Dental Practice Heroes

Playing The Dental Insurance Game: How To Slash Your Denial Rate

• Paul Etchison, Travis Campbell • Episode 582

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Claims keep getting denied? Here’s a hard truth: it’s probably your fault. But in this episode, Dr. Travis Campbell shares everything he's learned about how to master the insurance game, get your denial rate under 2% and stop wasting hours on appeals.

His insights cover everything from the common reasons SRP claims get denied to the simple step that makes crown approvals almost automatic. We also talk about what insurance reviewers actually want to see in claims, how to avoid surprise patient bills, and what every out-of-network practice should have in their office.

Topics discussed in this episode:

  • Why practices are going out-of-network
  • The biggest reason claims get denied
  • Perio protocols and insurance strategy
  • How to overcome the AI problem and get claims approved
  • Tips for dealing with insurance reviewers
  • The foundational restoration code
  • How to reduce crown denials
  • Metrics you should track in your office
  • How to calculate better estimates
  • The Dental Insurance Guy membership

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Paul Etchison:

I can't believe I'm about to say this, but it is time to stop blaming the insurance companies, right, I know, but in this episode, dr Travis Campbell is going to explain to us why most denials are actually caused by us, the dentists. He has a ton of insight into how insurance reviewers think, what they look for in claims and what we can do to drop our denial rate to just under one or 2%, and this will help you, whether you're in network or out of network. I learned a ton during this interview on how to play the dental insurance game, and I know you will too, so don't miss this one. Let's get into it. You are listening to Dental Practice Heroes, where we help you to create a team and system-driven dental practice, one that allows you to practice less and make more money. I'm Dr Paul Etcheson, a dental coach, author of two books on dental practice management and the owner of a five-doctor practice in the south suburbs of Chicago. I want to show you how being intentional about ownership can create a practice that supports your life instead of consuming it. So if you're ready to create a true business that runs without you, you're in the right place. Let's get started.

Paul Etchison:

Hey, welcome back to the Dental Practice Heroes podcast. Thank you so much for tuning in with us today. I got a great interview. A repeat guest multi-practice owner down in Texas Got Dr Travis Campbell on and you might know him as the dental insurance guy he is the one that you might have seen on Facebook that if somebody asks insurance question he's got a very knowledgeable and comes from a place where he knows what he's talking about. And, oh man, is there a lot of people that don't know what they're talking about? It seems like, or we're all confused. So we're glad you are in our industry, travis. Welcome to the podcast man. How's things going today?

Travis Campbell:

Well, thank you, paul, things are going great, great yeah, and would you agree?

Paul Etchison:

there is a lot of confusion around insurance.

Travis Campbell:

Absolutely. I mean, insurance is complex and I don't think the insurers really go out of their way to make it any easier for us, and unfortunately there's a lot of misinformation out there, so it can be daunting for people.

Paul Etchison:

How did you decide that this was something you wanted to get really into deep? How did this happen, where you got, maybe found yourself into it very deep?

Travis Campbell:

Well, when I first started, I owned a practice, I did a startup, and how we get paid is a big part of our world. It, you know, for lack of a better term, it ticked me off Kenwood and so I had to find answers. So I looked all over the place. I found answers that did not make sense or did not actually match the information I could find, and so that's what got me to look into it is. I couldn't find anything good, useful, and so I started reading contracts and researching state laws and what we can and cannot do and what the insurers can and cannot do, and then a lot of people just start asking me questions about it.

Paul Etchison:

I feel like there's a big push right now. I see it on the internet with Delta, where a lot of people are going out of network. And I have dropped Delta and you know it was the right time for my practice. We were at capacity where we needed to do something with our capacity and all we could do was thin our herd. So we got rid of our lowest paying plan. But I can tell you, I still have Delta patients and I'm still working with insurance and I think a lot of people think that you get out of network, you don't have to worry about that anymore. What have you seen in the industry?

Travis Campbell:

So I mean it's an interesting trend because pre-COVID 95% of offices were in network with at least one company, delta usually being that one company, I would say. Now the number is probably more about 90%. So number of out-of-network offices have more than doubled. The interesting trend is I'm seeing that people are starting to, instead of drop Delta last, actually drop Delta first because of their fees that aren't increasing. Well, at least with umbrellas. All the other companies are playing ball. So that's been an interesting kind of flip in the industry.

