The ability to differentiate products and procedures has not always existed in dentistry. The explosion in dental technology has allowed this to evolve. The question is often asked, “But will insurance companies allow you to do this?” For Heaven’s sake people, why do we as health care providers continually ask this question? Remember these words: VALUE ADDED SERVICE. When you differentiate a product or service, it is either a cosmetic or a value-added service. These costs are between you and your patient; they are not covered by insurance because they are “created” codes, not covered codes.

I am not an insurance advocate from a provider standpoint, but do understand this: insurance companies provide insurance products to customers. These customers (your patients) are led to believe that their dental insurance is the best thing that ever happened to them. If you slam their purchased product, you’re slamming their intellect, and you just might lose patients for doing so.

Most insurance contracts, whether clearly or hidden, allow for value-added services and cosmetic upgrades. These services are billed directly to the patient, not to the third party insurer. Billing such services using the “unspecified procedure by report” codes only delays insurance claims because they are usually confused as to the 9900 type CDT codes that you may use on insurance claims. We simply teach our clients how to create new codes to track upgrades and value-added services.

Dental Insurance reimbursement fees provide the basics to their customers (our patients) yet certainly do not prohibit their clients from technologically improved prosthetics, restoratives, or services that may be more expensive to us providers. They never expected us to pay for our patient’s oral healthcare. That has been one of the biggest fallacies of misinformation that has propagated throughout our dental profession. All dental insurance companies simply require the patient to be informed for increased value-added service costs. In addition, they want you to have something in writing for the patient to sign explaining the additional fees for the upgraded service you provide.

What are you saying, Rob? You read correctly, and it has always been legal. It would be an insurance rep’s lunacy for their customer not to let the CEO’s daughter, Suzy, have those super expensive crowns on her newly fractured front teeth if their client is willing to pay more out of pocket for better technology. Doc, you do not need to pay for them either! You would bill the insurance the regular D2940 code for an all porcelain crown, and bill the patient a created code, description, and fee for the upgrade. Such a code might read like this: D2995, IPS eMax, $150.

Codes, descriptions, and fees can be created in most practice management software. Just look under the “office manager” icon, go to practice set-up, and then codes and fees. Remember to check the box that says, “Do not bill to insurance”. When insurance companies see an unidentifiable code, they reject the whole claim and require an explanation. They all understand the phrase, “cosmetic upgrade” when it comes to an explanation of more expensive dental materials. Do not attempt to explain the difference between zirconium and lithium disilicate ceramics. They are not dentists, and the claim will be delayed further.

Most of the time our worst enemy is ourselves, only because we don’t communicate with our patients about newer and better technologies, and the costs associated with them. It’s a fear thing. Often, we don’t know for ourselves what’s out there for lack of continuing education, and we certainly don’t read those insurance contracts from front to back. Allow common sense to prevail.

Attend one of our intro courses, or webinars on The Clinical Business of Dentistry for in-depth training on this “trading up” concept. As of to date, not one office has been disappointed! Stop doing free dentistry on your patients, and learn how to recover forgotten profitability again with the oral healthcare you provide.

Dr. Rob…

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