The Saga of Estimating and Explaining Insurance

Today’s episode continues the saga from last week’s episode (“Are Accurate Estimates Important?”). Dr. Kuba continues to unpack details about a disgruntled parent in her practice that ended up with an unexpected bill of $1,700. Today, they discuss more oversights from the team including coordination of benefit issues (involving primary and secondary insurance), miscommunication to the parent when insurance failed to pay, and failing to advocate for the parent to pursue better reimbursement from insurance. Alongside the inaccurate estimate, these missteps have Dr. Kuba and Bethany evaluating what to do with this parent and with the team. They conclude the episode with a detailed account of how they responded to the parent’s disgruntled email. Deep and meaningful tips are included in this episode PLUS so much more in the June bonus episode.

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Transcript

0:00
Are you looking for a podcast where you can hear from real [music] people regarding their real dental drama? If

0:08
so, then you've come to the right place. Join hosts [music] Bethany Penny and Dr. Reena Kuba as we

0:15
dive into the solutions we've created and the mistakes we've made while managing dental drama.

0:22
Let's get started. Okay. Uh are you okay if we just jump right in? Let's do.

0:28
Okay. So, if y'all haven't listened to last week's, you need to. It's breadandbut stuff that happens in our

0:34
offices every damn day and it wears us out. And this is what wants to lead us to retirement or to, you know, whatever.

0:41
Like, this is where a lot of times, too, for me, it's I guess I have to do every

0:47
damn thing by myself in this office cuz the two veterans like messed up something so blatantly obvious. I guess

0:54
it better be me. Which, come on. you know, then I stop and go, okay, yeah, you would have missed this, too, but

0:59
it's not your area of expertise. And no, you need to be able to rely on your people. Mistakes will happen. How do we

1:05
minimize them? What do we do? So, this was the classic, you know, they were given an estimate of $172

1:12
and now they owe 1,700. And now the parent is emailing going, I think y'all

1:17
need to write this off. Y'all messed up the insurance. Um, in the last episode we kind of established that no, we're

1:24
not gonna in our office we're not going to hide behind the insurance was the issue. Therefore, I'm going to write it

1:29
off. I know a lot of people do that and maybe in network, I don't know, whatever. That's a whole another messy

1:34
bag. To me, it's like, yes, I'm not going to write that off, but I don't know how to reply to this parent. And

1:40
so, we started talking last episode, how are we digging into this um

1:46
this mess to be able to craft this email? And ultimately, what are what are

1:51
we doing if we're not writing off? Do I just send an email saying, "Nope, not our problem. It's an insurance problem.

1:56
Take it up with your insurance." Like, I guess that is one option. Should I have done that? I don't want to do that. Um,

2:02
so we started diving into it. We at the end of last episode, we ended on

2:08
what really did happen with this um, estimate and all of that. So, now we want to continue and and share the other

2:16
things we learned in this process of digging through this. Yeah. So, insurance estimate I mean uh

2:21
estimate treatment estimate was first. Now, I think it's important for us to talk about one of the policy changes

2:29
that we felt like needed to change after looking at this scenario and that is how

2:34
we work with secondary insurance. I for years even before I mean insurance has

2:41
always been bad but over the last five six seven years it has taken a sharp decline and I have always preached don't

2:49
work with secondary it is I can't tell I would venture to say 100%

2:57
of the time it reflects negatively on the dental practice because it's hard to

3:04
explain it's hard to know even if we do a very thorough verification process on how the two insurancees coordinate

3:10
benefits. I it is so messy and convoluted and then

3:16
we're trying to present an estimate. The softwares don't know how to calibrate

3:21
with the two insuranceances involved. So the estimates are almost always wrong. We're usually having to go in and

3:27
manually correct those estimates which is PhD level. And so I have always said do

3:37
not file secondary insurance. I don't like it and I don't like the amount of

3:42
pressure it puts on the team. Instead, let patients know you file primary only

3:48
and you are happy to supply them with a claim. You're happy to support them in

3:55
personally filing that secondary on their own. And as a patient, I know that's annoying. I hate when I have to

4:00
do that or when I have to take those steps, but from a consulting standpoint and my job of protecting the practice,

4:07
it is absolutely the only way to go. And so here we are with this scenario that

4:13
popped up that was largely driven by secondary the coordination of benefits didn't play

4:20
out the way that the estimates said that it was going to play out. And so you and I said, which we should have caught and we

4:26
didn't. Yeah. Either way, I think so for for as long as I've worked with you, I've never

4:31
heard you say this because it's never really come up. I think do we have a handful of patients that have a secondary insurance? We must. But Biller

4:40
has been in this field for over 30 years and she feels relatively confident that she knows how to manage it more or less,

4:47
which begs the question, how did that crappy estimate come out of her hands? I still don't have an answer to that, but

4:54
it's just not ever come up. And so for me, I'm like I knew secondary insurance is a nightmare from when I was an

5:01
associate 20 years ago and I would just I could hear these conversations about

5:07
secondary insurance, secondary insurance. And then I think the first time when I started my own practice and I was the biller. I was the one coming

5:13
up with estimates. I was having to do all of that and I was like, "What the hell do I do with this secondary?" And I'm pretty sure I called said biller

5:20
because I knew her from the previous office. We didn't work together anymore. She didn't work for me. I was like, "What the hell do I do with this?" and

5:25
she's like, "Ugh, these are terrible." So, but then I've never looked at it again because it's not it's not every

5:31
day that you've got somebody coming in with a secondary insurance. So, I think um it just hasn't been on my radar until

5:38
now. And I kind of was just like, "Why are we even filing to secondary? Like,

