Are Accurate Estimates Important?

Today’s episode jumps straight into the deep end of managing a practice. Dr. Kuba shares about a disgruntled parent in her practice that ended up with an unexpected bill of $1,700. Travel together with Dr. Kuba and Bethany as they discuss step by step how they investigated the account and used it as an opportunity to learn and improve. In today’s episode, they discuss what all went wrong with the treatment estimate and then discuss the changes that could have been made to ensure a more accurate estimate. Deep and meaningful tips are included in this episode PLUS so much more in the June bonus episode. 

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Transcript

0:00
Are you looking for a podcast where you can hear from real people regarding their real dental drama? If so, then

0:09
you've come to the right place. Join hosts Bethany Penny and Dr. Reena Kuba as we dive into the solutions we've

0:17
created and the mistakes we've made while managing dental drama. Let's get started.

0:24
Lady, I'm sitting here giggling.

0:26
What? because you came into my car looking all cute and I believe you're going to church after we record here and my plan is to go back to bed.

0:36
So, I look like a bum off the street and I'm like, you know, this is how we should be recording like the live, you know, like when we've done the live

0:44
sessions and we look put together with our matching coffee cups and shirts and all of that. And this is reality right here. This is reality right here.

0:52
So, typically I look like you. Please.

0:56
This is This is This is rare that I'm dressed for something rather than for bed.

1:02
I felt kind of when you came in. I was like, "What the hell?" Like, I literally rolled out of bed and you look like you belong on a magazine cover. Um anyh who,

1:11
I guess I take solace in knowing I am going back to bed after this. You're the winning one here.

1:18
Yes, you've got stuff to do. Um so, okay, real quick before we jump because I think I've got a really good topic for today. lots to to come out of it. I

1:26
think super helpful stuff. Um before I do that, I'm going to like give ourselves a little doot because I um you sent the June digest.

1:37
Yes.

1:38
And I must have written my articles back in April. April. Yeah. A couple months ago.

1:45
And um you know, same same as like what I'm doing here. I have no idea what I'm saying. Just stuff's coming out of my mouth. Then I hit send and you and

1:53
Sarah, I'm like, "Hopefully y'all can turn this into some semblance of usefulness and edit out garbage, whatever." So, I print the June digest

2:02
cuz y'all sent that. And I'm like, I have no idea what I wrote about. And I'm reading it and I'm like, this is actually pretty good.

2:10
And when I say that, I mean like useful tips. Yes, this is really useful. So, I think y'all my article topic was um I

2:19
think I've mentioned before I consult for different agencies. I guess you could say that. And uh so I was just

2:27
coming back from one of these um consulting periods. Sorry if y'all hear that noise. We're in a garage and somebody's horn is now everybody knows.

2:35
Yeah. The true reality. Um anywh who uh the the tips that I had I was like this

2:42
is what we see every time I'm presented with these cases it's 80% are one of these issues. Maybe not the main issue

2:51
but it's it's definitely in there. So um I think super helpful and it made me sad cuz I was like you know there's u

2:59
subscribers that get this content but really everybody could use these tips.

3:05
everybody listening could use these tips and if you're not a subscriber, you're missing it. Yeah.

3:10
Um and then your article too where you had real life examples of things gone arry in these dental offices. You're you're there all the time.

3:18
Yeah.

3:19
Um and people are missing that. So anyway, I you know, you and I always talk about how can we make things more accessible to people. I don't think

3:27
there's anything different we could do here other than you've got to subscribe.

3:31
So uh no, this was not a shameless pitch for is subscribing, but it it is like it it was really helpful.

3:40
Don't miss the resources. Really just encouragement. I think again the whole reason this podcast exists is to be helpful to people and every once in a

3:48
while you and I I'm proud of every month that we put out quite honestly. Um, at one point I put them all in a binder

3:56
just to like flip through and my husband was watching me flip through these months and months of work that we put together. And I told him, I was like, I

4:04
am like exceedingly proud of the content that we put out. It's just it's helpful.

4:10
It is it goes beyond what the podcast can do and really gives tangible takeaways.

4:15
I don't think there's anything else like it in terms of resources I could go to unless you I don't And maybe even then if you hired a full-blown

4:23
consultant firm, but it's like a lot of this comes from things you and I see every day. And um like I guess I I put a

4:31
teaser in my article that was like, "Oh, coming next like how to pick a lawyer." Yeah.

4:36
And should I should I need a lawyer? I was like I don't even remember what I wrote. I can't wait for July's digest to see what I talked about cuz I don't remember. And

4:44
I guess I could go back into my email and look for it, but I'm going to wait for July.

4:48
Your vantage point on that, too. like that's a vantage point that very few a handful of dentists are going to have

4:55
because you've seen lawyers in person and how they represent their clients.