Paul Etchison:

Yeah. So if someone's getting out of network, and whether in or out of network, how can we play the insurance game better so that we can be reimbursed more?

Travis Campbell:

Well, I mean, the number one thing is realize you know there's a lot of things insurance companies are at fault for.

Travis Campbell:

The one biggest challenge I see is, you know, does complain about denials and honestly, in most cases the denials are our fault more than the insurer. So we've got to understand if something's just purely not covered, you're going to get the denial and you're going to have an upset patient if you didn't understand at the front end that it was just never going to get paid to begin with, because it's the surprise bills that cause the most upset ever. So it's learning. Either, you know, get good verification, get good breakdown of benefits so that you don't have these surprise bills and you can give your patient a good estimate in or out of network, and then realizing for services that are covered, making sure you document in a way that the insurer wants.

Travis Campbell:

Whether or not you like the way the insurer wants, it's a different story, but document in the way the insurer wants and then you don't get denials. I mean crowns, scaling and root planings are probably the most common complaint that I ever see. And yet most claims I see they're denied because I get them sent to me every day almost and I saw why they denied it, sent to me every day almost and I saw why they denied it. So you kind of see it from both sides and realize if you want to win the game you just have to learn how to do a little bit better documentation, which clinically takes an extra like 60 seconds, and then you just avoid the denials to begin with.

Paul Etchison:

Now, when somebody gets a denial, I mean we'll often if practice owners sometimes we've got to write the narrative. I mean these are things that my team does for me. I signed them, but I remember in the beginning this was completely foreign and new to me. And it go through the process. We do two quads, then we have them back two weeks later and we do the other two quads and then maybe it takes another 30, 60 days for the claim to reclose and come back or get denied. And now at this point we're so far removed from that procedure that we're saying, okay, well, maybe the insurance is going to make this look like this was our fault, that it wasn't a necessary treatment, and that we're now over diagnosing. So now we've got an upset patient and now I'm going to think twice next time. I think somebody's perio, that's not perio. So what advice would you have for dentists in that regard?

Travis Campbell:

I mean, you probably hit the nail on the head of probably one of the worst things that insurance plays this game with is, yeah, it makes dentists second-guess themselves on completely legitimate procedures. And so you know, if you look at the most conservative approach AAP, ada, say what 70 to 80% of adults have perio or some form of perio. And yet if you run by all practice management softwares I mean they all say the same thing is practices tend to only treat about 6% of their patients. Well, let's say, every patient that doesn't show up in your office has perio. So of the ones that do show up, it actually ends up being about 40%. Is what an office should be treating with something other than a prophy.

Travis Campbell:

Now, that could be be more frequent, or it could be SRP or whatever. Well, there's a huge disconnect between 6% and 40%. And so what are we doing to the public? I mean, we're not treating one of the most rampant diseases on the planet Well as an industry. That's kind of a horrible thing on our end. And yeah, insurance has a big play, because if you can't get your SRP claims paid, then you're going to second guess whether or not you're going to do it in the first place, which, yeah, I mean, is a huge problem. I can say we do about 300 quads of SRP a year. We get denied on maybe one or two of them, and those one or two the patient's already paid because we already knew it was going to get denied. We were just trying to see if we could push the envelope a little bit. But it's all documentation and it's completely different now than what we were doing 15 years ago when we were getting all the denials.

Paul Etchison:

Yeah, that's amazing Because I feel like I mean, I'm just all anecdotal it definitely is more than two quads or two patients at my office. It's a ton of them. I mean, we have a box. We have a box for denied SRP claims. We have enough of them to create a box. So what is the documentation that we're missing out on? And what's reasonable? Because we all went to dental school and we've all filled out a perio chart. And what's reasonable?

Travis Campbell:

Because we all went to dental school and we've all filled out a perio chart and we've filled it out to dental school guidelines doing FGM and bleeding at sites and all these things. And you can spend a lot of time coloring a perio chart. So what is the say? We all and that's the sad part is actually most of us don't document. According to the way that at least most dental schools teach it, 90 plus percent of the claims I see denied that come across my reports. There's no general margins, there's no bleeding.

Travis Campbell:

On probing, I mean there's nobody who would say that's adequate and yet it's such a common thing to just put in pocket depths. I'm sure you know the same. You can't diagnose on a pocket depth. You have to diagnose on truly clinical attachment loss. So that's the first thing is make sure you actually have a complete chart. The second is photos. I mean I don't know about you.