5:44
we just shouldn't." And you're like, "Yeah, that's what I tell you." I'm like, "Oh, well, I never knew that because it's not come up." So, we're

5:50
going to instill that in our practice now. Yep. and say, "So, but it can't just be

5:58
that like you and I need to come up with now what is the verbiage for when a patient walks in and they're like, "Here's my secondary." Oh, no, we don't

6:04
file the secondary. Like, right? Like, how are you not going to piss that patient off? Are what is going to be our verbiage? So, we're going to draft some

6:11
verbiage. Um, and then in my to me, I'm like, we need to have that in our financial

6:16
policy. like that needs to be something that the parent acknowledges that says we we are only going to deal

6:23
with your one insurance the other one's up to you I guess to me then my next question on that is

6:31
from what I can gather with this secondary like apparently it's for a lot

6:37
of them it's uh where the the if the I feel like this is what I've

6:43
heard so you're going to correct me because I'm very little knowledge on this, but if the parent is like, "Oh,

6:50
no. Dad's like, "My insurance has better coverage. File mine first and then we'll file mom's." We don't have control over

6:57
that. In insurance world, they go by whoever's birthday comes first is the

7:02
policy. So then to me, if a patient is coming to us going, well, here's my policy and

7:08
dad's policy. Are we kind of going whoever's birthday and then that's the one we are choosing as primary. How are

7:14
we deciding which one? This is where we do need to actually do a little bit of leg work when the parent

7:21
says kiddo has or even adults can have both their own policy and their spouse's

7:26
policy. It's easier with adults because their policy is always going to be almost always going to be primary and

7:33
the spouses would be secondary. So then it's real easy to say no, I'll take your policy that's primary. with kids it's

7:38
more convoluted and we do have a responsibility to follow appropriately to the right primary. So as much as I

7:46
want to say we don't have to think about secondary we don't know which one is secondary until we actually do the

7:52
research to ensure is it the birthday rule that is determining this here. So

7:57
to me it does require with a verification with somebody who's doing verification on your team for them to

8:04
confirm with both insurance companies the So then would you say in that case then

8:10
if part of our verbiage is going to be and our protocol is going to be oh you have two insuranceances. Okay then we're

8:15
going to do our due diligence to call to figure out which one you need to call too. Yep. Absolutely.

8:21
And give the parent the verbiage to say how do I know is it going to be my insurance or my husband's insurance. But

8:26
but would they like say mom has Delta? Would mom call Delta? She would call Delta. And then Delta then Delta would say,

8:32
"Well, who's the other one? Oh, the other one is Etna." Yep. And this is how we work with that.

8:38
Y and maybe then in our paper we have something like I acknowledge that I will follow up my I don't know. We have yet

8:44
to come up with this document of our new change. It's helpful to encourage the parent to contact their insurance anyway because

8:51
one of them they're going to be filing the secondary claim with. So, it behooves them to get on the phone with

8:57
the insurance company anyway to first of all confirm what we're going to get. We,

9:02
the dental office, is going to get anyway, but they're confirming that information and also asking my dental

9:08
office has said that they'll supply me with a claim to get reimbursement from the secondary. How can you tell me about

9:14
that process? How do I file that information to you? So, it's beneficial for the parent to get on the phone with the insurance company anyway.

9:21
Is it I'm just asking curious here. Would would we say we determine Delta is

9:26
the one that's primary for this kid. [clears throat] Would we file that first and then give stuff to the parent or do

9:33
we say here's what we're filing, you file the same thing with the other one. What is the timing on that? On the day of treatment

9:39
the claim. So, what I don't want is for this to continue to be something that feels like

9:45
it's our responsibility, and I don't want the parent to be confused by that either. So my recommendation is on the

9:52
day of service when we've filed that electronic claim to the primary, we also

9:57
print out a paper claim for the parent and they can take that up with insurance. If insurance wants to wait on

10:02
the primary to pay first, well then the parent can talk to insurance about that. That's we're we're not going to wait for

10:09
primary to pay and then print a renewed claim with that information. No, we are

10:16
out of the equation. We provided you with the claim. you go take a do with it what you need to do with it. So that's

10:22
my recommendation. I think the the hesitation I could imagine a lot of people saying is well

10:28
they're not going to move forward because it looks like their estimate is

10:33
$30,000 but they will move forward if they think other insurance is going to pay their portions. The problem with that is like

10:40
we're finding for ourselves, it screwed us over. Kind of assuming both insurancees would pay full. Um, which we

10:48
know they're not going to because they're just not. And then now if you're like, well, I was just trying to help the patient. She really needed her

10:54
buildup and crown. But now she's pissed at your office. Who knows what kind of

11:00
liability you've put yourself in. But also, what I think we've talked about this in a few episodes. What is a

11:06
patient going to do? They're going to office hop. Yeah. They're not going to go back. They're not going to come back to you.

11:11
They're just going to cancel the appointment and move on. And if you're in a metroplex like we are, there's five dentists on every corner. They'll find

11:17
another corner. This is where actually we see a lot of uh board complaints come

11:22
through because you better hope your crown or bridge or whatever is a,000%

11:27
perfect because the corner dentist down the street might go, "Oh, well that's an ugly margin." Or, "Oh, that shade isn't

11:34
nice. Oh, you just got that last month. Hm. That's all it takes.

11:40
And then that patient's going, "Wait, what? That crown's not good." Well, you know what? They didn't get my estimate right either, and now I owe them money.

11:46
And the crown they did was bad. So, it opens up a whole another can of worms. Yep.

