Author: Darren Kaberna

Dental insurance, on its own, can prove to be challenging enough to decipher. Therefore, when two different coverages are thrown into the mix it can become even more complex and hard to understand. In order to facilitate your efforts, there are a few rules of thumb that should be followed for better treatment estimates and finalize the patient portion, thus making your job easier.

WHAT DOES IT MEAN TO HAVE DUAL COVERAGE AND IS IT THE BEST CHOICE?

What it doesn’t mean, is that the patient has double the coverage. But the good news is that it usually indicates a lower out of pocket expense for the patient.

Suggest a cost parison for premiums, deductibles, copays, etc. when a patient asks about adding a second plan. The benefit may not be worth the cost in some cases, but in others a slam dunk. Be sure to read the fine print on both of the dental policies to see which services each one covers or if there are any waiting periods and how the benefits will be coordinated.

PRIMARY AND SECONDARY – WHICH PLAN PAYS FIRST?

The primary carrier will pay first, the secondary carrier will pay second only after the primary carrier contributes. The general rule is that the plan that covers you as an enrollee is the primary plan and the plan that covers you as a dependent is the secondary plan. If the enrollee has two plans through current employment at two jobs, then the plan that has been in effect the longest is usually the primary.

The general rule is that the plan that covers you as an enrollee is the primary plan and the plan that covers you as a dependent is the secondary plan. If the enrollee has two plans through current employment at two jobs, then the plan that has been in effect the longest is usually the primary.

The purpose of establishing an order of benefits right away is to avoid processing delays and prevent overpayment, which can cause bigger headaches in the long run. In most instances, dental plans coordinate benefits – this means the primary plan will pay the claim as it normally would, and the secondary plan will pay what is left based on its coverage limits and up to 100 percent of the total claim. However, a secondary plan with a non-duplication-of-benefits rule reduces what would have been paid by what the primary plan has already paid, thus leaving an out-of-pocket expense for the patient. The only difference to this rule is if a plan has a no-coordination-of-benefits clause, meaning it does not coordinate benefits, will automatically be considered primary, and special rules are used to designate the order.

WHAT ARE THE RULES OF DUAL COVERAGE?

-The birthday rule is used if the patient is a dependent on both plans – the policy of the subscriber with the earlier birth date in the year is primary. EX: Mom DOB: October 7, 1977 Dad DOB: December 14, 1970 – In this scenario the Mom would be the primary insurance holder because October comes before December.

-If a patient has 2 policies through the same company, you will only need to submit one claim. The insurance company, in most instances, will process the primary and secondary together.

-The primary carrier pays its normal benefit and any calculation or adjustment of benefit is done by the secondary carrier.

-The secondary carrier will almost always require that an EOB from the primary insurance company be included with the claim submission. 

Taking the time to learn and understand the details of how dual insurance and the coordination of benefits works will surely alleviate insurance issues within the office. Not to mention, having a front office team that can help the patients with such knowledge and precision is just one more thing that adds value to your practice and will make you stand out.

Pay attention to the details of your life and business! Perhaps recalibrate!

Are you the kind of person that waits for disaster to strike before action, or, are you the kind of person that throws the proverbial dust under the rug of accountability to avoid confrontation?

Often when our Accelerate My Practice Coaches are onsite in dental offices and are quickly asked, “I don’t like confrontation, are you going to make me confront someone?” We often answer this way – would you prefer not to have confrontation and implement boundaries, so confrontations become minimized or even eliminated?

Let’s start with three areas;

1. Goals
2. Example
3. Humility

Goals – Do you make them? Are you the New Year’s Resolution-er, finding yourself miserably failing on the “new you” by February 1^st? By far, most humans do not set goals. Even less of goal setters follow through with accountability to those goals. Which are you? What would be your odds to make a goal AND visit the accountability that matches that goal daily? You would have a 365% better chance of maintaining your goal if you visit your goal daily. Let’s break this down to smaller pieces. If you made a goal, attaching accountability to it, visited that newly made or revised goal once a week, your chances increase for success verses hitting the goal full out and burning out in a month, eg, New Year’s Resolutions.

Examples – When you create your goal, do you give it relation to something reachable, attainable? Here is an example – Losing weight. How many people know HOW to do this (everyone)? Eat less, move around more. If you want to lose 50 pounds and just lose your umph, have you ever thought of losing one pound this week? Break it down. Mel Robbins, in her latest book, Take Control of Your Life, challenges changes to be a Lego piece at a time, not the finished product that overwhelms. Bit by bit, Lego by Lego, building sustainability along the way.

Humility – A humble servant will build boundaries and stick to the boundaries with steadfast humility. Boundaries are created to avoid confrontation. Done with humility, power prevails through servant leadership, a trait Accelerate My Practice teaches with consistency. For some of you, this may sound a little challenging… how do you serve with humility to be a powerful leader?

That’s where we come in!

At Accelerate My Practice, we focus on the mindset of the how and why in our thought process. We take you from your excessive weight to just a pound a week, metaphorically speaking. We do this through the three areas mentioned above. Want to know more?