Travis Campbell:

When I first started, internal cameras were expensive. They were four or five $6,000 a piece. But now they're a few hundred dollars a piece and you can have them in every operatory and you can use them for literally every patient and photos make a massive difference. I mean that's the biggest thing. What's better than any narrative you could ever write A picture, and then the last thing is to realize most claims nowadays, at least the first time it's sent, is completely processed by an AI, and for most of the major carriers it's processed by an AI that's reading your x-rays, and so there's some subjectivity to probing.

Travis Campbell:

There's some subjectivity to even angulation on the x-ray and there's subjectivity in where you start that measurement, from the CEJ to where's the level of bone damage, and so you're going to have issues with that. If you have a lower end or earlier stage case, your narrative has to be that much better and you probably should be circling and marking up that x-ray to show what it is that you're seeing. I mean, in some cases you've got to realize these reviewers the information they get is not necessarily the same quality as the information we send out, because we send all electronic claims but they get the resolutions removed. Sometimes they're printed and then copied. I mean they get all sorts of crazy stuff, and so sometimes it's just not better data. How many of these? I mean they get all sorts of crazy stuff, and so sometimes it's just send that better data.

Paul Etchison:

How many of these? I mean, is it normal that we're talking to like that initial, like that they're going to reach back out and say we need more information, or they're going to say they deny it and you're appealing, Like is that a normal process or is that an indication that we aren't sending the right information the first time?

Travis Campbell:

I mean that's a great question For crowns. In most cases I say it's not sending the right documentation to begin with For SRPs, unless you have an AI in your office that is actually doing the measurements for you and you can send that. On the claim, then I would say that, sadly enough, a lot of SRP claims you're going to expect to have to deal with. One appeal you're going to expect to have to deal with one appeal.

Paul Etchison:

So how do we balance the? I mean, filling out a full perio chart like we did in dental school takes time and taking a lot of photos takes time. How do we find that balance between what should we do on every single patient and when should we do it versus? Are we just doing too much for these outliers that may just get denied every now and then and just deal with that?

Travis Campbell:

I'm very process driven. I like efficiency, I like things that are easy. So the way we look at it is let's find what the worst insurance company to work with is, find the level of documentation they want and then do that for everyone and therefore you never have to think about it. And then do that for everyone and therefore you never have to think about it. And the documentation requirements yeah, they take extra time but, like I said, for Crown it's maybe an extra minute, for SRP it's maybe an extra five minutes, but then you save your front team hours worth of work and you get your collections and you don't deal with pissed off patients and everything else. So it's just keeping something that's simple for the team. When you're dealing with denials every week or every month, then, yeah, it's worth it to change and you have a box of them.

Travis Campbell:

Yeah, but the difference between a little bit better at documentation, which and let me go back to say this is always entertaining, because I have people that ask why are we doing this for insurance? Technically, actually, you're not doing it for insurance, because what happens when the patient comes back and says well, doc, my tooth didn't hurt until you touched it. Correct level documentation, you put up the picture, the conversation ends. I mean, it's a no-brainer. Show the decay, show the damage With SRPs. Honestly, patients aren't going to really understand most of what we're dealing with on that end. But if you ever have a malpractice claim or a state board complaint, that level of documentation is going to protect you far better than anything else.

Paul Etchison:

Yeah, we just had one of my associate partner. She had to be part of a deposition. She was not the dentist being sued, but she was the second opinion one of the other dentists that the patient had seen afterwards and she had said the level of documentation they were asking and the detail that they went through her notes line by line, was it scared the hell out of her. And she said I think we need to document way more than what we're doing. And after hearing her story of what they were asking her, my God, like I'm looking at my notes, being like man, I hope nobody does anything to me because I don't think I have this level of documentation and I think I don't know if this is right. But I think, like the number one lawsuit is is it undiagnosed perio? It's up there, yeah.

Travis Campbell:

Depends on what year you're looking at. It's almost always undiagnosed. Perio wisdom teeth with complications, implants with complications I mean those are your top three. Always Keep in mind, the level of documentation I'm talking about is not that much more from a written point of view. It's a lot more from a visual point of view, because I mean, one photo is worth more clinical notes than you could ever write.