5:00
So I'm like I again it is maybe a shameless plug but it's not a fruitless one. It's one that's

5:07
meant to be helpful. That's why you and I are here. So well that's why I was again just sad because I was like oh my gosh everybody

5:15
needs this. Um, okay. So, on to the topic today because I think this is another one that everybody needs. I think this happens in our offices

5:23
possibly every day or every week. And honestly, this week, um, I could have at

5:30
least six episodes of just the random that's happened in my office this week of things that we were dealing with this week. Mhm.

5:37
Yeah. Yeah. Yeah. Um I feel like I was kind of quiet there for a little bit and then this week alone I'm like, "Okay, well, we've got podcast podcast topics

5:45
till November, Bethany, because there's it was a it was a week.

5:49
We made up for lost time." That's I guess. Well, yeah. Anyway, the one that I thought would be super helpful for now. And I know it's fresh on both of our minds cuz you were just in my

5:58
office like 3 days ago and I was like, "Help, this just happened, right?" I was just told about this on uh it would have

6:05
been 5 days ago maybe. So uh yeah, it was a Tuesday, so five 5 days ago.

6:13
Anyway, I'm sitting there in the office, summer busyness, whatever. And my um team lead comes in and she's like, "Did

6:22
you see this email?" I'm like, "You're going to have to be more specific." Um, which chances are no, I didn't see the email because people try to keep me from

6:31
all of this stuff because I am very emotional. I, you know, so it was an email from a parent that they were

6:39
saying stuff like how our office didn't look at their insurance, right? And then therefore we missed something and so

6:48
therefore we should write off the $1,700 we have build them for.

6:54
So, I know a lot of y'all are probably thinking one of two things. Like, uh, you know, yes, write it off to avoid an

7:01
issue. Majority of y'all are probably going like, hell no, like $1,700, like that's your problem. So, I think that's

7:09
exactly where my brain went first. I, you know, kind of gau like $1,700, please. Please, why should I eat that?

7:16
Um, but I think that's the problem cuz a lot of us will be like, hell no, patient. You're out of your mind. you owe the $1,700, pay your money. So, I

7:24
think that's misstep number one because I think a lot of us do that and we move on and we're like, nope, you got to pay it. That is just Yeah.

7:32
move on and keep going.

7:33
And I think if you if you tend to do that, you're missing a big red flag because if a patient is taking the time to email you, because most people who are balanced disappear.

7:44
Yeah.

7:44
Right. Like if a lot of times this just goes away, but this patient is like digging their heels in and going, "Uh-uh, I'm not paying this. You're not

7:53
ruining my credit history. This is your mistake. You need to write this off." So, to me, that's point number one is

8:01
pause because the patient's taking time to email you directly and they they have coherent sentences. They're making a a decent case, honestly.

8:10
Um, I think my next default is nope. We have that clause just like every other

8:17
medical office there is that says it's your insurance. You will pay the office whether or not insurance pays. So that's my next default is to kind of go nope.

8:28
Did they sign the financial policy? Yep, they sure did. Go back and look through their document center. Look, there's mom's initials. Highlight that part.

8:35
Send that to the parent and off you go.

8:37
Like case closed. I'm not responding to this other than nope, you're responsible for your balance. like regardless. Um I think that's flag number two, misstep

8:46
number two, that again the patient the patient knows that. We all know that going into any office.

8:54
But if if I had received a $1,700 bill that I didn't think was fair and maybe why did I not think it was fair? Maybe I

9:02
asked 10 questions at the front end going, "Are you sure this is covered?

9:05
Are you sure this is covered?" Yeah.

9:07
How is this? And yes, we can all hide behind the, well, we thought it was covered, but we don't know what your insurance does. That's on you. I'm still

9:16
going to be left with a really bitter pill in my mouth.

9:20
Um, and this is me running a practice knowing about how insurance can screw everybody. I think I still would have that reaction.

9:28
So, what is the red flags all about? To me, it's like if you miss these, these are what's leading you to said board

9:35
complaint, lawsuit, bad reviews, really bad for business kind of things. So, it

9:41
is vital to pause and take a look and deep dive into this. And in my opinion,

9:50
I may they may still complain against me. They may still um say, "No, your office was the shady one. Y'all messed up. Y'all whatever." I

9:58
think legally, so we we'll go through more details here. legally, I think I'm fine. Even if you went through a board complaint, I think I've got all the documentation I need, but do I really want to run myself through that ringer?

10:10
Um, the other thing, like in Texas at least, it's who was the rendering doctor? And so at the end of the day, if

10:17
they did complain, and I I see this all the time when I'm consulting that a dentist, say with um you know, Smiley

10:27
Pie Dental 123, that's big corporate chain, whatever, and they're like, "Well, I didn't know what they were being buil. I didn't know they had a problem with the billing. All I did was

10:35
the bridge, and they don't have a complaint about the bridge. They're happy with the bridge, so this is out of my hands." In Texas, nope. Yeah.