Visit our website, Accelerate My Practice and contact one of our coaches. What we do and how we do it has been sustainable for many Doctors throughout this amazing country! Call us! Is it time for you to recalibrate?

In the third part of the Dental Implant Case Episode on AMP TV we realize how many topics are addressed in a surgical office when it comes to advanced surgical cases.

Think about the entire process:

The diagnostic wax up process, when to include an orthodontist, immediate vs. delayed loading options, space limitations, digital vs. analog techniques, surgical guides. 3D printing, planning how many dental implants are needed for different people, designing different prosthesis. Think about how you begin to provisionalize an entire arch if you need to, what abutments to choose/design, the CBCT…the list literally can go on forever.

Then I paused and realized that none of these things matter unless a doctor and treatment coordinator can connect with a patient on a different level and the patient earns your trust and allows you to do the dentistry of today. None of the training you have gone though can be used, none of the materials can be used and none of the technology can be used unless you get a “yes” from the patient.

Of course considering all of these things listed here are critical to great dentistry; however, maybe one thing that is overlooked too often is the fact that doctor/patient relationship and understanding what is driving your patient is just as important.

What is important to the patient?

Before you jump the gun and get to plan and preform a great surgical case, take the time and communicate with your patient about what is important to them. Why are they there in your office, what are they looking for or what is their primary goal going into treatment. If you take the time to learn these things about your patients and make a plan based off of what they need/want and you provide them options that allow payment to be reasonable you will always be closer to getting the “yes” you are looking for, the “yes” that allows you to do the dentistry we all love being a part of.

Planning the case and using the technology is wonderful but in my eyes, meeting someone and changing their life for the better is the greatest opportunity that we have in dentistry. That does not happen without slowing down and doing a proper consult and truly learning about what is driving your patient.

https://vimeo.com/255609857

We believe one of the major obstacles in dental treatment presentation/dental implant presentation is getting to the dental patient’s “WHY.” WHY do they want this treatment; how is it going to impact their life? If the dentist can get to that WHY, you will get to the emotional connection. You are on your way to getting the patient to “want” it perhaps even more than they “need” it.

This TV Show is the second part in the journey of Jan, a patient that needs a minimum of $35,000 worth of dental treatment and is looking for options to pay for it.

One of the points mentioned in the show is that there are always options. They might be a Chevy option, instead of the Mercedes, but you don’t have to accept that there is nothing for you to do. Basically, giving up before starting. How bad do you really want it? What are you willing to do to get it?

Knowing the WHY is a must in treatment presentation but other musts are:

1. Always have x-rays up
2. Always have the pictures up
3. Always have a hand mirror available so patient can see how they look
4. Always have models of each option you are presenting
5. Always make this patient your priority and do not allow interruptions.

As you are going through each option, don’t forget to bring the emotions, the patient’s WHY. This also shows the patient that you are listening and are empathetic; you care.

After the patient chooses their option, the next step is to create a financial estimate of the cost. One fact to take into account when presenting financials is that patients usually identify with a monthly payment rather than a large sum.

Don’t forget to watch the third installment of Jan’s journey. If you would like training on treatment presentation/case acceptance, contact AMP or your coach!!

https://vimeo.com/254759108

Over the next couple of days we will be focusing on a dental implant patient that came to us seeking advice.

We are excited to have the opportunity to share Jan’s Dental story today. This will allow us to provide Dentists and teams with a dental patient’s perspective.

Imagine the last time you bit into an apple; how long has it been? For Jan, it has been decades since she could enjoy that simple pleasure. Jan reached out to AMP for a second opinion; she doesn’t have the finances to move forward with needed treatment so she started doing research on how to obtain the financial means to save her smile.

About Jan

Jan was born with a congenital birth defect that deprived her of many permanent teeth. While most of us can recall high school as a time with friends or playing sports she remembers spending most Fridays driving an hour and a half to the school of dentistry for treatment needs.

She saw how the struggles of missing teeth affected her parents and yearned for a different outcome. In her early 30’s Jan went to a dentist in Tulsa who asked her “If you could change your mouth in anyway, what would it be?”

For Jan it was a powerful question and the first time she ever had a dentist ask what she wanted. This led to a total mouth makeover with Dental implants, bridges, and a permanent non-removable lower prothesis. Her dentist in Tulsa said the work would last for about 20 years. Now, 23 years later, Jan is in desperate need of treatment.

Case Presentation

An essential part of case presentation revolves around the patient sharing their story. Therefore, we understand how this has affected their life and why they desire the treatment.  Allowing us to connect the dots with an emotional connection to their treatment needs. The condition of Jan’s mouth has deteriorated with her remove-able prothesis becoming loose. She carries fear of it falling out in public and her husband has to help her put it back in at times. She cannot eat certain foods and chews most of her food on one side of the mouth. Smoothies have become a great friend to Jan. Solid foods, even lettuce, have to be cut up very finely before eating.

Tune into AMP TV as Jan shares how this has impacted her quality of life and we discuss how as dental professionals we can help lead Jan to the solution her heart desires.

https://vimeo.com/254727789