Travis Campbell:

So do I spend? Are my clinical notes as detailed as others? I've seen no, but they hit on the specific points insurance is looking for, which is usually the why you're doing treatment. And yet most of the time our clinical notes think of it through what you write. It's the how you do it. Well, nobody cares how you did it. Nobody's arguing the how you do something when you're getting in a lawsuit or when you're getting in a board complaint or when you're getting insurance to fight things. Their number one thing is why you did it. So that's the focus is it needs to be on the why you did what you did, not how you did it or what you did.

Paul Etchison:

Let's pivot a little bit here. We talked about Perio. What about crowns? I'm interested to hear about what we can do to get less crown denials. And then I'd love to hear what you've heard about the new code with the mini buildup code. I don't know what it is, but I'm guessing you do.

Travis Campbell:

Okay, I'll deal with that one in a second because that one's fun, but I'm guessing you do. Okay, I'll deal with that one in a second because that one's fun. So what will we deal with with crowns? It's all visual. Again, it's all visual documentation. Now we do have a standard narrative sheet that's like a menu that we check off things. That makes things really easy. The other thing is the visuals you got to think about.

Travis Campbell:

The insurance company and the reviewer want to see what we saw clinically while we're working and yet most of what we send is before we even look at a tooth or touch the tooth, you know. So if you have a patient comes in with an obviously broken tooth with a massive hole in it, nobody's going to even question that claim. But when you have someone come in with a restoration that's failing completely obviously and yet on an x-ray looks fine, you got to change how you document because you want to show the damage. You want to show it where you can see the worst case scenario. You can truly figure out where you actually said, yes, a crown is needed, which is usually after the restoration's out. So it's a huge difference on the when you document more than necessarily the, what you're documenting, plus to think about.

Travis Campbell:

You know you're trying to get past that AI, because if the AI flags your claim, my guess is most insurance companies that get sent to a department that all they have is a little bird that goes deny, deny, deny, deny. So you've got to get past that AI. Well, a restoration on an x-ray to an AI looks fine, and so that's the problem. It's where it's at least entertaining. I'm not necessarily saying everybody needs this, but it's wildly helpful to have one of those x-ray AIs in the office, because then it shows you what the insurer is seeing, and if it's saying I don't see the problem, then you know the insurance AI is going to turn it down immediately and you're going to have to deal with an appeal, if nothing else, to get to an actual live dentist. And at that point it's the. Did your photos and everything actually document truly where the damage was and what it was, or is it just a picture before you even started?

Paul Etchison:

so if we're taking a picture of a mid procedure tooth and this is something I do and I think I know what you're going to say about this but I I have moved my camera angle to be like no, no, yeah, right there, take it, hit it and then my assistant hits it, because I don't like hitting the button on that thing, because I feel like it can move sometimes.

Paul Etchison:

But it's like setting up the perspective. It's like photography rules you don't have the horizon go through somebody's neck if you're taking a portrait of them. Is that? What you recommend doing is actually looking and realizing. That's more than just taking a picture.

Travis Campbell:

You're absolutely right. It's showing what you see, and the challenge is, photos are two-dimensional objects. I mean, they sort of have a little bit of depth perception to them, but they don't have a ton. They're not a 3d picture, they're not a 3d graphical image and so, yeah, you're going to have to sometimes change the angle, and that's some of what we do with our training.

Travis Campbell:

There's an online video we've got that I've put together that has shown here's multiple views of the same tooth, and do you see how these three pictures barely even show it versus? These two are okay, but this one's the best because you just change the angle slightly just so that you can see what it is that you're seeing clinically. But the other thing is don't overwhelm the reviewer. The reviewer has very limited time to look at the case, so you never want to send eight photos for a crown. At most, you send two or three, just the ones that truly highlight what it is. You want them to see what they want to see so that they can approve your case. Now you asked about the mini buildup for lack of a better term and the quote new code. The code for the foundational restoration, which is what you're talking about, actually came out in 2014. So that's why I laugh is it's not a new code, by any means.

Paul Etchison:

Oh, it's a new code in my office. I don't know where the hell it came from.

Travis Campbell:

It's a 2014 code. One of the bigger challenges I see with our complaints is insurance companies saying a buildup is inclusive to the crown. That shows up on denials a lot For one, we've got to realize insurance companies. It's probably sadly going to take a lawsuit to do it, but the way they word things is completely inappropriate. That's one of them. To claim that a buildup is part of a crown or inclusive to a crown is completely inappropriate. No one clinically would agree with that whatsoever.

