afford treatment and they walked away not getting it, well, this eliminates that. This gives them more options in order to have the treatment that's necessary rather than waiting around for the money to come in so they can afford it.
S2: 17:40Sure. And again, I can't say this enough, the practice can still be fee-for-service and continue as is. But obviously from the couple of stories you just shared their patients are going to be that much happier when they do get some reimbursement which obviously you guys help with. And then this is clear as day to practices that are not fee for service how they can tap into these benefits even more.
S3: 18:11No, absolutely. Yeah. And the thing that gets me the most is the patients are already paying for these benefits and a lot of dentists have either had a bad taste in their mouth because they tried to do it themselves. And like I said, there's a lot that goes into it. Medical is very detail-oriented and they are expecting certain things on the letter as a medical necessity or certain things, and we go over that in training - what our clinical team looks for in the chart notes that need to be there. And there's also medical terminology versus dental terminology. So it's doing it correctly and accurately that's going to get the offices or the patients reimbursed.
S2: 18:46Great. And I know we-- obviously we're talking to a lot of general dentists on our podcast and the listeners, the majority, are general dentists but we have a good chunk of them that have sleep practices and we obviously help those practices as well. Can you tell us a little bit about that and how you're helping your practices that are treating for sleep and TMJ?
S3: 19:13Yeah. So what we do is, in the training again, we kind of go over what's highlighted. A lot of times, and I'll give you an example for a sleep client. Say they have a low age [inaudible] in their sleep study and it's not necessarily within the medical policy for an approval. If they have an underlying condition such as hypotension, history of stroke, heart attack, [inaudible] depression, anxiety, anything like that, a lot of times offices don't know that that should be put into the information given but that could be difference between the approval and the denial. And then when I first start off with sleep and TMJ centers that are new to it, their number one question is, "Oh, I can't diagnose them with hypotension. That's outside of my scope." And I said, "No, but if they've been diagnosed with it before, you just use the diagnosis [inaudible] meaning you'd already diagnosed it with them. You're adding it on there to strengthen your case." So we kind of go through all the chart notes with a fine-toothed combed and we always tell them, especially for TMJ, I always want to know on a pain scale of 0 to 10 - 0 being no pain, 10 being the worst - [inaudible]. And the reason I tell them to always put this in their notes is because, with insurances, the pain level is high up there as far as urgency of getting stuff done.
S3: 20:35So it typically goes trauma then pain and then depending on what the procedure is or what's going on afterwards is the order that the diagnosis should go in, the pain is always really high up with the insurance companies as far as claims. Now, kind of ironically on the backend the claims when they go through the insurance company it's an algorithm in the computer. So if it has certain codes they'll automatically deny it. If it's not in the right order if the diagnosis kind of isn't put in the right order. So putting that information in the correct order which is where our expertise is is what get the claim pushed through.
S2: 21:13All right.
S3: 21:13So there's a lot of stuff on our end that most offices don't know. So we'll put the diagnosis codes in the correct order. We'll attach the right modifiers to get paid or paid at a higher reimbursement. So we do all of that. We're literally taking it off of your hands or off of the office's hands so they can focus more on patient care.
S2: 21:33Yeah. You guys are like medical billing wizards essentially [laughter]. Working your magic behind the scenes.
S1: 21:40I really kind of related to the same thing that it's not totally a different thing is about it's very similar to us, right? Obviously, the dentist that we work with here at My Dental Agency they want to focus their time practicing the dentistry and a lot of them have a very specific type of dentistry that they are really passionate about and love and they don't want to be involved in marketing and growing their practice. Obviously they know it's important, they want to achieve those goals but it's not their specialty just like you wouldn't sit Jackie or I down in front of a patient and ask them to do any kind of dental work on them, right? I mean it would be a nightmare. And so I mean what you do is very similar to that. I mean a lot of-- Jackie and I talk to practices every single day-- I mean literally almost every single practice that we work with and that we speak to has had a bad experience with a marketing agency, that doesn't mean that all marketing agencies are bad, that doesn't mean that what we do isn't important and necessary for a dental practice to grow but it's the same thing with you. I mean a lot of practices is probably the reason that they are fee-for-service, not that there's one overarching reason but one reason is probably because they've had some difficulty or bad experience with insurance in the past and it's not just because you had that one bad experience or have a set up the list that may not be 100% correct doesn't mean you shouldn't be looking into these other options because at the end of the day, a lot of the practices, certainly the practices we're working with but a lot more than that are investing quite heavily in their marketing and they're driving new patients to their practice that are asking questions about insurance. And obviously and we're big believers in not kind of being in network and having to deal with those contracted rates and things of that nature but there are ways like we've share today like you've been so kind to share today, Tonya, that these practices can really be taking advantage of these benefits these patients have to complete more of these treatment plans.
S1: 23:35So I think it's just a huge value. We're not obviously preaching to these practices that they should become insurance drive or not be fee-for-service - that's not at all what we want and we love working with fee-for-service practices. The large majority of the practices we work with are exactly that. It's just I think that there are some really good ways that they could be completing more treatment and really getting in front of more new patients and getting more of these new patients that are showing interest in calling the practice to actually come into their practice and complete treatment which is obviously why we invited you on the podcast to talk about that today and really educate our listeners.
S1: 24:11So, Tonya, I want to thank you so much obviously for joining us today. It's been a pleasure having you on our podcast. I know our listeners are going to get quite a bit of value out of all the information that you shared here today. But for those that want some more information about MDFC and what you guys can do for them, tell us where they can find out more about you guys.
S3: 24:31Yes, thank you so much for having me. Yeah. If you go to www.mdfc.info. So it's Micheal, Delta, Frank, Charlie dot info. It gives you a summary kind of-- it's our webpage but it'll tell you all about us. And then if you have additional questions, feel free to reach out to my assistant, Miranda Kennedy, at 210-879-9630.
S1: 25:03Perfect. Thanks so much, Tonya. Once again, their website is mdfc.info if you want some more information on what they can do for your practice. So thank you so much for joining us, Tonya. We really, really appreciate it and hope you have a great day.
S2: 25:16Thanks.
S3: 25:16Thank you.
S1: 25:20We hope all of you enjoyed today's podcast. Be sure to subscribe on iTunes or your favorite podcast platform to make sure you receive all of our future episodes. I also encourage you to visit our website at mydentalagency.com or email us at podcast@mydentalagency.com if you have any questions or comments. Thanks so much for listening.
S2: 25:36See you guys.