Collect Upfront
If you want to try and avoid getting caught in this “ no win ” chain of employment notification delays , the answer is simple . Talk to your patients and learn up-front their latest employer / employment status . When a patient lost their job last week or even yesterday , it will not likely matter what the insurance company says on the phone because they don ’ t have up-to-date information . the fallout when we have nothing to do with the situation .
Ultimately , since the problem is created between the employer and insurance company the ultimate solution needs to lie with them as well . But it will only change through being regulated nationally . Thankfully , this is one of several urgent battles for the ADA . However , until the time in which politics catches up with ethics , dental teams need to understand what to do to help resolve and respond to the refund demand challenge . Talk to your patients , stay informed about their employment status , and respond to any changes in a correct , proactive manner . When you are proactive , you can often avoid most insurance refund demands and protect your offices and your patients from surprises .
It is rare that an insurance policy will cover a patient for the entire month after the end of employment , as many believe . Most will cover the patient up till the moment employment ends , and not a second longer .
When you know a patient has moved past their employment date , the most prudent path is to have the patient pay for their treatment 100 % out of pocket ( in-network fees if contracted ). Send the claim on behalf of the patient , and mark “ Assignment of Benefits ” ( the check ) to go to the patient .
Dr . Travis Campbell is a practicing dentist and multiple practice owner who lives in Prosper , Texas with his wife and two young children .
Having gained a reputation as an expert in the complex area of dental insurance , Dr . Campbell is commonly known as “ 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 .
His most recent textbook , Understanding Dental Insurance , has become a bestseller in dentistry and has already sold out once in just a few months . He has also launched the most comprehensive online resource for dental insurance : DentalInsuranceGuy . com .
Legally , the insurance company must follow the path of money . Insurance must request a refund from the entity that received the check ( assignment ). If the patient received the benefits directly , the insurance company cannot come after the office for that refund , because they never paid you to begin with . They would need to correctly seek out the patient or the employer ’ s HR department to get that money .
Ethics / Politics
This brings up the question : “ If my office did everything right , why should we be subjected to the problems between the employer and insurance company ?”
Absolutely , this is an ethical problem . As you can see from the timeline above , the error is based on communication problems between the employer and insurance company . The patient may have some responsibility as well . But the office has literally nothing to do with the problem . Ethically , it is wrong that dentists and dental offices are involved at all in www . northtexasdentistry . com | NORTH TEXAS DENTISTRY 31