Travis Campbell:

What they're trying to say and what I get people think about is let's reinterpret insurance. When you see something that says this is inclusive of a crown, what the insurance company is really saying is there's not enough documentation to prove that you needed a buildup and that you did a buildup a true buildup, a 2750 or 2950. Up a true buildup a 2750 or 2950. Therefore, we're asking for more documentation so that it's not a 2949, which is that mini buildup. That's what they're asking for. They're asking for more documentation. So every time we've ever seen that, we've gotten the insurance to pay it, but it requires a higher level of detail.

Paul Etchison:

Basically, so when the insurance says it's inclusive to the crown, are you saying that's not a plan specific thing, that's a claim specific? Somebody said no, that wasn't a good enough need for a buildup.

Travis Campbell:

It is poor communication. So I've got lots of reviewers I've talked to. They're actually fun people. They're not the enemy.

Travis Campbell:

The one thing to realize when you're ever talking to a dentist reviewer number one is they're not the ones who originally denied your claim. That's a whole different set of people. Usually the ones you actually talk to are a higher level of people that usually have been with the company longer, and they are yelled at when they deny claims that end up in appeals. The other thing, though, is most of them truly want to help, and a lot of them dislike what their insurer is doing, but they have limitations on what they can do, and they can only make recommendations that follow the policy language. So if the policy language states that they need certain levels of documentation, they could completely agree with you.

Travis Campbell:

The case is necessary, but they can't sign off that insurance should pay for it unless you meet those criteria, and so the criteria they're looking for is usually what's the amount of damage that is missing on the tooth? The number one thing that pretty much help makes every insurer like a crown is there's a missing cusp. I mean not every tooth we work on that needs a crown has a missing cusp, but missing cusp is like the almost guaranteed holy grail of getting crowns paid. But if you have that and you have the documentation, the photography and the notes that say that, you're pretty much going to get past almost every denial issue on crowns.

Paul Etchison:

Yeah, that's interesting to think about. Is that because we always think this is this evil person that has jumped ship? They used to be one of us and now they're not one of us and now they're over there? And I think if you talk to them, if we actually spoke to them about what they see, it would be very similar to if you talk to somebody who runs a dental lab and they'd say you should see the crap that people send to me and get upset about, like the quality of the impressions or the quality of documentation, and then they're upset that they can't get things approved. And it's not maybe that the person's mean and just wants to screw you over. They literally don't have what they need for their job. Like, put yourself in their shoes. I love that.

Travis Campbell:

Dentists don't usually like to hear this, but if you're having a major challenge with denials, more than likely it's on you, more than likely it just means you need better documentation.

Paul Etchison:

I'm just curious. When we look at our practice, we can look at metrics like our cancellation rate, our reappoint rate. Are there any sort of metrics with denials, or how many crowns should go through without buildups and how many crowns should go with buildups, Stuff like that that we can look at and see are we meeting our baseline and do we have a problem that we are unaware of?

Travis Campbell:

Um, I mean that comes from so many different angles. It's a great question. So I mean, first you got to think about, while most offices have a fairly average patient pool, every office is different crowns per patient population or X number per year or anything like that. I would say the biggest thing is just going back to the original training that most of us had for what's needed for a crown. Is there more than 50% of true structure missing? Probably need a crown at that point. Is there pain upon release of biting pressure? Well, that's correct too. Sundar, you need a crown. Is there posterior root canal? You need a crown. Is there a missing cusp? You probably need some kind of full coverage restoration. So those are kind of the diagnostic things. If you want any From a, here's another one that came up. That was interesting too.

Travis Campbell:

Someone two years ago sent me this letter that said they were doing too many three, four and five surface fillings in the posterior. I looked at the number of crowns he was doing. He was doing more three, four and five surface restoration fillings than he was doing crowns by a large amount. And the insurer was just seeing it, as most of us don't do this many large surface fillings, so something's wrong. Now the insurer probably wanted it to be stop sending as many surfaces. I actually told him because when I saw the number of crowns he was doing, I said the insurer is actually telling you you're underdiagnosing crowns Again, it's just the game to play is what are they looking for and what's another way to potentially look at it.

Travis Campbell:

So yeah, there are some challenges with are you diagnosing things correctly? Are you too conservative or too aggressive? You're going to have an issue either way. Insurance companies, I mean, they go by statistics and so if you're doing way too many or way too few of something, you're going to stand out and not in a good way. But that's the outlier 5%.

