432: Trends in Insurance Reimbursement - Dr. Roy Shelburne - a podcast by ACT Dental

Trends in Insurance Reimbursement

Episode #432 with Dr. Roy Shelburne

Everything you know about dental insurance today — well, it may be different tomorrow! So, to help you stay ahead of the trends and changes and protect your practice, Kirk Behrendt brings back Dr. Roy Shelburne to share his expert advice. There are ways you can maximize your reimbursement, and it starts with one thing: read and understand your contracts! If you want to collect every cent you're entitled to, listen to Episode 432 of The Best Practices Show!

Main Takeaways:

Dental insurance rules are constantly changing.

Always read and understand your contracts.

Double and triple-check your documentation.

Audits are done for a reason, not at random.  

Be prepared when communicating with insurance.

Quotes:

“What you know about dental insurance today, the rules are going to change tomorrow. The codes are going to change tomorrow. So, we have to continually keep our focus on understanding and doing it correctly.” (4:36—4:52)

“[Insurance companies] like claims that are clean. They don't like to have to send it back and ask for other information. It’s harder for them and it’s more expensive for them. So, that's the reason why they're concerned about having it done the right way.” (8:29—8:42)

“So many dentists look at the contract and only review the fee schedule and think, ‘Okay, I can live with this fee schedule.’ But, in fact, there are all kinds of other limitations or restrictions on that plan that have a broader effect on the reimbursement scheme. So, they aren't aware. It’s like, ‘Well, this says it’s going to pay at this amount.’ However, there's also a different section in that contract that says, ‘Oh, and by the way, under this situation, we can't pay. Under this situation, we can't pay.’ So, it’s understanding, first off, the restrictions and limitations not only in the fee schedule, but also the way the contract is set up.” (9:18—9:59)

“The contract, primarily, is seldom read. Or if it’s read, it’s misunderstood. And secondarily, the contract that you've signed with the insurance company gives them the right to change that contract with 30 days’ notice. So, not only have dentists not read the contract when they signed on originally, those letters that the insurance companies send to their network dentists periodically could have some very significant modifications to that contract where they're letting you know it’s changing, and the person who gets that letter, or the doctor who gets that letter, looks at it and goes, ‘This is junk mail,’ dumps it in the trash can, when the contract has been changed and it’s been disclosed in that letter that you haven't read.” (10:14—10:56)

“The concern is, we’re talking about inflation and how it is now increasing at a not foreseen rate. Maybe, what was it, in the ‘80s, it was similar to this? But now, do the costs for dentists go down? Absolutely not, as far as you have to pay teams more money. We have to be competitive in the employment market today. And as far as the supplies, they’ve gone out the roof. And what has been the trend with reimbursement? Has it increased? No. Absolutely, it’s going down. How do you make that work? How do you work harder and make less? And how many additional patients do you have to see, and what's your capacity?” (13:39—14:33)

“As far as the EOB, I think it’s meant to be obtuse, to be able to not follow. The more confused you are, the less likely you are to go ahead and counter, to appeal that denial.” (18:34—18:46)

“Ignorance is no excuse. And honestly, the bottom line, you're going to bleed a whole lot of money on the table if you don't pay attention.” (20:30—20:36)

“In my experience, although they say it’s a random audit, I don't think that's a thing. It’s an audit that is caused,...

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