Helping Patients Understand Their Benefits
Episode #365 with Dayna Johnson
“Sometimes, you have to spell things out in crayon for people.” And this is exactly what today’s guest does best. Kirk Behrendt brings in Dayna Johnson, a Dentrix expert, to share advice for helping patients understand their insurance benefits. It is more difficult than ever to navigate insurance — for both your patients and your team! To be better prepared for your patients’ questions and to become better advocates as a practice, listen to Episode 365 of The Best Practices Show!
It is up to dental practices to help patients understand their plan coverage.
Start with the basics and don't overwhelm patients with details.
It is harder than ever to figure out what the patient owes.
Use verbal skills to communicate to patients’ their out-of-pocket costs.
Make sure your practice management software is up to date.
See the reality of what happens at the front desk.
“There are a lot of things that dental teams have to deal with with their patients, their practice management software. I think about the dental team as the advocate for the patient. They're advocating on the patient’s behalf for dental benefits, and they're advocating for their patients for preventative care. And we’re not just dentists; we’re oral health physicians. We’re in the healthcare industry, and it’s up to our teams to advocate for our patients for good, recommended healthcare, for oral healthcare, and getting that paid by the insurance companies. So, there's a lot that our dental teams are having to navigate themselves through.” (3:39—4:30)
“A lot of times, patients don't even care if it’s covered or not covered, ‘Just explain to me what my out-of-pocket is and how I can afford to pay for it. Because you're recommending it to me, and I know I want it because I trust my doctor. Now, how can you help me afford it and pay for it?’ And that's what I want our offices to do, is to really help advocate for their patient as far as understanding what their benefits are. If something’s not covered, or if something has some kind of limitation on it, then how can our teams give that information to our patients without owning those insurance benefits — because those do belong to the patient.” (5:55—6:35)
“Start with the basics. Sometimes, you have to spell things out in crayon for people. Whenever I'm working with a team and we’re presenting treatment, recommended treatment, and they're discussing it with the patient, it’s easy to try and give the patient too many details, too much information. And then, that just confuses people. I always try and help my teams to start with the basics. Let them know what their out-of-pocket is. So, if we’re presenting a crown and a buildup and we know the buildup is not covered, just give them the total, ‘The total is $2,000. Your expected out-of-pocket is going to be $1,500.’ And then, if the patient says, ‘Well, why is my out-of-pocket so high?’ then, we can start adding layers of details.” (6:51—7:54)
“We really want to try and keep it simple. I always try and present things in a very simple way. That way, it sometimes will eliminate a lot of those questions that we don't really need to get into if we don't have to. If patients are okay with a $1,500 out-of-pocket, then we just talk about, ‘Okay. Well, what are our options to pay for it?’ Now, if they start to ask, ‘Well, why is my out-of-pocket so high?’ then, we can add on a layer of, ‘Well, your insurance company, they don't cover this particular service.’ And then, we can start going into different layers of details as patients ask questions.” (7:56—8:38)
“It is harder than ever [to figure out what the patient owes]. When I was in my own dental practice, it used to be insurance covered 100, 80, 50 percentages. You had a maximum; you had a deductible. And there weren't all these limitations and frequencies and exceptions. Nowadays, insurance companies are downgrading crowns. And they're downgrading from a porcelain crown to a PFM. And a new team member that comes in, they don't know the difference between a porcelain crown and a PFM. They just don't know the difference. And they don't know the difference between a bicuspid and a molar, or an incisal and buccal.” (9:27—10:19)
“It’s not necessarily the insurance companies’ faults. A lot of times, it’s the employers that are requesting these types of plans because they want to cut their overhead expenses for employee benefits. And so, they're wanting to cut things out of the insurance plan. So, the employers are negotiating these different wacky plans with the insurance companies.” (10:42—11:06)