Paul Etchison:

Yeah.

Travis Campbell:

The other 95% of us. That's not the issue at all. The only true metric I would tell people to look at is well, I guess there's kind of a couple, but the number one is collection rate. An office should have minimum 99% collection rate. I mean there's almost no reason not to.

Travis Campbell:

The number one reason I see challenges is lack of correct collection upfront. The second one is how we estimate. Now I find a lot of offices and teams tend to like estimating in a way that makes it seem easier or better for the patient on the front end, but the problem is that means a lot of times on the back end we're having to tell them they owe more. The best way to estimate is in a way that the patient is never out of pocket more money than you told them. They can be out of pocket less. Credits are easy to give back and nobody complains when you give them money back afterwards. They only complain when you try to collect more. And so you know the average office that I've seen is somewhere around 25% of patients that have to be billed something after their insurance comes in. That needs to drop below one.

Paul Etchison:

So how would a dentist do that? Do you recommend changing the benefit coverage amounts that we calculate, or that's one way of doing it, absolutely it's.

Travis Campbell:

I would say every office is slightly different in this on where they are. So my recommendation is every time you have a surprise bill you have to tell the patient they owe more money after. That should be your red flag to figure out why and estimate everything when that scenario different the next time. So if that is, you had an estimate that insurance is going to pay 80% but for whatever reason they paid 70, yeah, change your percentage to say 70 next time. The number one concern is downgrades. Now downgrades are so common they're 80, 85% of policies right now.

Travis Campbell:

So I tell people, if you don't have a full, complete breakdown of benefits where you know every single code and what's downgraded and not you know everything, assume it is and assume they're going to pay for the lower service. So I mean, we all know composites a lot of times pay you as amalgams Great. Estimate the amalgam payment for your composite filling and then you will have a better estimate unless you're absolutely certain there's no downgrade. You know porcelain crowns tend to get paid at worst case scenario as base metal crowns. Always estimate that Implants and bridges a lot of times will get downgraded to partials If you're not absolutely certain they're going to pay for the implant, assume they're only paying for the partial. You do that. You solve a huge number of issues right there Now at a network. On the network, the number one is try to create a blue book. You know you've got, you're out of network, right it sounds like? Do you have a blue book?

Paul Etchison:

We didn't at first and, oh man, did we need it. It's different. Yes, it changed everything. Yeah. Yeah, we figured it out, but yeah, we didn't have it for a good five, six months going into it, and it was. We learned a lot.

Travis Campbell:

For those who don't know, a blue book is just a fee schedule of what insurance is going to pay as their UCR, which is not the office fee. That's their magic hidden fee. What are they going to pay to an out-of-network office? So you've got to look through every claim and start keeping track of those fees and once you have them which is sad that insurance won't give it to you because the only people that are really suffering are the patients Once you have it, then you can estimate pretty closely, very similar to what you could in network. But you have to have that fee schedule.

Paul Etchison:

Yeah, it is really sad too, Because it does. It screws them over, but they're never going to look bad. The insurance companies don't look bad, we look bad? Oh no, of course not. We had.

Paul Etchison:

I'll just share and I know a lot of listeners have heard this story before but when we went initially out of network with Delta, we had some patients that preventative was covered 100%. We said, great, here's our UCR. We've never used UCR for these coats because our cash patients would pay our cash price or membership plan and nothing else mattered in the PPOs. So we were getting on a hygiene visit, billing out $500, telling it was covered 100%. They cover 100% of their allowable amount and they get reimbursed. So they paid us $500 and then they get a check from their insurance carrier for like $130, $150. And that would tend to piss me off very much if I was in the patient's shoes and I completely understand that. And what was crazy about that is I didn't catch wind that this was even happening until about four months into it. So what was I doing, Right? Yeah, I take a lot of blame for that, but we figured it out. And then we built the blue book and figured out that game. But that was a first for us.

Travis Campbell:

Yeah, absolutely. And again it comes down to correct verification, correct fees and correct breakdown of benefits. If you have that, you solve so many issues right there and then, which is why collections again should be 99% as a minimum. Yeah, it'll ebb and flow every couple months, which is why the best way to do it is at least do quarterly tracking of it, because if you go less than three months you have too much ebb and flow and the number can go up and down a little too much. You do at least a quarter and there usually is very stable for offices across the country.