11:51
So, to me, it's like trying to that that the best thing you can do is try to prepare the patient for

11:58
not not a false scenario of this insurance may cover. I think the other thing that to keep in mind, I think most

12:04
of us, I know I would be like, "No, no, I should owe only $172 because I have two insuranceances." So,

12:11
they're going to between the two of them, they're going to cover all of it. I think as even as a seasoned owner, my

12:17
my default tends to be why should I have to pay for anything when I've got two insuranceances? This should be covered.

12:23
What you said in the last episode, well, both insurancees still have max. So if

12:29
your estimate is $6,000 and your insurance max benefits is $1,500, the patient's still going to owe

12:35
a substantial chunk. And so even though we may know that, the

12:41
patient may still not realize that they have two maximums and may still go, "Oh, I'm going to owe

12:47
nothing cuz I have two insuranceances. I am covered." And that is not the case. So, anything we can do to break that

12:54
bubble ahead of time, and I think this is a really smart thing to say, uh, uh, uh, and the parents like, "What are you

12:59
talking about? You're not going to help me." It is exceedingly complicated. And so, we're happy to do it for one, but

13:06
let the parent have some skin in the game. That way, at least that to them is already their red flag to go, "Oh, it

13:11
may not all be covered." Yeah. If they're not willing to file this and take care of this, this must be

13:16
something's up where it may not be. Yeah. Um, so if nothing else, that's

13:22
what that does for you. And I always tell offices when I'm talking about this policy, we want to

13:28
make it clear to the patient, to the parent, whoever we're speaking with, that there is a better chance that that

13:34
secondary insurance is going to reimburse their client, the patient,

13:40
than some anonymous dental office. So, they actually have a better chance of getting a better result out of their

13:47
insurance company than we do. they have no loyalty. The insurance company has no loyalty to us. And so I think also

13:55
alerting the parent, no, absolutely we want to support you. We're we we want to support you. We will print the claim for

14:01
you. You don't have to think about the codes or anything like that. Um so we want to help you with that information

14:06
and we're we're not just like go figure out how to file it and then you're having to call us, get the codes, find a

14:11
claim form. Nope. We're going to do that for you. um so that then you can p pursue your insurance company and

14:17
they're going to be much more inclined to pay you directly. So it is a verbiage thing that we've got to make sure our

14:23
team feels comfortable in explaining and it's not just oh it's too complicated for us to deal with our hands are off.

14:30
It's also we have found that insurance deals better with you directly than they

14:35
do with us so you're going to get a better result which is absolutely true. So, verbiage for your team on not filing

14:43
secondary, definitely making sure you have the paperwork that shows that we do not file secondary.

14:50
And just think about it, then it takes those estimates back to it. Estimates

14:55
are still complicated even with just one insurance, but they're exponentially less complicated when you only have one

15:01
as opposed to the two. So, your estimates are going to be more accurate if we eliminate that secondary from the

15:08
equation. Um, so I think that was a really important takeaway for our office. And then I'm okay with like as

15:14
you and I are building these verbiage things and the policy changes, I feel

15:20
like if they're useful enough, we can post them on the hub. Like I'm happy to share it. So if you need that,

15:27
um, put that out on the hub for sure. Yeah. So the only thing we've done so far, because this just happened a few

15:32
days ago, is that we are um, we know this is what we need to do and we're making this policy change. like we're

15:37
we're not doing secondary insurance. So, for those of you who don't do it, hats off to you. Uh good job. For those of

15:44
you that don't know, like I didn't know, go find out. It's a good change. Yeah, it's a good change. And again, I think it begs the question

15:51
like you've got an extremely experienced biller that has been able to navigate

15:58
secondary for a very long time and has navigated it relatively successfully.

16:03
But even an experienced biller can get tripped up by secondary.

16:08
Honestly, if I'm to think about it, I think I think it's home life stuff that

16:14
probably she wasn't honoring. Yeah. Yeah. And that can happen. Yeah.

16:20
Um Okay. So, back to the question then, what am I doing about this? So, I think

16:27
as we're digging through um you and I both found the breakdown that um Delta

16:34
or whoever it was sent us and in their breakdown it says they will coordinate

16:40
benefits. Yep. It clearly says that. And I guess I didn't know this. There's two ways they can do it. A carveout

16:46
method and something I never heard those terms. No idea. You knew what they were. But it says both methods they do

16:53
participate with. So, I still to this day have not read the email the parent

16:59
sent. Yeah. I'm just going off of what my lead who brought me the email and then I guess

17:05
you've read it. And so, from what I gather in that email, the dad was like,

17:10
"You guys didn't catch that. The insurancees wouldn't work together. So,

17:15
this is your fault and this is whatever." And so, I'm like, "Our documentation

17:20
says this, Bethany. Am I reading this? I don't know what I'm reading, but this is what it looks like." you're like, "That's absolutely what it says." So, as

17:26
you dug into it and you requested from my biller like the EOBS and like whatever, you like now when you look at

17:32
the EOBS, they didn't follow what they said they were going to, but they did Yes. clearly say. So, for me, I use that

17:39
as okay, here's here's the crux of it. Yeah. They're telling us that they are going to cover it.

17:45
That's the best I can do. Yeah. Um, so we printed that off. We highlighted that. Uh, I'll get to the

17:52
next part in a minute cuz I want to wrap up with like how did we end up responding? Yeah. Ultimately, but we

17:57
discovered a few more things in there. So, I think as you were digging through, you're like I think in episode one of

18:04
this last week, you mentioned that you started with going I read the chart notes. I looked at the ledger. I wanted

18:09
to look at um the the information they supplied as far as what they the

18:15
coverage stuff. And then you wanted to look at the EOBS. And so you discovered

18:21
Yeah. Talk to us about what you discovered. So when I looked at the EOBS because I saw the verification and I was like it

18:27
should have coordinated better so why didn't it? And

18:33
what is interesting when you look at those EOBs and this is where some of the

18:38
language gets really tricky because again this primary secondary is just

18:44
complicated. So they do coordinate benefits verification clearly says that but they use the carveout method which

18:51
means primary pays first and let's say primary pays you know a hundred of the

18:56
$200 even if secondary it's built into their clause that they would usually pay

19:03
the full 200. They're not going to duplicate what the primary has already paid.