10:43
You are the dentist. Doesn't matter if you work for corporate XYZ or what you're doing, you are on the line for anything. And if you have the

10:50
documentation, but now the parent throws in something about how the work, I mean, you better cross your fingers toes and that that all the work is fine.

11:03
I think I think if the parent just alleged financial stuff and you submitted that the parent signed the

11:12
policy, you might be okay. The case might go away. But if the parent had any sort of allegation about clinical care

11:19
at all in Texas, it has to be investigated which then say your bridge was perfect but you missed your blood pressure on the day that you gave the

11:28
three carpals of local and you don't have your consent form and you don't whatever like the case is still being opened against you

11:35
and now you're going oh I'm the dentist and yeah, you know, we forgot the but the patient's fine there's really no patient harm and all the rest is billing

11:44
issues that I have no control over in Texas. It don't matter. You're going to fry. So for me, I'm still going, okay,

11:52
my name's not anywhere on this patient chart. I've never met the patient. I've never talked to the parents associate.

11:58
This is associates like he's the one who saw the patient at their new at their first visit, treatment, planned, it did

12:05
the IV case, did everything. So, I'm like, even from that regard, I mean, I think I've got all our ducks in a row paperwork-wise,

12:12
but even if they decided to uh advance this, it's not going to be me. It's going to be associate that's going to

12:19
have to answer for all this. And that sucks. Yeah.

12:22
Cuz he has no idea and no control. But, um, in Texas, that's the way it's going to land.

12:28
So, I mean, I'm I'm doing my due diligence to protect my practice cuz I don't want my practice to have to deal with all of this. Um and and frankly

12:37
associate's not with me anymore, but I don't want him to have to go through all this either. Exactly.

12:42
But at the end of the day, like I'm going to be fine. It's going to be somebody's problem. It's not going to be mine. But in the meantime, it is kind of

12:50
mine cuz I don't want to ignore all these steps. Um so can we dive into like I throw this at you and how did your

12:58
brain process and Yeah. So, you brought it to my attention uh thankfully before I was going to be

13:06
in your practice and I knew this was going to be one that I wanted to look into. So, that's to to your point, we

13:14
can't ignore these when they pop up. And again, that doesn't mean that we have to attend to every single little fire that

13:20
brews, but I tend to heir on the side of what's the harm in looking into something rather than to just turn a

13:29
blind eye to it. And I actually see this a lot in practices where the owner is being a team member is bringing

13:37
something to the attention of the practice owner, but said team member will explain it away. Something like, "Oh, this parent's crazy. They always have all these stupid billing questions.

13:48
I'm so done with them. This is what I've done. Da da da. Are you good, doc, with that?" And so doctor is receiving

13:56
information that this negative review, this negative phone call, this negative email is coming from a crazy parent

14:05
and uh or a crazy patient and then the practice owner kind of dismisses that as, oh, okay, they're crazy, so I'm not going to give it a further thought.

14:15
We've got to be careful with that. I'm not saying there's not crazy patients, crazy parents out there. But I think if we assume that every negative thing that

14:23
bubbles up is from somebody crazy or unstable, then we miss the chance to actually dig into it.

14:29
Which to me too, if the person's crazy and unstable, is this really one that we want the fire to brew? Absolutely.

14:34
Go crazy on cuz let's not see the full extent of their crazy is kind of where I This is what we're saying. I'm super sensitive to these cuz I'm just like,

14:43
"This is going to shut my practice down." Which it's of course it's not, but that's just the peopleleasy in me.

14:47
I'm like, we we need to do our due diligence to look into this because again, if I was on the receiving end of this $1,700 bill, I would be pissed.

14:56
Yeah. Yep. And that alone, just shift shift that patient hat on and look at the facts and go, is this something that

15:04
I would be upset about? Yeah. even even being a practice owner, you can imagine yourself in different situations and know that that would be very upsetting.

15:13
Um, so once you brought it to my attention, I knew it was something that I did want to look into further. So, it was at the top of my list when I got to

15:20
your office that day. Um, I got the patient name from you and just started looking. I wanted to first of all go,

15:28
hey, do we have the documentation to protect us? I know you. I know your office well enough to know that it was there, but I just wanted to double

15:35
check. Why would I double check when I know documentation is one of y'all's strengths? Because why not?

15:41
So, but what what documentation in particular are you talking about? Like what were you looking at? So, I went into the patient's chart and first and foremost, I just read the chart notes

15:50
first because I wanted to get like a general idea of conversations that have been had with the parent, a general idea of like treatment plan, who saw the kid,

15:58
cuz I was completely foreign to this situation. I knew nothing other than, hey, this parent's upset. So, I wanted to f familiarize myself with the case

16:06
first. So, after I did that, then I went and I looked at the uh treatment estimate.

