A question was asked recently about a situation that happened in one of our dentist’s offices. This is a common mix-up where the patient’s expectation about what their insurance will cover isn’t met…
Before reading about the doctor’s question below, please note that the patient was so upset that after she spoke to someone in the office, she quickly resorted to posting negative comments on the dentist’s business Facebook page (which luckily the doctor was able to remove). If the situation had been handled correctly in the beginning the negativity could have been avoided.
The dentist wrote me:
“A patient is very upset because we charged for a comprehensive exam the first time we saw her and her insurance didn’t cover it because they had already paid for one somewhere else. So she owes us $41 for the exam. The patient says her insurance company told her we couldn’t charge her, but when we call the insurance company and asked them, they responded with ‘We would never say that, and absolutely you can charge a comp exam on a new patient.’ How do you handle this?”
And here’s what the patient wrote on the dentist’s Facebook page: “Has anyone else had any problems with this office over billing from what their insurance EOB states they should pay? And when you call to ask questions you are told to find a different office if you don’t like it?”
Here’s my take on the situation:
We always advocate for verifying benefits in advance (at least a week ahead, or more if possible) so you know exactly what the patient’s eligibility is. You don’t have to get a full breakdown, but at least get an idea of specific coverage for the most common procedures like comp exam, FMX, bitewings, etc., and then communicating with the patient to prevent this issue from happening. Note that we have an Insurance Breakdown Form in the All-Star Dental Academy Resource Library that can help. Had the team member checked the benefits in advance and asked the patient when their last exam/x-rays were, the staff would have determined that the patient wasn’t eligible for the comp exam. Doing this ahead of time would have allowed enough time to call the patient and prepare them for their visit. Patients should never be surprised or have the wrong expectations. It’s a different story if the patient was coming for an emergency visit, but with a comp exam, that’s not usually the case.
If the office isn’t going to verify the benefits upfront, they need to be sure to let the patient know the price to expect if it turns out the treatment is not covered. It’s also up to the staff to educate patients on the difference between regular exams vs a comp exam (since many patients assume they get two exams covered per year, but that does not include a comp exam).
Since the problem has already occurred, it’s time to suck it up and work to keep your patient happy. I wouldn’t fight over $41 (the cost of the exam in this case). It’s not worth losing a patient, having them get mad at your office, and potentially posting more negative reviews online or talking poorly of the office to the community. I would write off the fee and just be clearer in the future by checking insurance coverage thoroughly before the patient visits the office.
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