Understanding Dental Insurance

Episode #388 with Dr. Travis Campbell

Dentistry is the easy part of being a dentist. Dental insurance, on the other hand, can be a nightmare — especially when you don't understand it. And to help make dental insurance more of an annoyance than a nightmare, Kirk Behrendt brings in Dr. Travis Campbell, “The Dental Insurance Guy,” and author of Understanding Dental Insurance. If your biggest frustration is having your claims denied, read this book today! And to learn how to make insurance work for you, listen to Episode 388 of The Best Practices Show!

Main Takeaways:

Learn the myths about dental insurance.

Don't blame the insurance company if your claims are denied.

Provide more information to increase claims acceptance.

Know which procedures are covered under medical rather than dental.

Coding is how you communicate with insurance companies — learn it!

Quotes:

“Everybody thinks being out-of-network is the best way to make money. And I will say it’s probably easier that way. But what I've noticed is there are a lot of patients in the world that will only go see an in-network dentist. Period. They're brainwashed, or that's their mentality, or it’s financial. Whatever the reason, there are a lot of people that will never set foot in a fee-for-service office or an out-of-network office. It’s just what they are. And I wanted to help them.” (6:08—6:40)

“If we understand how insurance works, the amount of write-offs we have to take are so far less than what we think. When we went back in-network, most of my fee structure now is 15% or 20% discount, when it used to be 35%, 40%, 50%. Well, we also have plans for our cash patients, membership plans, where they get a 10% or 15% discount naturally. So, for me to give 10% or 15% to a cash patient or 15% or 20% to an insurance patient, is not a big difference. And so, I can treat everybody pretty close to the same fees in-network. So, why not? And our collections went up by $700,000 last year.” (6:45—7:35)

“The number-one thing I would say I learned myself was, we’re taught well in clinical. And when I first got out, the CE courses I took were mostly clinical. They're the fun stuff. They're the ones we want to learn more of. But I realized after spending a fortune on some high-end clinical classes on TMJ therapies and CAD/CAM and a lot of other things, it doesn't matter what we know if we can't communicate with the patient well enough to get them to want to purchase what we can do.” (8:34—9:12)

“When I started learning more about communications with patients, that opened up everything else. It doesn't matter if we’re the best clinician in the world to do an implant, or high-end surgeries, or whatever. Because if we can't get the patients to say, ‘Yes, I'm willing to drop X amount of money to have you do this thing that will change my life,’ it doesn't matter.” (9:14—9:36)

“I've been a business coach for quite a few dentists. And one of the biggest challenges I see [in] most offices [that] are struggling financially is treatment acceptance. And dentists have an average of 25% or 30%. And it boggles my mind because we always want new patients, but we have all these patients that aren't getting treated in the first place. And if we can just have higher treatment acceptance, we don't need new people. We could drop insurance plans. We can do a whole lot if we have the ability to take care of the people that are in front of us already.” (9:40—10:14)

“[What most dentists get wrong about PPOs and insurance is] listening to the myths. There are so many myths in the industry. Feeling like you have to file every claim, regardless, is one of them. Insurance companies don't want to see claims that they're not going to pay for. It’s a burden to them as well. And yet, I see it all the time, and it hinders what we do. Because insurance companies, for instance, if you do services that are noncovered, their software doesn't know how to deal with that. And so, while the law may state you can bill your full fee, the EOB software can't handle that — it’s not designed to. And so, you end up with a whole lot of challenges with getting things going, and it doesn't work. So, instead, if you just don't use insurance at all, then you can do what the patient needs for the price that you two come up with.” (10:26—11:21)

“There's this rumor that — most rumors have some shred of truth to them — you have reviewers on the insurance company’s side that are sitting there going, ‘Pay this claim. Don't pay this claim. Pay this claim. Don't pay this claim,’ without even looking at it. They just kind of shove them into a “deny” pile. The challenge with that is, for one, are there one or two reviewers that do that? Probably. There are humans everywhere; humans screw up. But on a systemwide basis, on an insurance companywide basis, they can't have that happen. Because, again, there is scrutiny from the state department of insurance that's always looking over their shoulder, just like the state board is always looking over our shoulders. So, they can't have policies that recommend that. They only have people that screw up within the company of themselves.” (14:06—14:54)