16:13
So, I'm going to interrupt again. So, I guess here's another nugget of if you haven't left enough notes Yeah.

16:19
in the chart note, then that that's tip number, you know, 10, whatever we've talked about here. Like, if your notes are garbage, then if you had gone in

16:28
there, and I have no idea. I still to this day, I still haven't read it cuz to me, I'm like, this wasn't my patient. I have no idea. Yeah.

16:34
Um, the only reason this one stands out in my mind is cuz the kid has a very unique name. And so, and I think that's

16:41
where it caught my it didn't completely catch me off guard. I mean, it did, you know, but 2% I was like, uhhuh,

16:49
because I did see this kid's name on the schedule last week.

16:54
And then that's all I knew about it. But then I I see that they've when I when the staff member is like, "Hey, you know, look into this or whatever." And I

17:03
click on it, it's like patient has a broken appointment. And then I was like, "Oh, so they never came last week." And

17:10
as I'm digging through, I'm seeing, "Oh, you didn't come because you had said $1,700 balance." So then you go back and you see like all of this work was done back in November and we're in June now.

17:22
Yeah.

17:22
Why is this coming up now? And so I think I without looking into all of it, I was like, "Well, that's probably why it's coming up because either the parent

17:31
has ignored it, we've been fighting it, I have no idea what's going on." But now when it's time to get this kid's reare and the parents are trying to come in

17:39
for that and they're like, "Wait, what?" So, I'm sure they knew about this balance, they're probably hoping it's going to go away. Yeah.

17:46
And now they're cancing that appointment and now they're trying to fight the $1,700. Cuz to them, it was probably like, "Oh, there's no real consequence to this, right? Until there was."

17:55
Yeah. They keep sending us these emails with this bill. Let's just hope it goes away. I think that's human nature. I remember we I mean even again me being a

18:02
practice owner when we get medical bills from my parents' facilities I'm always like well let's just see if they actually pursue it. I think in my mind

18:10
I'm always like is this one of those that because they're on Medicare that it's going to get denied first and then the office itself will write off a bunch of things and so like what truly is the

18:19
final bill? I don't know. Let's wait to see what they say. Yeah.

18:22
And then yeah if I needed to get my mom back into her nefrologist and they're like well you actually owe $400. And to me, I'm like, "What are you talking

18:31
about?" Oh, yeah. I guess I did get a series of emails that said, "Check her portal." And I didn't want to go into her portal just because I didn't want to deal with it. That may have been what all those alerts were about. Absolutely.

18:42
Okay. So, tell me now why I owe this $400. So, I could see myself doing that every day. So, I could see where these

18:50
parents are going, "Shit, this $1,700 is still looming and now it's affecting my ability to get care for my kid." Yeah.

18:57
What? I better pay attention to this now cuz I've been dodging it.

19:01
Even just you dialoguing how you've done that I think is so important on balances because I think we've become jaded to

19:10
how patients actually process bills and we don't think about how we respond to those bills. My situation is a little

19:18
bit different than yours in that I get bills. I get text bills for especially we're we're bffs with children's medical

19:26
since we have five children. we always owe them something. I'm like, I'll be paying them till I till I'm dead, I think. Um, and I'll get a text

19:35
email or a text bill from them. And my assumption, cuz my husband pays all of our bills, is he's on it. But what if

19:43
he's not on it? What if every text that I've gotten, I've just assumed he's on that? He set up the payment arrangement with Children's and it's taken care of.

19:51
But what if he never did?

19:53
That's exactly the same with us. I'm like, I'm ignoring this. And it has, you know, not even a medical bill. Let's say the electric company for the office or

20:01
whatever, and then I finally get like some certified letter of something saying, "Hey, you owe this or or from uh

20:08
malpractice insurance." How many times have we had where they're sending all these bills? I'm like, I don't. And my husband doesn't follow a strict regimen

20:16
of when he pays bills. He kind of just gets around to it, you know? Like some people are like, "Oh, the first of every month." And he kind of just does it. And I have to see like as I'm adding stuff,

20:25
I'm like, "Dude, can you take care of this?" Oh, yeah. Yeah. I'll get to it.

20:29
So, I never know by the time he's cuz it's happened a lot of times too where he's like, "Oh, no. I paid that, but because you do like auto pay or whatever

20:37
it is, from the bank." So, it's like if you if it was due tomorrow, but you auto pay, whatever that's called, pay today.