19:09
They're not going to pay the $100 that the primary has paid. They're only going to pay the remaining $100. makes sense.

19:15
They're not going to overpay for a procedure. That is nonduplication.

19:21
That's a non-duplication clause. So, when you look at the EOB, it'll say there a little code, you know, C E2 for

19:29
for the description of this and it says due to non-duplication clause,

19:34
this isn't paid. Well, non-duplication, you're like, okay, then mathematically

19:40
it should add up to be the total that was built. And in a lot of those codes that I saw, they list that

19:47
non-duplication clause, but when I mathed it, I'm like, it still doesn't add up to the whole code, the whole fee.

19:55
So why? Especially on the zirconius. So for example, just to dummy it down

20:00
more. So say tooth number A we build out for $200. Insurance one paid 100.

20:08
Insurance two should pay the other 100. So for tooth A, they did that. They paid 100. Now tooth B insurance one paid zero

20:17
which means secondary should pay 200 and they said no it's a duplication so we're

20:24
also paying zero but that's not that's not coordinating the benefits B wasn't covered by insurance one which means you

20:31
should pick up correct the 200 so they have listed a lot of these rationale as with what's a

20:37
duplication and it's like but yeah in A you followed that clause but not in B

20:43
primary ran out of funds and didn't pay for anything for B. You guys were supposed to pick up the rest of that and

20:48
you're going, "Nope, it's a duplication." What duplication is there? There isn't a duplication cuz there's Right.

20:53
And keep in mind, we have to keep the insurance game at the forefront of our

20:59
mind here. This is a game for them. How can I get away with paying the absolute least amount possible? And when you've

21:06
got primary and secondary, they have a lot of shields they can hide behind because it's fuzzy, it's weird, it's

21:13
gray. What do you call non-duplication? What does the primary call non

21:18
duplication? What is who does me looking at this going, "Well, that doesn't seem like non-duplication to me." So, it's

21:25
very subjective. And so you've got an insurance company that's hiding behind some of these quote unquote

21:32
non-duplication clauses, which makes it sound like non-coordination of benefits.

21:38
Non non-duplication and coordination of benefits sounds very, very similar. And

21:44
so I'm looking at the claim going, whoa, whoa, whoa, whoa, whoa. Secondary did not hold up their end of

21:51
the deal. They clearly say that they coordinate benefits. They clearly say they follow the carveout method. And yet

21:57
this whole claim to me, there's multiple codes that I can identify where they paid nothing on that they should have

22:04
paid something on. So I reach out to the biller and I'm

22:09
like, "Hey, when you talk to, let's say Delta, when you talk to Delta, what did

22:15
they say about this code, this code, this code?" Because to me, they they quote non-duplication, but that doesn't

22:21
make sense to me. And her response was, "Let me call

22:27
them." And my little ticker went up and I was like, "Have we not called them? Have we

22:34
not talked to them about this claim yet?" And we have not talked to them. Now, slippery slope here, but I'm like,

22:44
I am always the one that's like, "Don't do any more work with insurance than you absolutely have to." But we've got a

22:52
patient here or a parent that's about to receive a $1,700 bill when the estimate

22:59
was $1 whatever $72. That warrants a call to insurance. Why?

23:05
For for the benefit of the patient? Yes. For the benefit of the practice? Yes. To

23:11
ensure that we can't do anything else to advocate for the patient in this case? Yes. Because Biller, you know how our

23:19
patients are. You know, this patient is going to be a

23:25
and I say our patients, any person I I would. You told me 172. I know that's an

23:31
estimate, but I thought that could have been like at most 500. What is it? 1,700. To protect the practice, you need to

23:38
pause and take a look at where this could have gone arry. Yeah. Yep.

23:44
And the fact that we didn't call insurance says that we we didn't process all of

23:51
that. We didn't process all of the negative ways that this could have impacted both the practice and the

23:57
parent. Now, we could we could lean on that argument of it is what it is. It's

24:03
insurance and the parent needs to pick that up with insurance. And I agree with that to a certain point. But is there

24:08
anything that we can do to even just learn from this situation and go why why

24:14
does insurance consider this non-duplication? But instead, what we did when we got that claim is we apparently relayed that

24:22
information to the parent via a invoice and a comment that the reason that

24:30
there's a $1,700 balance is because of a non-duplication clause. Well, the parent

24:38
I would have done this as well. the parent interpret that as non-coordination of benefit cuz that's

24:44
what it sounds like. Non-duplication clause. That's not what it is. That's an insurance terminology blah blah blah.

24:50
But the parent hears that and goes, "Oh, you said that these insuranceances

24:55
coordinate. So now you were wrong. They actually don't coordinate because of non-duplication of benefits."

25:03
Well, now it looks like we made a mistake saying that secondary isn't going to pay because they don't

25:09
coordinate benefits. So now, dad's like, "The mistake was yours." Even that simple explanation that we

25:16
tried to offer, first of all, we didn't do our due diligence. We should have found out more information before we relayed that information to the parent.

25:23
But second of all, because we used weird terminology that the dad doesn't understand, who would understand that?

