Figuring accurate dental treatment co-pays is particularly tricky due to the complexity of dental insurance industry policies such as UCR and treatment downgrades. When figuring accurate co-pays, the treatment coordinator will need to take into account deductibles, yearly maximums, percentage of coverage, UCR and downgrades. This process can be difficult at first and leads many dental offices to choose to just collect a certain percentage and then bill for the outstanding balance once insurance has paid.

My office attempts to avoid billing patients by figuring accurate treatment co-pays and presenting them to the patient prior to the beginning of treatment. My patients sign a treatment plan estimate acknowledging the estimated amount and the fact that while we have attempted to give them the most accurate estimate possible, they will be responsible for any remaining balance once insurance has paid. We are able to accomplish minimal billing by asking the insurance company a series of questions which I will post in another entry. Often insurance companies will state their UCR for a particular procedure. For those companies that don’t state their UCR, we keep a spreadsheet derived from EOBs to track UCR payments in order to more accurately estimate co-pays for our patients.

Following this protocol has benefited my dental practices in multiple ways:
1) Less unhappy patients who are surprised by a large bill after treatment has been completed,
2) Less work for my staff in terms of billing and re-billing to track down patient payments,
3) Increased revenue as our office ensures payment for the work that is completed by collecting at the time of service and
4) Minimal use of collection agencies.

The Dentistry’s Business Secrets’ Practice Management Tools CD contains a “Checklist for Creating Accurate Dental Treatment Plan Estimates,” as well as the wording we use on our Financial Agreement Form.