20:44
Well, the bank's not going to release it. they're not going to get it for at least 5 or 6 days, but then by the time they process it. Well, then for them it looks like we're overdue cuz it was due

20:52
tomorrow. My husband's like, "Nope, I autopaid it the day before." And I'm like, "But it's not instantaneous." So then I'll get these letters. He's

20:59
like, "Oh, no, no, they should have had it by now." They I'm going to ignore it.

21:02
Well, then then sometimes I'll get these that it's like last chance. You no longer have malpractice. And I'm like, "What the hell are you doing?" Oh, yeah.

21:10
I guess I did forget that one. So, it's the same thing. But I ignore all of these because I'm like, I don't want to deal with it. I don't know if it's legit or not. Maybe it'll go away.

21:18
Yeah.

21:20
Whether go away means like whether they build inaccurately because it was late and so now they're billing again but they should have gotten it but their

21:28
auto build sent the reminder bill or if it's just going away cuz he's taking care of it. Either way, I'm not dealing with it. I don't want to deal with it

21:36
and it's poof going away. But, you know, it's interesting like you and I can sit and talk about two very similar scenarios and two very different ones

21:43
with the the bills of your parents coming in. And yet often times we look at our patients as

21:51
if they are vicious criminals that they are receiving these shady looking at them. They're reading every

21:59
aspect and they're like, I refuse to pay this $1,700. Watch them. You come and get it. I'm not giving it to you. And I'm like, that's just not the case.

22:08
They're real people like you and I are.

22:11
And who knows what they're Did they get those emails or text messages? Did the wife assume that the husband was getting them? Did the husband assume that the

22:19
wife was taking care of it? Did they assume that this was a faulty bill and that insurance was probably still pending and that this was going going to

22:27
go away? Like, these are all very real reactions to bills. And so we can't just assume right out of the gate that now a

22:35
parent is questioning it and they're like, "Ah, they've gotten these bills for the last six months. Why now are they questioning it?" Well, why now?

22:44
Because we talked to them over the phone about their child's upcoming appointment and brought the pending balance up and they're like, "Whoa, wait, wait, what?

22:52
There's a bill?" And then we scoff at it and we're like, "Oh, they knew. They knew." Come on, guys. It's like, let's let's factor in the human.

23:02
That is my exact reaction. That is, too.

23:05
I'm like, come on. You were hoping this would go away. You were hoping I would just write this off. But you're right.

23:12
Like, now we're dialoguing. I'm like, no, I could very well see how this would happen. And I'm not sure if these parents are divorced, which of course then complicates the situation. And as

23:20
we're about to start talking about here, the next onion layer of this, apparently a lot of this was the two insurance thing. So, mom had her insurance.

23:29
Uh I guess um she didn't schedule because she the

23:36
estimate was too high. Then when we called back to say, "Hey, you know, do you want to schedule or not?" When the unscheduled treatment list and we're calling to see and she's like,

23:45
"Actually, I have another insurance." And I guess it was dad's. So, I think I could totally see now thinking about what you just said. I think you're

23:52
totally right. Like it's kind of like they're going, I'm not expecting $1,700 cuz I just submitted two insurances.

23:58
So, one of them must still be figuring out.

24:02
Absolutely. That is a perfect reason as to why they would wait to pay it. When there's two insurances involved, the

24:08
assumption is, oh, they're just waiting on the other one to pick it up. And I think this was to me for the parents that would have been a very fair assumption

24:16
that to and when you're getting these notices about the $1,700, you're probably going, "Yeah, that office is wrong cuz I submitted two insurances." So,

24:24
yeah, it'll go away eventually. They'll sort it out eventually and we'll all be good.

24:29
And then now they're like, "Wait, like you said, wait, what?" Yeah.

24:33
Um, okay. So then you said you started looking at you were telling estimate first is what I wanted to look at because I wanted to see

24:42
what did we tell this parent about what their anticipated co-pay would be and how far off were we. Um so I started there.

24:53
I'll come back to what I saw there. Um, so it started with treatment estimate and then after that I went to we have what's called a financial arrangement

25:02
document that I wanted to see if we had that on file. Based on the estimate, we did not have that on file. The dollar

25:09
amount wasn't high enough to warrant a financial arrangement document because we do those for a certain higher treatment cost. So I didn't see that on

25:18
file. And then I wanted to actually see on the consent if we had all of the signatures that we needed. Did we have

25:26
all the the parents signing saying no, I understand that this is an estimate. I wanted to see those initials on there

25:33
and make sure that we were covered. But then I really wanted to although in Texas would that matter?

25:40
No. I don't think in Texas they care about whether the parent initial that I understand this is an estimate. Like if you didn't have that, there's no

25:49
standard of care violation that would it only gives us the argument or the leverage of no look, you said that you

25:57
saw this was an estimate. So no, from a protection standpoint, it does very little.

26:01
But then, but it's still valuable to say to the parent like, oh, for sure. This is why you want it. Yeah.