“[Some dentists], when they get denied, blame the insurance company or the reviewer as opposed to looking at their own claims and going, ‘Was this denied because I didn't provide enough information?’ And that's the biggest thing, is if we can't look at ourselves and find the potential faults that we created, then we can never improve ourselves.” (15:03—15:26)

“I get claims all the time, usually for scaling and root planing or crowns, where a dentist goes, ‘Look, we submitted everything we should have, and we got denied.’ And I look at the claim and then go, ‘Well, I can see why you did what you did. I'm not disagreeing, as a dentist. But you've got to realize you don't check off all the boxes here that the insurance company is needing to say yes or no to reimbursement.’ And in most cases, it’s because over the years the onus on the dentist has increased, but we have not kept up with that.” (15:28—16:03)

“In most cases, it’s, provide more information. And when you do that, you take what traditionally is something that's denied 30%, 40%, 50% of the time and make it denied less than 1%, which is what our experience is. We don't have scaling and root planing claims denied. We don't have crown claims denied. But we also provide the level of information [insurance companies are] looking for.” (16:47—17:09)

“[Dentists] absolutely need to learn coding. That's your communication with the insurance company. It’s your communication with the office of what was done. And, in a lot of ways, it can make a huge difference on your income. Example, if you file for an exam, there are multiple different exams. You could do the same exact work but file the exam correctly and actually get paid 20%, 30%, 40% more.” (22:43—23:10)

“The coding is a huge portion of it. Just learn it. And it’s not super difficult. You just have to look into it, because it’s something that's not taught in schools, because schools don't have to deal with insurance, because they rarely file claims.” (23:33—23:46)

“We hear it all the time, but I don't think we internalize it — patients cannot appreciate good dentistry or bad dentistry. They don't have a way to really distinguish between one or the other. But what they do appreciate is how they feel when they leave the office. Did you hurt them? Did you listen to them? Did you answer their questions? Did they leave confused, or did they leave with clarity? And that makes a huge difference.” (24:52—25:18)

“Dental is a lot about the evidence. Show an X-ray. Show a photo. Narratives are somewhat important, but not super important. Medical is the exact opposite. Medical is all about the story, and the story is in the coding. Whereas in dental, you've got one code for one service, and that is what it is, in medical, you've got a code, and then multiple modifier codes. And those modifier codes each tell a part of the story.” (32:23—32:50)

“If you fall, and hit your head on a toilet, and break a tooth, and need the tooth replaced, you go into the coding. In medical, it’s, replace tooth because you broke it, because your head hit a toilet — and oddly enough, there's usually a modifier code pretty close to that, because they’ve got modifiers for everything — because a slip and fall. And those are the modifier codes. They work backwards. And if you understand that, you can get things like implants paid for by medical. The thing that often dental doesn't pay for, either at all or you max out so quickly, dental becomes useless. So, implants, wisdom teeth, bone grafts, sedation, or any traumas, all of these are covered under medical policies.” (32:52—33:46)

“One of the complaints that comes up a lot is for people who do wisdom teeth on a regular basis. A lot of times, you have to submit to medical before you submit to dental. It’s just the way the policy is written. Well, this is because they're run by the same company, and they were purchased through the employer under the same package. And so, what happens is, a lot of these policies like why implants are not covered under dental, it’s because they're covered under medical. And the insurance company does this because the employer says, ‘I want implant coverage,’ and the insurance company says, ‘Great. We can do it, but not under the budget you want for your dental. But we can throw it into medical.’ It’s because the insurance company knows that most dentists don't know how to file medical. So, if they throw it into medical, they’ll probably never have to pay for it. But what’ll happen is, because it’s already in medical, if you file under medical, you'll get coverage because it’s there.” (33:49—34:42)

“Most often, when you see policies that certain things aren't covered, which is weird, like wisdom teeth or implants, it’s not because there's not coverage for that employer’s policy, it’s just moved to the medical policy. And so, it’s really interesting on how this works on a bigger picture. And by understanding it, you can actually learn to file the medical and get coverage for these services that the patient does have coverage for.” (34:43—35:11)