Travis Campbell:

And the last thing is what's your denial rate? And denials meaning not the like expected first-line SRP denials. I'm talking about denials that you have to deal with more than once, or you know, like crowns the first time denials are then. Or denials on your basic services where a lot of times it was just you didn't know there was a limitation. I had somebody this week send me already that they got denied on fillings because they didn't realize there was a waiting period and that fillings were considered basic and that the waiting period was for basic but not for diagnostic, and so the insurance paid literally nothing on a $1,500 claim and they were like what do we do and I'm like you're probably not going to collect all that $1,500, because I don't know how you describe that to a patient to get them to pay for something that would have been 100% covered otherwise?

Paul Etchison:

Right. So pretty much, just look and see what's happening, get the pulse on your practice and take a little deeper dive into what's going on and why, and you'll probably figure something out. Just ask enough questions. That's what it's like doing one-on-ones with your team. If you feel like your practice has no problems, you're not talking to your team. There's things going on. So talk about dental insurance. Guy man, I love what you're doing because there's so many people now we're struggling to hire with dental experience. And it was hygienic, and then it was, and now it's every position, it seems, and it's just the labor force thing. And there's so many of us that would love to go outside of dental, but we just don't have a good resources for learning the dental insurance side. So we want to find people with experience. What does Dental Insurance Guide provide to dentists and what have you put together? So we want to find people with experience. What does Dental Insurance Guide provide to dentists and what have you?

Travis Campbell:

put together Because I've looked at your program and I love it so good. Well, thank you. So it's an online training program that has courses everything from basic to advanced that can take anyone from where they are now to being a quote expert in filing and managing insurance claims. So it doesn't matter where somebody starts with. And the fun part is we even added this year, you know, filters to say what is the level of experience that this course kind of deals with, and so someone who's new can deal with all the basic courses first and kind of get that low level understanding before they move up, versus someone who's coming with experience can go in there and start at maybe the intermediate or the advanced levels. And the great part is it's a membership, it's not a paper video. It makes things easy for people.

Travis Campbell:

And there's almost 50 courses now and a new one that comes out every month, and then I'm on there answering questions almost every day. So there's a Q&A feature, and the funny thing on the Q&A feature is I think I get more team members to actually ask me questions because their doctors give them access to the portal. Then I get doctors asking questions. Well, to your point, you don't know what these things are dealing with because the team wants to try to insulate you, because they know you're busy, and so they're trying to deal with the insurance stuff. Well, giving them access to someone who can answer their questions has been huge for a lot of offices as well.

Paul Etchison:

Yeah, I could see that the mini insurance buildup or the mini buildup that's been out since 2014. Is there like people talking about this or am I like the last to come to the party, Like why did I just hear about this?

Travis Campbell:

Well, I will say you know more than most because you even knew there was a second code. Most of the time when I even ask people, when we're talking about buildup denials, who knows there's actually two codes for buildup? It's maybe 5% of the room that usually raises their hand and most of them I see my book on their desk. So there's a reason they knew it. So yeah, I mean it's a very common question because most people don't read through a coding book. I mean I will say you probably have to take a couple of caffeine pills or something to do this. But years ago I picked up a coding book and I read it cover to cover. Now it was boring, but you learn a ton and you realize there's so many codes that we should be billing out that we're not, or codes that we should be billing different than what we are to get better results.

Paul Etchison:

Where is Dental Insurance Guy? Where do they find more information? Check out your courses and everything that you offer.

Travis Campbell:

Dentalinsuranceguycom. That's great. I like complexity, you know.

Paul Etchison:

Yeah, yeah, great, great domain. Well, man Travis, thanks so much, man. It was a really great episode and I know, gosh, sometimes I have guests on and I'm just asking questions for the listeners, but this was a lot for me. I mean, I learned a ton and I know if I learned a ton, everyone listening learned a ton as well. So, man, I love what you're doing in the industry. That's someone who really got deep into the insurance and just a very not the most fun subject to become well-versed in, but something that is such a large part of our practices. It's amazing we don't know more about it and I just love that you put something together, a nice program for dentists. So thanks for taking some time out of your day and coming on the program and, man, I hope I can have you back sometime in the future.

Travis Campbell:

Awesome, it was a pleasure to be with you here, paul, again.

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Dr. Paul Etchison

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