26:06
This exact scenario to be like, no, see, you you acknowledged that you knew this was an estimate. You signed your initials here. But at the end of the day

26:15
is like that's a moot point because it's like that's not what we want to hang our hats on or you know just that's our security. No, don't don't bank on that

26:24
being your security. But I really wanted to see the pursuit of the parent regarding the balance.

26:31
Um so I started looking at any kind of documentation when did we start billing this parent? Did we have any conversation with this parent because

26:40
they seemed surprised somewhat surprised by the bill. So I wanted to see our pursuit of that. So I looked all into the account to figure out how we've been

26:48
pursuing them. And then the third thing I wanted to see which I had to get from our billing person is I said I want to

26:55
see the claims. So show me the claims and I wanted to look at why insurance short paid because it ended up being

27:03
insurance short paid which should not be surprising but I wanted to see why they short paid. And so I looked into the uh

27:11
EOBS and then dialogued with your billing person because I wanted to know had she spoken to insurance regarding

27:19
these EOBS cuz I saw some inconsistencies where I thought they should have paid for something and they didn't and I wondered why.

27:27
Does that answer your question on what?

27:29
It does. And so I'm going to switch to not switch to but add on like those last two things you mentioned did not occur to me would not have occurred to me like

27:38
all I had done to investigate this myself cuz it was brought to me say on a Tuesday you were coming on Wednesday and I'm like okay here's another thing like

27:47
I don't want to ignore this email I don't know if this email came in on Friday on Monday on Tuesday on last week when kid was supposed to come in I have

27:56
no idea when this email from this parent was sent and in my mind. The longer we ignore it, the more you're going to fuel

28:04
this parent into getting enraged. Um because again, society now, we all want everything right now. Yeah.

28:10
So, I was like, we this is time is of essence here. Um so, let me try to do my due diligence. And in my mind, what I

28:19
wanted to make sure was that we had um the policy that says I know that my whatever my insurance doesn't cover, I'm

28:26
liable for. And we did have the parent initials on that. And then I think then then I just didn't know what to do with it. I'm like because the parent in their

28:34
email was saying something about how we missed that insurance wouldn't their two insurancees wouldn't work together. So

28:43
maybe when they called their insurance probably one of them said something like, "Oh yeah, no, we have a clause that says we don't coordinate benefits." We told them that.

28:51
We told them what? We told them that insurance said that they don't coordinate.

28:57
Right. I saw that in one of the notes, but but I think that was after it didn't get paid.

29:05
So, I wanted to go to the initial like if we were talking about this in October. Yeah.

29:10
And then knowing what we knew back in October, is there anything we could have done different? And so from my side, I'm

29:17
like, okay, we've we've and then to your point, which I didn't even think about, but yes, that you have the initials on the this is an estimate only. We've got

29:25
the big red stamp that says estimate only, and then we've got the policy that says I know I'm liable for whatever insurance cover. I'm like, what else?

29:34
How do I word this to say honestly even if even if we

29:41
um thought that the insurancees would work together and we missed it? Like what if the explanation or the breakdown said we

29:51
will not work with that insurance company? We missed that.

29:55
Does that still make me liable for the 1700? And I'm like no, I'm still not liable for this. Like that's an insurance issue. and back to the clause

30:04
you signed that says we're doing our best to try to let you know but this is an estimate only. So, but then why would we want to know if we

30:11
missed it? I think to your point like if we miss something in the verification process, what do we then do with that?

30:18
Does that make us culpable in this whole situation which no it doesn't but it's still helpful to know did we miss that

30:25
right so that we can avoid such pitfalls going forward with this but as far and and then I'm thinking

30:32
okay but so I know that we are covered legally and whatever but I still don't know what I have to go back to the

30:40
patient to like how am I responding to this email sorry you know that you're liable for any balance see the sheet you

30:48
signed you owe us 1700 like what what am I doing to smooth this over and not fan the flames

30:57
and so I think that's where I was stuck so I was like no I really don't and the stucker that I am part of me goes maybe

31:04
we should just write it off and you know say we missed it cuz that's what the parent was accusing us of in the email was like y'all missed this you didn't

31:12
give the right estimate you didn't whatever and I'm like that is the point of an estimate sir like we don't know

31:18
and everybody knows insurance is a scheme you know like whether it's dental

31:25
medical car like whatever like we we all know this so shut it sir and just pay the money but you're right like you especially

31:34
were like no I want and I was like I just want to know for going forward if there's any pearls to take from this so that we can avoid this going forward but

31:43
other than that I just don't know how to reply to this email.

31:46
Yeah. Um, and so then, uh, I guess you got in there and you want to go over kind of what you found.

31:53
So there I went about it. I knew we needed to respond to the parent, but I wanted to figure out if there was any

32:00
quote unquote fault that we had in the process.