25:31
And because we didn't get a further explanation from insurance, we can't offer anything more than that little

25:36
code E15 that says this is a non-duplication of benefit code. So we gave very little information which

25:44
then confused the dad thinking that we made a mistake in the verification process which we didn't but it looks

25:50
like we did now. And the only thing we have to go back on that is to say look they did coordinate because look your secondary did pay for

25:57
some things which means they are coordinating. Yeah. Because how else do you if I was the parent? I'm like, this is semantics.

26:03
Call it whatever the hell you want. I'm not paying the $1,700. Y'all made a mistake somewhere.

26:08
No, they did coordinate benefits. They just were shady in what they decided to coordinate. And what is their

26:14
definition of uh the duplication? Do we have different definitions of that? Which how can you?

26:21
I don't know, but insurance will find a way. So alto together, I think our

26:26
biller just really missed it on a lot of fronts. whether that's home life stuff and or like it would have been different

26:32
days, right? Like this would have been say in October that she's putting the estimate together and then by December

26:38
by the time the claim the EOBS are coming in, maybe she it didn't ring a bell to her because she was like, "Oh,

26:44
it was an IV case. Treatment must have changed. Maybe they needed to do more treatment." Like, so $1,700. She

26:50
probably didn't even go back and look at that initial estimate. In her mind, it's like, "Oh, they did a lot of work. 1,700

26:56
is probably what this patient owes." and then she just sent it off and copied the comment on the bottom of the claim and

27:02
didn't think twice about it is what my guess is what happened. So those are two missteps there. I think misstep number

27:09
three or four was she never did call the parent. So, in December, once she, you

27:16
know, processes the EOB and she sees that $1,700 is what's left, then she

27:21
sends, like you said, the invoice and the parent gets that, which, like we talked about in the previous episode, I think I would have looked at that and I

27:26
would have put it in the garbage cuz I would have been like, this is probably still probably still pending. Still pending. Then she proceeds to send

27:34
a text the next month. You owe this text to pay. Do you want to pay it? Yeah. That went unanswered.

27:41
The next month, I believe she sent another text. Yes. Yes, that went unanswered. Then she sent the

27:47
email. She sent an email, I think. Yes. I think it started with an email, ended with an email, and two texts in

27:54
between. So, there's four attempts, right? And or I think she added a fifth because she went back to me and said,

27:59
"No, no, this was the other attempt." And I was like, "Okay, whatever." I think one of them was a you're being sent to collections now. No response to

28:07
that. Correct. So now it's with collections, which I think the parents still probably

28:14
either didn't realize it's in collections or they're ignoring those collections comments. Like whatever it is, it we said in the last episode, I

28:19
think what's brought this out is they couldn't come back for their recare because we're like, well, you owe the

28:25
$1,700 and they're like, what the hell is happening? Yeah. So, um, that's where all of this is

28:30
coming back out now and you're concerned with this. Mhm. So,

28:38
well, part of my concern is I reached after seeing the attempts to tell the parent about the bill. I wanted to see

28:45
before we sent them to collections, did we ever try calling them? So, yes, we've

28:51
got a couple of emails on file. We've got a couple of text messages on file, but did we call attempt to call them at

28:57
all before this upcoming appointment? And I looked through all the records. I

29:03
couldn't see any record of attempted phone calls. And so I reached out to the bill and I was like, "Hey, did we ever

29:09
try to call the parent about the bill?" She ultimately said yes. I tried calling

29:14
a few times, but there's no documentation of that. So when I first looked, it looked like we had never even tried to call the parent cuz again, we

29:22
get emails and text messages all the time about bills. What's going to wake us up to the fact that this is actually

29:28
a bill? I'm getting a phone call from the office being like, "Hey, I want to make sure you're getting these texts and emails. Do you have questions about

29:34
them?" And again, most parents aren't going to answer, and that's fine, but at least we show that we attempted to

29:40
contact this parent, especially before we turn them over to collections. Now,

29:46
that can't that's not always possible to get on the phone with a patient or a parent, but we at least need to show

29:51
that we tried. So that was one of the takeaways too from this is we've got to

29:56
make sure that there are tangible efforts being made to contact these parents. So first of all we should have

30:03
pursued insurance to get a full explanation. We should have tried to advocate. I think the other misstep that

30:10
I think you didn't say here even when you said did you try to call Delta or whichever insurance it was did you try

30:16
to call and talk to somebody about some of these? We didn't even have the uh EOB

30:22
from Delta. Yeah. The only thing we had was the one EOB. Yep. And then she got the other one and then

30:29
you were like, "Okay, but did you call to ask about these?" And she's like, "No." Yeah. Um, and so to me it it really did put a

30:37
murky feeling in my stomach going, "This is the person I rely on for everything AR." And maybe I should have paid more

30:46
attention knowing that she had all these like home life things going on. But again, I'm just like I'm just exhausted.

30:52
That's like my least favorite part of anything is dealing with the AR billing stuff. And I bury my head deep down into

30:59
the sand and trust that she's got 30 years of experience that she would look

31:04
into this more. And I'm trying to find a reason that she didn't or wouldn't or couldn't. And I

31:11
really don't have I mean like talk about like from front to back like all rookie

31:19
mistakes. Yeah. And it really does break my confidence. Yeah. We we just celebrated 10 year

31:26
anniversary. Like you've been here long enough. So I don't you know this for me is a pause moment to go I don't know

31:31
what's going on with her. Does she need more support? Was this just a weirdo fluke that just happens to be I I really

31:38
don't know what to say. Well, and even if it was a weirdo fluke, if we look at this one weirdo fluke

31:44
scenario, first of all, trace it all back to last week's episode. We could have shrugged this off as crazy parent,

31:52
tell them they owe the bill and move on and we would have missed this blooming of all of this information

31:59
that we ga gained from this which is we missed it on multiple levels. We missed

32:06
it with that initial estimate. We didn't pause. We didn't slow down long enough to actually look at it and and absorb

32:13
what we were seeing there or question should we move forward with this? We missed it because we did incorporate

32:18
secondary into the process and we should have eliminated secondary or at least we should have done a better job of

32:25
understanding where secondary failed this particular parent, this patient.

