Thank you so much for your videos, as an office manager, I can say that everything you are saying is spot on!! I had a question about patients who have out-of-network PPO coverage and their plan is based on their own fee schedule. When asking many insurance companies who are not in network, they will not disclose the fee that they actually use to determine benefit for a patient. How would you approach this to make it more clear for the practice and the patient. For example, a patient gets a prophy, the office fee is $100.00. This patient has an out-of-network PPO plan that says they cover preventative at 100% coverage. The EOB comes back and the insurance only paid $60 and the $40 balance is the patients responsibility. Thank you so much for your insight!
@alexanderhall2558 This is a question that comes up for all offices who maybe out of network on one or more plans. To get fees for procedures for out of network plans, it’s never an easy task in the beginning. When you’re unsure of what you’re going to get paid, you’re going to want to underestimate what the insurance will pay and collect more from the patient. In your example, you mentioned $100. I’d collect 80 from the patient and let them know it’s possible you may end up with a credit once we generate a claim on your behalf. As you’re doing this in the beginning, you’re building a “blue book” of fees of procedures for that particular plan. So next time you see a patient with the same plan and benefits, you know what to expect from the insurance and you can collect appropriately. This is for preventive. For basic and major restorative, I’d most definitely send in a preauth to get the fees. Again, once you get the fees, add them to the blue book. So essentially you’re building up the fees database on your end. Depending on which practice management system you’re using, you can utilize the built in blue book feature to do this. When you get started, Starting the conversation with the patient with full honesty is the best course. Don’t go around and tell the patient you accept their plan because they’ll assume they have to pay nothing for preventive. Whether it’s in person or on the phone, let them know they’ll have a small oop for preventive, but you will send in a claim on their behalf to get them benefits. Majority of the times, it’s HOW you say it to the patient. Hope this was helpful. Don’t hesitate to reach out if anything else!
Thank you so much for making these videos. It has really helped me through a startup practice this year. I am wondering if you would be willing to talk more about how you operate without hygiene? I am really interested in this model given the fact it’s hard to find a hygienist and the hourly pay desired is very high. Thank you!
I am 2 months in a start up and this is super helpful to me! Where in Open Dental do you put the past history of a tooth? for example "tooth #2 had a crown or filling done in 2021"
@KristinaBosworth, I’m glad the video is helpful for you! For history that is important and relevant to whatever I may need to do on a patient, we just put it in the chart module in the blank note section under the tooth chart separated by dates. Keeps it simple and accessible and attached to the chart. Hope this was helpful!
@Efahsal I don't have a video specifically for new graduates. I've delved into topics important to new graduates such as student loan debt, associateships, etc. via my newsletter in the past. All the written blog posts on dentalstartupacademy.com and the videos here on UA-cam have to do with starting your own practice, and managing it. I basically share all the things I run into in my own practice. But you're not the first one to mention this, so I will add to my list for future videos for topics for new grads for sure!
Thank you so much for your videos, as an office manager, I can say that everything you are saying is spot on!! I had a question about patients who have out-of-network PPO coverage and their plan is based on their own fee schedule. When asking many insurance companies who are not in network, they will not disclose the fee that they actually use to determine benefit for a patient. How would you approach this to make it more clear for the practice and the patient. For example, a patient gets a prophy, the office fee is $100.00. This patient has an out-of-network PPO plan that says they cover preventative at 100% coverage. The EOB comes back and the insurance only paid $60 and the $40 balance is the patients responsibility. Thank you so much for your insight!
@alexanderhall2558 This is a question that comes up for all offices who maybe out of network on one or more plans.
To get fees for procedures for out of network plans, it’s never an easy task in the beginning.
When you’re unsure of what you’re going to get paid, you’re going to want to underestimate what the insurance will pay and collect more from the patient.
In your example, you mentioned $100. I’d collect 80 from the patient and let them know it’s possible you may end up with a credit once we generate a claim on your behalf.
As you’re doing this in the beginning, you’re building a “blue book” of fees of procedures for that particular plan. So next time you see a patient with the same plan and benefits, you know what to expect from the insurance and you can collect appropriately. This is for preventive.
For basic and major restorative, I’d most definitely send in a preauth to get the fees. Again, once you get the fees, add them to the blue book.
So essentially you’re building up the fees database on your end. Depending on which practice management system you’re using, you can utilize the built in blue book feature to do this.
When you get started, Starting the conversation with the patient with full honesty is the best course. Don’t go around and tell the patient you accept their plan because they’ll assume they have to pay nothing for preventive.
Whether it’s in person or on the phone, let them know they’ll have a small oop for preventive, but you will send in a claim on their behalf to get them benefits.
Majority of the times, it’s HOW you say it to the patient.
Hope this was helpful. Don’t hesitate to reach out if anything else!
@@nilaygshahthank you so much for your help!!
Thank you so much for making these videos. It has really helped me through a startup practice this year. I am wondering if you would be willing to talk more about how you operate without hygiene? I am really interested in this model given the fact it’s hard to find a hygienist and the hourly pay desired is very high. Thank you!
Amazing content. Teamio was what I was looking for a long time.
@taeyunkim1348, thank you for the feedback! Have you had a chance to see the website at teamio.app
I am 2 months in a start up and this is super helpful to me! Where in Open Dental do you put the past history of a tooth? for example "tooth #2 had a crown or filling done in 2021"
@KristinaBosworth, I’m glad the video is helpful for you! For history that is important and relevant to whatever I may need to do on a patient, we just put it in the chart module in the blank note section under the tooth chart separated by dates. Keeps it simple and accessible and attached to the chart. Hope this was helpful!
@@nilaygshah Thank you!
Hey, new grad here. I'm glad I came across your channel. Do you have any advice for New graduates? Or maybe a video on it? Thanks
@Efahsal I don't have a video specifically for new graduates. I've delved into topics important to new graduates such as student loan debt, associateships, etc. via my newsletter in the past. All the written blog posts on dentalstartupacademy.com and the videos here on UA-cam have to do with starting your own practice, and managing it. I basically share all the things I run into in my own practice. But you're not the first one to mention this, so I will add to my list for future videos for topics for new grads for sure!