“For people that really don't have the details yet readily available, first, it has to start with the verbal skills. And you may agree that we first have to let our new team members know that we don't have guarantees in the dental industry. We don't have any kind of guarantees that the insurance company is going to cover this. So, I think the first thing we have to really teach our new team members are these verbal skills, that, ‘This is your out-of-pocket. We’re estimating your out-of-pocket is going to be $1,500.’ And I think also letting our new team members know that the patient is ultimately accountable for the full balance, and this is what we’re anticipating your insurance company is going to cover.” (12:47—13:41)
“What I've also been doing a lot of times is printing all the details and handing it to the patient. I was working with a team the other day, and I said, ‘I would print a copy of this for the patient so that the patient understands this is what we’re working off of with your insurance company. Now, if there's something on here that comes back and it’s not on this sheet, then there's no way we could've known that it was not covered.’ So, I do like to try and get my teams to give the patient exactly what we’re working off of. It also helps teach the patient what the details are with their plan. Because that's usually the hardest part, is patients don't know what their plan covers.” (13:42—14:32)
“I work with some teams that say, ‘Well, if we gave the patient an estimate and then the insurance company comes back and says, ‘Oh, there was a waiting period on that bone grafting, so we’re going to now write it off,’ and I'm like, we really want to also advocate for our teams and our doctors that you don't own this insurance plan. This is not your plan. This plan belongs to the contract between the employer and the dental insurance company, and we’re just the third party taking care of the patient. And so, if the insurance company denies something, the doctor doesn't have to own that. Why should he take the hit for that?” (15:50—16:42)
“The doctor believes in the treatment that he’s performing, and he deserves to get paid for it. And if the insurance company doesn't pay for it, then the patient pays for it. And so, I think it’s really important that patients understand what the total cost of the treatment is. So, the total treatment is $2,000, and their estimated out-of-pocket, maybe the dental team says your estimated out-of-pocket is $500, but the insurance company denies something, and now their out-of-pocket is $1,000, that the patient already understood that they would have to cough up the difference. And that all comes back to verbal skills.” (17:14—17:56)
“Delta Dental just keeps doing what they want to do because nobody stands up to them. So, since there's really not much we can do, unless we had a big organization really take on the insurance companies, it’s up to us as the dental practice to help our patients understand what their plan limitations are, and that they are responsible for those limitations, those out-of-pocket expenses. And if they want better coverage, they need to advocate that with their employer or with their insurance commissioners, or anybody that lobbies in Washington.” (19:53—20:34)
“One of the most common things I see [dental practices get wrong] is that one of the processes in the software, specifically in Dentrix, is that when you run the month-end process, it resets the patients’ benefits used and it resets it back to zero if that plan is going to renew. We’re getting up to end of December, so a lot of plans are going to renew in January. There are also a lot of plans that renew in October, and there are a lot of plans that renew in July. If the dental team is not running the month-end process, then it’s not resetting the insurance benefits used back to zero. And so, then the software is underestimating because it thinks that the patient is maxed out. Then, you're not getting an accurate estimate. That's probably one of the most common things I see.” (21:05—22:11)
“It could be that maybe [practices] just think [the software is] running, and they don't check it. Or a lot of office managers, they want to hold the books open because, ‘Well, I need to make changes to the month.’ And I'm like, ‘No, you don't. That is a security issue.’ And so, I think there are multiple reasons why offices don't run month-end. And a lot of it has to do with, they want to keep the ledger open so they can fix it. And I'm like, ‘No, you really don't need to do that because that's a security issue.’ That's an accounting problem right there.” (22:53—23:31)
“Number one, make sure that your system is up to date. That's first off, is you need to know how much does the patient have in a maximum left available. What is that annual benefit, and how much do they still have left this year, and have they met their deductible. Insurance companies haven’t increased the annual benefit for over 40 years. But dental costs, dental treatment has been rising year, after year, after year.” (23:39—24:16)