“The biggest part is getting it to the point that insurance is less of a nightmare and more of an annoyance. I can't ever tell people it’s not an annoyance. I mean, it is what it is. But when you understand it, I stopped beating my head against the wall with insurance and started realizing, ‘Okay, if I can tweak one or two little things that I'm doing, I save my team vast amounts of time and we’re a lot more productive.’ And that is how we have the patient numbers; we have the collection numbers. We do a lot in-office, but it’s because of little things. It’s the little things we do every day that add up to make a massive difference.” (38:53—39:38)

“I get people all the time going, ‘How do you produce the numbers you produce being in-network?’ Well, it’s not one thing. It’s all the steps we take in combination. And that's what I would say for anybody trying to improve their office, is there is no magic bullet.” (39:40—39:55)

Snippets:

0:00 Introduction.

1:05 Dr. Campbell’s background.  

4:42 Why Dr. Campbell flipped from dropping insurance.

8:06 What dentists get wrong about insurance.

10:18 What dentists get wrong about the PPO or insurance game.

12:57 Other myths dentists tell themselves.

17:24 The current state of negotiations.

22:05 Advice for younger dentists.

26:28 The future for Dr. Campbell.

30:03 The Dental Insurance Guy website.

30:26 Dr. Campbell’s workshops.

31:37 Dental versus medical insurance.

35:15 Dr. Campbell’s fee-for-service/PPO debate.

36:28 Dr. Campbell’s plans for another book.

38:23 Last thoughts on understanding dental insurance.

Reach Out to Dr. Campbell:

Dr. Campbell’s Facebook: https://www.facebook.com/drtcampbell

Dr. Campbell’s website: https://practicewhisper.com/

The Dental Insurance Guy website: https://thedentalinsuranceguy.com/  

Resources:

Understanding Dental Insurance by Dr. Travis Campbell: https://www.edrapublishing.com/home/546/understanding-dental-insurance-a-guide-for-dentists-and-their-teams.html

Paul Homoly’s books: https://paulhomoly.com/speaker-development-books/

Dr. Travis Campbell Bio:

Dr. Travis Campbell has been a practicing dentist since 2009, after graduating from Baylor University in Waco, Texas, (2005) and then Baylor College of Dentistry in Dallas, Texas.

Yes, Dr. Campbell is a born and bred Texan, and proud of it!  But even more notable . . . dentistry simply runs through his veins. He announced he “wanted to be a dentist” after his first dental visit at the age of three, and never once changed his goal. Today, dentistry remains a passion. He still loves the clinical side of treating patients. Yet, early on, he developed a similar passion for the business end of running a practice. In fact, before he graduated from dental school, he built a vision and business plan for 380 Family Dentistry in Prosper, Texas. At the time, Prosper was a very tiny community well north of Dallas. There were cattle living across the highway from that first office!

Over the ensuing years, he has built that single-dentist practice to its current position as one of the top 1% in the country. Through his experiences, he cultivated a personal “mission” to try and help other dentists avoid the typical pitfalls to become highly successful business owners.

Dr. Campbell is an author, trainer, speaker at dental conferences, a contributor to various online dental communities, and dental coach/consultant. He has been dubbed “The Practice Whisperer”, which became the title of his first book as released in 2019. Ever an entrepreneur, Dr. Campbell purchased a second dental practice in Garland, Texas, in the fall of 2019.

Having gained a reputation as an expert in the complex area of dental insurance, Dr. Campbell’s new “moniker” is “The Dental Insurance Guy!” From understanding insurance to developing strategies to accelerate practice growth, Dr. Campbell delivers practical, actionable content that dentists and team members can use immediately. He dispels many of the myths and misinformation around today’s dental insurance policies and explains how to navigate the complexities of being an exceptional dentist, business owner, and leader while still having a life outside of work.

Dr. Campbell lives in Prosper, Texas, with his wife and two young children.

His most recent textbook, Understanding Dental Insurance, has become a bestseller in dentistry and has already sold out once.