32:05
I think that's important because it should guide the way that we react to the parent. It doesn't mean write off or

32:12
not write off. It just means what are we saying to this parent and if there is something that we did wrong, we need to

32:20
learn from it to protect us going forward. So as soon as I pulled up the estimate, so I looked at the all the

32:28
chart notes first and then I went to the estimate and immediately I was like

32:38
because the estimate instantaneously I looked at it and I was like it's wrong.

32:43
I again I don't know this patient. I didn't do any of the I haven't even looked at the verification form yet. But I can look at that estimate and know

32:50
that it was wrong because it was we'll give loose numbers here. Uh but it was

32:57
over is an IV case and it was over $5,000 of dentistry that needed to be done.

33:04
Very extensive case. And there's two insuranceances that are clearly involved on this estimate. But

33:12
the parent portion was only hundred and some odd dollars. And again, I'm going to use loose terms just to protect uh

33:21
information here. So, it was a little more than $100. That in and of itself, $5,000 case, estimated portion is

33:29
hundred and some odd dollars. Okay, that right away should stand out to anybody that's presenting treatment as

33:37
something's up here because even with two insuranceances, that would mean one has a very one or both has a very high max, which is not the norm anymore.

33:48
But the other, even if they did, say the max was each 2,000, that's still only 4,000. The patient should still owe a 1,000, not $172. Correct? Like that should be a

33:56
very simple red flag. Y um and the other thing is cuz there are some cases now there are some

34:03
insurancees now that have high maxes like5 6 $7,000 but they have a really high deductible.

34:13
So this is kind of a new plan that I've seen roaming around. And so I'm like okay maybe they've got one of those plans that has a really high max but

34:21
there should be a really high deductible. And I know with two insuranceances, if there's a really high deductible, it's still considered quote

34:30
unquote covered. Everything's covered on the procedures, which would then cause the secondary to not pay for those

34:38
things. So I'm like, even if it's a high max high deductible plan, they should still have to pay the deductible regardless of secondary.

34:46
So I was like, some already something's wrong just by the just by the amount that the parent was going to owe. But then as I traced my eyes down, I was

34:55
like, "Oh my gosh, we've got zirconia on here." I'm like, "Let's scan across." So I took my finger across and I'm like, "Patient portion zero on a zirconia.

35:05
What in the crap?" Of course, it's never a zero on a pediatric zirconia crown. And so I was like, "Okay, that's wrong.

35:14
All of this is wrong. It's all wrong." And so I knew our estimate was wrong from the get-go, which then caused me to then go look

35:22
into the verification like, how do we even get this? But regardless, we're wrong on the estimate. Now, does that mean now the parent doesn't owe $1,700?

35:31
No, that's not that's still not what I'm saying. But it means, okay, we have got to pause and look at these estimates

35:39
more closely. So, let's talk about estimates first before we get to the other things. So, I think that that again is the crux of where my defense

35:47
starts going, well, I mean, an estimate is just an estimate.

35:51
But if I was told my estimate was $172 and I got a bill for $1,700, I think I would be like, WTF?

35:59
Yeah, somebody has lost their mind. And is it insurance or this dental office? It's one or both, but it's not me and I'm not paying this. How could you tell me I

36:07
only owe $172? It would be different if it was you told me at $172, but I got a bill for like $250. Okay, so we were a little off. This is not a little off.

36:17
This is significantly off. And so I think I would be suspicious of everything and all the above, which

36:24
again that suspicion then to me casts a light on the entire office. So if you can't even get this basic estimate right, then

36:33
or even close to right, even close to right, then what else is going on in your practice? How do I know that your treatment plan is right? How do I know that you're right? Like if any

36:40
doubt casted on some aspect of your office is not good for the entire office.

36:46
Um so I think that's number one. The um the person in our office who is more or

36:54
less like the treatment coordinator kind of going over this, she even said to me, she said, "Oh yeah, it looked weird to me." And she goes, "The saga of this is

37:02
that like the parent, the kid's hurting, there's a mouthful of decay. Give her the estimate." and she's like, "I can't afford this." Then she said, "Okay,

37:10
well, let me give you a couple weeks." She called her back the next week or whenever she called her back. Then the mom mentions the secondary insurance.

37:16
Mom sends the information. Treatment coordinator sends it to our account or our um biller.

37:21
Biller biller comes back with this new estimate. And then treatment coordinator was like, "Yeah, when she gave it back

37:28
to me, I was like, that's weird." But then she just that's weird. And she proceeded with it.

37:33
She proceeded with it. So then the pair, she's like, "Oh, well, it's only $172." Then she said, "It still took the mom

37:41
another month or so to come up with $172." Yeah. And now this woman is facing a

37:48
$1,700 bill. And I think that's where most of us are like, I just feel bad.