“Most of the time, when patients are doing maybe a couple crowns and some fillings or some SRP, they're going to max out anyway. And so, usually, we just need to know what's their annual benefit, because they're probably going to max out anyway. But if the maximum benefit in the computer is wrong, then we’re giving the patient an inaccurate estimate.” (24:18—24:42)
“What I love about some practices that I work with, they will give, ‘Here’s a total dollar amount for this treatment. And this is going to include both crowns, both buildups, and a filling on that tooth that you need. So, the total treatment cost is $10,000. And that includes all these procedures.’ They don't line item it out. It’s just, ‘This is that treatment for that upper right area. It’s going to be $10,000. Your out-of-pocket is going to be $8,500. We can talk about financing. We can talk about a couple payments. What are your thoughts?’” (25:55—26:49)
“[Students] come out of dental school, and they really haven't had the opportunity to sit side by side with maybe their front desk team member and to see all these details and all these complexities with insurance before. So, I think that it would really be great for those dental students to sit side by side with, or maybe even pretend like they're the patient to really understand what their patients are going to be going through, and those questions that their patients are going to be asking. And I think it would really help the students to develop their own verbal skills around insurance. And then, I think it would also really help them to identify, ‘Do I want to be a PPO practice, or do I want to be a fee-for-service practice?’” (31:32—32:30)
“The new dental student that's graduating from dental school is going to want to go shadow a doctor and see, ‘What kind of technical skills does this doctor have?’ But I think, shadow the front desk. Be a fly on the wall and watch how they present treatment and watch how challenging it is for them to gather these insurance benefits. Because it is challenging.” (34:53—3521)
“See the reality of what happens at the front desk. Because a lot of times, the clinical team doesn't even know what the front desk is doing.” (36:22—36:28)
1:11 Dayna’s background.
2:41 What dentists are actually involved in.
4:40 Helping patients understand their out-of-pocket.
6:35 Keep things simple for your patients.
9:03 It is now harder to figure out what the patient owes.
11:57 Where to start.
15:19 Don't take on insurance as a responsibility.
20:35 What dental offices get wrong.
24:45 What dental offices do right.
25:37 Advice for younger dentists.
30:55 Shadow the front desk team.
37:01 Last thoughts.
38:59 Dayna’s courses.
Reach Out to Dayna:
Dayna’s Facebook: https://www.facebook.com/DentalConsultantConnection/
Dayna’s social media: @dentalconsultantconnection
Dayna’s courses: https://novonee.com/store/
Dayna Johnson Bio:
Dayna Johnson has helped dental offices from around the country easily transition down the path to paperless using her years of experience as a dental office manager and Certified Dentrix Trainer. As one of the Pacific Northwest’s most trusted consultants, she gives a straightforward and complete assessment for each of her clients. No two dental offices are alike, and Dayna channels her passion for going chartless to help each of her clients fulfill their goals and increase their profitability.
Dayna’s expertise has helped her earn prestigious honors such as:
• Spirit Award for Independent Certified Dentrix Trainers for her loyalty and dedication to the Henry Schein brand.
• Teaching Dentrix seminars for Henry Schein throughout the United States.
• Authors the national blog for dental office managers for Dentrix users.
• Featured speaker at the Business of Dentistry Conference in Las Vegas.
“Going chartless” is an often-used and often-misunderstood term in the dental world. Dayna’s expertise will allow practices to see benefits such as automated systems that give team members more time to spend on patient care, integrated electronic services to ensure your patients know your practice is keeping up with the latest technology, making the patient chart more accessible, and allowing the clinical team to treatment plan while the front office can be working ahead on payment plans and insurance issues, raising the level of office security to comply with new HIPAA requirements, and much more.
With 18 years of experience in the business and technical sides of dental offices, Dayna’s passion for efficient systems is grounded in personal understanding and professional expertise. Dayna knows firsthand the problems that occur when collections are down and a schedule is full of holes. She has also lived the frustration of too many hours spent hunting for misplaced patient information and mishandled recordkeeping.