32:31
But even beyond that, we didn't do our homework with insurance to figure out

32:36
why they short paid so much. It's evident short insurance shorts all the time. It's part for the course. It's

32:42
daily. But in this particular case, it was a big difference in our estimate and

32:48
what the parent is now going to owe. And we didn't take the time to figure out why. And then finally, when billing the

32:55
parent, we used technical language, non-duplication clause, which the parent

33:02
misinterpreted to think that we didn't understand the coordination of benefits or didn't verify that accurately. So now

33:09
parent thinks we did something wrong. We haven't really done anything to support our case and and break it down more

33:16
simply for them or to even show, hey, we went to bat because we thought it was odd, too. And that when that EOB came

33:23
in, I got on the phone with Delta and I asked them about these codes and this is what they said. And I think that's

33:29
wrong. And so I'm contacting you about this bill because I think you need to go to Delta. And we didn't do any of that.

33:35
We just said, "Here's your bill. Wash our hands of it. Best of luck to you.

33:40
you owe $1,700 and by the way, you never responded to our texts and emails. Now, we're going to send you to collections.

33:47
You look at the whole scenario of this and I doubt that this is happening

33:52
regularly in your practice, but it should force us to pause and go, make sure.

33:58
Yeah. And it then forces some system changes like, okay, now we're eliminating

34:04
secondary. Forget that. We ain't playing that game anymore. That's a good change. Now, let's go through all the changes of that. Coaching your team on estimates to

34:12
go, okay, everybody needs to know where do you pause on these estimates and let's look at some highlighted ones that

34:19
cause issues with estimates. Encouraging your treatment coordinator and your team for that matter. Slow down. Not that

34:27
those estimates have to be 100% accurate, but at least slow and think about it and make sure, does this seem

34:34
accurate? And if there's anything that's standing out, let's not just move forward with it. Um, let's make sure

34:40
billingwise that we've got phone calls that go out, that we've got some protocol before we send a parent to or a

34:46
parent or patient to collections. When do we advocate with insurance for a patient and when do we say, "Okay, no,

34:53
this is not one that we need to advocate for." So, it just opened up this whole can of worms that I think is a good can

34:58
of worms for us to pause and consider from time to time. So, I can imagine an audience member now is going, "But it's

35:05
not my problem." Especially if you're I think a majority are more like me going, "I don't want to. I'm trying to learn

35:12
how to improve my bridge. I'm trying to learn how to incorporate AI. Are you kidding me? I got to deal with this now,

35:19
too. Like, where do I draw the line?" Legally, you're fine. Like even if you

35:25
did blatantly tell the patient and and even if the the verbiage had said we will not coordinate and then you acted

35:31
like it didn't coordinate legally you haven't done anything legally wrong. You are fine.

35:37
Where you need to go into this is how does this affect the image of your

35:43
practice? Yeah. And the profession of dentistry honestly like this is don't we all hear this?

35:49
that office screwed me, that office, whatever. And you're kind of going, wasn't really the office, it was the the

35:55
insurance that did. But this is like in my mind best practice for the liability

36:02
of your practice because a patient thinks they were done wrong and they're going to blame you. And so

36:09
even whether legal entities would agree with that or not, it's still a major impact on your practice and a headache

36:15
to deal with. And you don't want to have to write off that 1,700. That's that's a lot of money. It's a lot of money for

36:21
you, but it's a lot of money for that patient, too. So, how you handle this and what you glean from this does

36:27
matter. Um, is what I kind of want to reiterate because it's I think there will be audience members that are like,

36:33
ain't my problem. It is your problem because it's going to reflect poorly on your practice. Y

36:39
and I think most of us are going, man, I've had to have like the turnover of trying to find a good front desk. I

36:44
don't know if they're getting it right or not. I don't want to deal with that, friend. At some point, coming up with

36:52
some auditing system because you don't want you don't want to be spending all

36:57
this money on marketing dollars to get a patient in. You don't want to be doing great patient um experiences and all of

37:03
that and then lose the patient on something like this. And then the the negative impact of word

37:09
of mouth that this can have in your community. Yeah, you do good work, but what does that matter? You're shady with

37:14
your insurance practices, with your billing practices. No, I'm not shady. It's your insurance. I had to your office. That happened to you, too. That

37:22
happened to me, too. So, it's it's just um it is important to pause and it is

37:28
super yucky that we have to deal with this. Um but it is what it is. Uh I

37:33
think then so to come to kind of wrap this up back to what am I replying to this parent without going

37:40
they did tell us they have this. you did sign off on this. It was just an estimate. Sorry, chump. Like, this is

37:46
not my problem. Do I just write it off? Because the temptation's there. I did

37:52
say I'm very tempted to write off because I know these are exactly what trigger board complaints. And if a board

37:58
complaints involved, I can guarantee you I will spend more than $1,700 with an attorney to go over this case. I'll

38:04
spend significantly more. Should I just write this damn thing off and move on?

