Dental insurance plans don’t pay for tooth whitening, yet most dental offices charge the patient for it directly. The same applies to electric toothbrushes. However, when it comes to better technologies, materials, or skills, offices will write off thousands of dollars each month.
In those three examples just listed, you wouldn’t think of not charging the patient for those services. In contrast, very few dental offices charge for local anesthetic, oral facial images, and pulp vitality tests, yet you should. There are costs of goods combined with overhead associated with those services. This ultimately means you’re losing money every time you don’t bill for those procedures. No business runs like this, and neither should any dental practice. The majority of dental teams have been convinced that if dental insurance won’t pay for it, they have to write it off. Heaven forbid you actually charge the patient directly for services the PPO Plan won’t cover.
The Problem
I learned many years ago never to treat the PPO patient to their insurance plan. Imagine doing an anterior case from tooth #4 to tooth #13. You want the best for your PPO patient, you want that smile to really pop beautifully with translucent teeth, slight color variations from the middle third to the incisal third. Maybe some I-1 incisal edging, and some small portions of chalky white to mimic what they had before, and insisted they have on the new ones.
Will the hundred-dollar-a-unit lab be able to follow those requests? Nope. You’re going to have to run with the “high-end” lab or put some time into your Cerec unit when you make the crowns. Either way, to accomplish these life-like crowns, you’re going to need to go with the more expensive technology, whether in a lab or in your office.
Your patient is insured, the plan states that you have to charge the contracted amount regardless of maximums met, and the reimbursement fee is $650 per crown. Your lab fee is $285 per unit or the equivalent in CAD/CAM fees. You’re not going to be profitable, it’s that simple. Anyone who looks at their overhead understands the lack of profitability, or worse, the fact you are paying for your patient’s dental care. Every, or nearly every procedure should be able to stand on its own when it comes to profitability. This has become nearly impossible with PPO reimbursement rates, and the cost of doing business within the dental industry.
Most dentists will do one of two things when it comes to crown procedures:
- They routinely order a cheap crown to increase profitability
- Eat the cost of the better crown with their PPO patients
Neither of these options sounds good to me. Is there a better way?
It’s Right in the Contract 
Little did you know you can still give your patient the beautiful crown they want and deserve, and be paid fairly for your work. Your contract will allow you to charge a cosmetic fee payable by the patient. It’s right in your contract. You know, that contract you have never read…
If we can charge for whitening and electric toothbrushes, why don’t we charge extra for better materials? If given the choice, your patient would likely be willing to pay an additional fee for the better crown. In fact, over 99% of our patients choose the better crown every time. It’s just a matter of educating the patient, and understanding your contract with PPO Plans.
Why Won’t Insurance Pay?
Every time I talk about any value-added service with dental team members, I almost always hear the question, “Will dental insurance pay for it?” Dental insurance plans will never pay for any additional value-added services, let alone many procedures that are actually listed on the fee schedule because they are considered “non-covered” services.
The premiums paid out by your patient’s place of work, or the patient themselves, are not high enough for the dental insurance plan to cover dental procedures at a price point that is high enough for you to break even. Don’t even think about making a profit with traditional thought leadership with current billing practices.
Most dental offices treat according to “perceived” insurance regulations. This means that they only charge for what the insurance is willing to pay. So either the dentist is losing money by providing the best products and materials, or the patient isn’t receiving the best quality work. Sounds like a lose-lose situation to me.
Stop Working For Free
You need an oral facial image to prove the need for treatment, yet the insurance plan won’t pay for it. “Oh Rob, it only takes a few minutes to take a photo, why would I charge for it?” Well, let’s see, the camera wasn’t free, the operatory wasn’t free, you don’t work for free. Or do you?
The patient comes in for a limited exam, you smooth off a fractured tooth that is cutting into the patient’s tongue. You do a pulp test on it, you take a bitewing and periapical x-ray on it. You take an intra-oral photo of it too. There are six codes you can actually use on this visit, yet the patient’s insurance will only pay for one, maybe two. You write off the rest, or worse, you don’t even code the work you just did.
In this example, you just treated your patient to the dictates of the insurance perceived ideologies. Yet, you could have charged for all of them if you knew how to do so. But hey, since the insurance isn’t going to pay for it, why would you even think about charging for what you just did? Would medical charge for all those codes? Of course they would, and they do every day. Medical bills for everything, yet dentists are made to feel guilty to charge for their services. This is a bigger problem than anyone wants to admit, let alone change.
The Solution
Dental teams, do you realize you are conditioning your patient to receive free dentistry at your office? Forget the value-added services we discussed earlier, we are talking about codes you actually contracted with, and that you can charge for. And just because the patient’s dental plan won’t pay for it, you should not write them off. When you do, you are playing right into the hands of the dental insurance companies, giving them the fuel they need to call a code “non-billable” let alone “non-covered.”
Would medical write off procedures at will? Nope. You would get a bill in the mail right after your medical insurance paid their portion. Actually, medical facilities now require patients to pay their deductible and copay prior to rendering services. The more you educate your patients about this, the easier it is to not feel guilty for charging them for dentistry.
There are costs to running your business. There are codes, descriptions, and fees for what you do, and if insurance isn’t going to pay for it, you shouldn’t have to eat the cost. You never have had to eat costs if you understood how to push back with the contracts you signed. Stop conditioning your patients to receive free dentistry. You didn’t go to dental school, pay all that tuition, make all those sacrifices, just to be taken advantage of. If dental insurance doesn’t pay for it, charge the patient. It’s really that simple.
If you need help in learning how to implement the things I have discussed here, you owe it to yourself, and your dental team, to take our training courses here at My Practice My Business. Visit our website, listen to the testimonials, surf the content of our training programs, and then just sign up for our guaranteed training programs. It will be the best business decision you will ever make in your dental career.