38:11
No, not in this case. No. Um,

38:16
do I say, "Okay, yes, my team my team what am I undermining my team at

38:23
this point?" Like, yeah, Biller missed all of these things, but that just means she wasn't having her finest billing

38:28
day, but did she really do anything quote wrong? No. Did she do some things that weren't very wise? Yeah. Uh, so but

38:37
what do I say if I choose to go ahead and write some of this off cuz I feel bad and I'm hoping not to trigger a complaint and what if I offer to say

38:43
fine, we'll we'll take off half, but the parent's still going to be like, but what about the other half? Why would you

38:49
just take off half? Like that's not going to solve it in this case. I don't know. I don't know how that would play

38:54
out. What would the verbiage be? What would the rationale be? I have no idea. Do I just again, yeah, say, "Sorry, you

39:01
owe this." I I don't know. I don't know what to say. So, by the time you were there and we'd already kind of deduced

39:07
all this and kind of had just, you know, been slapped in the face with all these things that aren't happening that should have been happening. Um, so trying to

39:15
resolve all of that. But I was like, Bethany, again, I don't know when this email came in. I don't want to just

39:20
continue to ignore it. I don't know if this email sat there for 2 weeks and they've all been dancing around it trying to dodge me cuz they know m

39:27
missteps were made. Um, I want to respond to this today. What are we

39:32
replying? And so you had said, "Oh, well, I'll tell the biller to say all of this." Well, I know our biller is very

39:37
black and white. And I was like, "Uh-uh. I don't want Biller writing this because it's going to be clouded from her

39:43
perspective." And I think she at this point realizes she's again not done anything wrong, but she's just done some

39:49
things that weren't really protecting the practice. And so, what is she going to say? Because she already said the

39:56
non-duplication. and that I I just think these are terms that are norm in her world that the rest of us have no clue.

40:03
So she doesn't even know what she could be saying that could set off another train of thought that we don't need to

40:09
get into. So I was like, "No, no, no. You and I are drafting this email." So can you talk us through how you

40:15
Yeah. So what I wanted to do in the email is I wanted to make sure that we still seem supportive of the parent

40:23
because at the end of the day I still believe that their secondary failed them

40:28
and that's not fair and as a parent myself I would be upset by that and so I wanted to provide them with good

40:35
information that they could use to hopefully go and fight with uh Delta I

40:42
think was the secondary on how they short paid. U also I wanted to imply that they

40:50
should go and fight Delta because at the end of the day this is an insurance

40:56
issue. Again, did we could we have done a better job of preparing the patient for the parent for

41:04
the balance that they would owe? Absolutely. We could have prepared them for that 1,700 if we would have done a

41:10
few things. But regardless, secondary still paid way less than they should have paid. And so I wanted to make sure

41:18
that email encouraged them to go and pursue that from insurance. But I also

41:23
wanted to make it clear that the balance wasn't changing, that we're not we're

41:28
not doing anything on that side of things. So I just uh you went and

41:34
printed everything out. We printed verification out to show and we highlighted the part that said yes they

41:39
do coordinate benefits. Uh you also printed out the uh

41:46
the initials on the initials. Yes. That I am responsible for what insurance. And I didn't want to

41:52
highlight that because I didn't want that to be like sorry you said you knew this cuz it's not super helpful at that

41:58
point but I didn't want to not put it in there. It's like you knew this policy. Yeah. So ultimately, you're asking me to write

42:05
it off when I'm telling you and you acknowledge cuz you signed it that it says I'm responsible for whatever

42:11
insurance doesn't pay. Yeah. So it's not that I didn't do the right work. I didn't do anything like I've

42:16
upheld my end of the bargain. I kind of gave you a crappy estimate, but that's not illegal. That's not whatever, but

42:22
you were you acknowledged that this is what So we put that at the back of the of the stack of things we were emailing

42:28
them. Um, and then you kind of had it as here's, you know, your insurance did

42:35
tell us they're going to coordinate benefits. See, attachment one. We've highlighted that for you. Here's where

42:41
and and you were, you know, I wouldn't have known how to do this. You were phenomenal and uh pivotal in saying this

42:47
is what your primary paid. Um, this is where they failed you. Like these two

42:53
codes where they didn't pay anything or they paid like 70 on one and the other one's the exact same thing, but they

42:59
paid 50 on that. Why why wouldn't they pay 70 on both? The whole thing doesn't make any sense. And that's what you were trying to highlight. Like this is just

43:05
arbitrary what they decided to pay. So they didn't pay any of these. I would pursue this with insurance one.

43:12
Paragraph two was this is where again this said your benefits are coordinated.

43:18
They didn't pay anything on this. they short paid on this, you should absolutely pursue this other one. Um,

43:25
and then uh I so then the third onion layer was, you know, the parent wants us to write it off. And even if I had

43:31
decided I wanted to do that, which thankfully through this process, we determined I wasn't going to do that. And there was no there's no good way to

43:37
do that. How was I going to was I just going to send the message like, "Yeah, you're right. We we did a wrong

43:42
estimate." And then they can go and post somewhere else and be like, "Oh, yeah. All you have to do is be a squeaky wheel." like what what am I? So, um but

43:51
then it came out that now that it's in with collections. Yeah. We can't and I I guess that's something

43:57
I didn't know like could I just take it back from collections and your response was I said no. So, and again every

44:04
collection agency is different. So, this is where you'd have to check with your collection agency, but most of them do

44:10
not want you to take the balance back from them because they're usually paid a

44:16
percentage of what they collect. So, now you're like, "Oh, I turned this account over to you, but I'm going to pull it

44:22
back. I'm going to write off half of it and I'm going to collect the half from the parent." Well, collection agency's

44:29
like, "Hello, we've been working on this account and we would like to be paid." So, they don't like for you to pull

44:34
those accounts back onto your plate. So, but regardless of that, so that's

44:41
collection agency protocol. You have to check with your collection agency. But regardless of that, we've already gone

44:46
through the process and the paperwork and all of that of turning it over to collection. Don't back down from that.

44:52
Just it's in the hands of collection agency now. So, we it's kind of out of our hands in a lot of ways. Um, so this

45:00
is now something you'll have to take up with the collection agency, but I didn't want it to look like we weren't doing

45:06
anything. And so what I put in that email was, we will communicate to the

45:12
collection agency that we approve any kind of payout plan that they can come

45:17
up with with you. um almost like we're giving the collection agency approval or

45:24
sanction to stretch this out a little bit to make it affordable again. And and the the verbiage I love

45:31
that you put in there was to give you time to pursue this with the insurance. So again, your your messaging of you

45:38
need to pursue this. I wouldn't settle for paying this money.

45:43
Your insurance screwed you. You need to fight your insurance. These are the codes you should fight them on. These

45:49
are the non-duplication things that they said that don't make any sense. You should fight them on that. The what the

45:55
only thing I can do is that I can tell collector agency to back off for 4 months. Give them time to fight with the

46:01
that making it seem like you should fight. Yeah. Use that time, use that grace from the collection agency to fight this

46:08
claim or this uh balance. And honestly,

46:14
I don't know if that email's going I don't know how that email is going to resonate, but to me, I'm always like,

46:20
let's shoot our best shot and thoroughly think through the core message of what

46:26
we were trying to tell that parent. And the core message is we can't do anything about this balance, but you should most

46:33
definitely But you can. Yeah. We can't do anything. You can. Yeah. Yeah. Um, and I think the response, do

46:42
you want to say the response? I think he just Yeah. The next day I reached out to Biller at the end of the day and I was like, "Did we hear from

46:47
dad or is he ignoring this email too?" You know what I mean? Like if we' had that going into it before last episode

46:53
where you pointed out like the reason why people they weren't they weren't trying to make out like bandits on us.

47:00
They probably just thought that this wasn't a real bill. But when they had never replied to our previous attempts,

47:06
like is he ignoring this one, too? And no, he didn't. I guess he replied back and said, "Can you send me the original bill you sent me?"

47:12
Which makes me go, did he just delete it again? Did he just disregard it? Or had we sent it to the mom? Are they

47:19
divorced? Are they together? Even if they're together, kind of like you said in the previous episode, maybe is one parent getting stuff and the other one

47:25
isn't, like where did this go off the rails? Yeah. And I think uh again, why

47:32
why am I even bothering? I just said it a minute ago because it does impact the impression and the taste that this

47:38
patient has in their mouth. We tap dance on our heads to try to make this a great experience. This is always the number

47:43
one way to ruin it as finances and something not being covered. So, could we have done our due diligence to not lose a patient, not have negative

47:51
uh words being said about our practice? At the end of the day though, I feel like we have done everything we can. Is

47:58
this parent still gonna pursue anything further against us? It's possible, but

48:03
to me, this is where my journey ends because in Texas, it ain't going to be me. It will be my if they do go to the

48:11
board, it will be my time to have my team put the chart together to send it into the state board, but I'm done after

48:18
that. This is going to be on associate then, which is going to really suck for him. So, for me, I'm like, I have done

48:23
my due diligence to protect you and to protect my practice. try to help the patient.

48:29
Yeah. But I can go to bed now going I I've done everything that I can do

48:34
and um and have made changes out of it. So to even take this scenario where

48:41
we've learned from it, we we're choosing to not bury our heads in the sand. We're choosing to fully look into this painful

48:49
scenario and go, what can we learn and how can we improve from this? which to

48:54
me is a way of protecting the practice going forward. Um, and and to me that

49:00
was worth the hours that you put into it, that I put into it to just fully

49:05
absorb ourselves in the uncomfortable situation of this. We've learned a lot and we're implementing things from it.

49:11
And to me, that's the the beauty of this scenario, the silver lining that we've got to look for. I do. This is another

49:17
one of those where I just do wonder uh you know like Wednesday night I went home and I was like what do people do

49:24
without a Bethany? What do they do without you? Um and and

49:30
nobody try to be a client cuz I don't want her time taken away. So yeah, be a subscriber. That's how you can

49:36
right. Whatever. Come to a crash course, but don't take my Bethany time away. But I'm just I just I don't know how people

49:42
do it without help and support and so complicated. back to what we said at the beginning of last episode. We're

49:48
here to talk about this because it happens every day in our offices and to try to be a resource. Um so hopefully

49:54
you've got resources. Absolutely. Absolutely. Yeah. Listen to these two scenarios and and don't turn

50:00
your head away. Dig in and again access the resources that we've made available

50:06
because we do want to support practices. That's why we spent two episodes talking about this. It's important. It really

50:11
is. So take the time to really absorb. If nothing else, if nothing else, I

50:16
think to me what should resonate with yourself and with team members and

50:22
everybody at the end of the day, our mission, and we say it, it's one of our office goals is to help keep these

50:29
babies in our community healthy. That's why we show up to work every day. And now this kid is not getting his reare

50:37
because of this pending balance. Yeah. And this is a kid that obviously needs the

50:43
reare. He had a mouthful of issues at a young age. If any kid needs the help,

50:51
it's this one. And we because of all of our little missteps have contributed to this kid not having

50:59
access to care. Yeah. Yeah. It's detracted from the core mission and therefore requires our

51:05
attention. Thanks for joining the conversation today. We hope that you are comforted in

51:11
knowing that you are not alone, but we also hope that you're walking away with [music] some really great tips and

51:17
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