37:54
And but at the same time, it's not my problem. It's your insurance problem and whatever. But I would say, yeah, it didn't sway me to say, our office

38:02
made this mistake. we should write this off. It's not worthy of that yet because we have that. Now, if you're an office that you tend to write things off or

38:10
you're a very heavy insurance office and you know, different story, but for me, that's the whole reason we got out of insurance and

38:17
why I'm like, I'm not playing this stupid game.

38:21
I have no idea what your insurance is going to cover.

38:24
That's on you. So, we are very But I do think this is one that's really not fair to the patient. I really don't like the taste that's left in the

38:32
parents mouth. Even if they were to turn around and go, "Okay, you're right. I signed this. I knew that the estimate and I know my insurance is terrible.

38:39
Okay, fine. I'll pay this." I still think it's left a pretty bad taste in somebody's mouth, which is not good for word of mouth. And next time they're in

38:46
the office, if they loved us, Yeah.

38:50
that now we've created this patient that's going to be watching everything we do from a very negative perspective. Yeah. Uh it's a liability waiting to happen.

38:58
Yeah. Um, so I think for me that's where I was fresh, which was funny because when this person, this uh, treatment

39:06
coordinator came into my office and I'm questioning her now. And of course, I know she's watching her words cuz she's like, I'm I might be on the line for

39:13
this. What did I do to mess up? So, she's not quite throwing the biller under the bus, but I think if she had to, you know, she knows at that point,

39:21
she's going to throw the biller before herself under the bus. So, I kind of said, "Well, you've been doing you've been in dental for 12 years, 14 years.

39:30
You know better. It's not like you just started. You just graduated from wherever that you were an RDA that's rolled into the front. You've been doing

39:37
front desk stuff for over a decade. How did this slip your eye?" Yeah.

39:43
And she really didn't have an answer to that. Yeah.

39:45
And I was like, "You know what I find grossly unfair is this is not my patient. Never met him. Didn't do the work. I pay you all a lot of money.

39:55
Y'all are not y'all are very well taken care of in my office because I want y'all to be able to do all of these

40:02
things. And now you just something that's like a even I know $172 on an IV case doesn't make sense. That is ridiculous.

40:12
And you have years of experience that should have been your gut reaction and you chose to ignore it. Yeah.

40:18
And proceed. That's not even counting the zirconia part of it. Like you should know that too. And Biller, you've been doing this for 30 years.

40:26
Yeah.

40:27
What made you think that that looked right? You're the one who gets all the EOBS where all of these aronia are denied. What would make you think the

40:35
patient owes zero? So from my side, I'm like, I keep thinking I've got well-trained people. I'm not hiring the new grads. I'm trying to train a lot.

40:47
How did both of you miss this?

40:49
Why am I? And I said it to I said, "Why am I left holding the bag on this one?" I was like, "You two you two want to split the $1,700 cuz that seems more

40:57
fair if if we're going to write this off cuz that's the way treatment coordinator was starting to come in was like, "Yeah, we kind of messed this up and whatever."

41:05
And and I I think again she was trying to dance around it and I stopped her. I said, "Okay, so if this is our mistake, whose mistake?" Well, you know, the

41:14
biller I just, you know, when mom said there's a secondary insurance, I just sent it to the biller. This is what she came back with. Okay. So, it's it's on

41:23
her then. Like, there there's no mistake of anybody else's. And so, if it's our mistake, then our office should write this off. And she kind of was like, I

41:32
mean, that 172 was really hard for her to pay, too. Okay. Well, if you think our office should write this off, I don't think it should be me. And

41:39
frankly, I don't think it should be associate cuz he did a good job. I'm assuming the work is fine. the parents aren't concerning concerned about that.

41:45
The two people culpable here are you and her. Y'all splitting the 1700. Then she kind of started changing her tune a little bit to like, well, the parents

41:53
should have known like whatever. I'm just like just get out of here. Get out.

41:57
Um, so that I guess that's tip number. It was a big reality check for you and I to go, what the hell are they doing?

42:05
Yeah. Yeah. And for us to then go, how do we prevent this going forward?

42:11
Because thankfully in this scenario, you've got two extremely experienced people that made this mistake.

42:22
And it was it wasn't a complicated mistake. It was stupidity.

42:25
It So what happened? Is it just laziness? Is it just we're thinking about other things? We're

42:32
and I think it comes back to the we always want to lean onto somebody else's expertise. And in this particular case,

42:41
treatment coordinator because of the double insurance really leaned on Biller. Uh Biller may have not been

42:49
fully involved in the process. Put what she thought was a good estimate out.

42:55
Treatment coordinator trusted, blindly trusted. And again, I would never want to advocate for not trusting your

43:02
teammates, but there comes a point where you're like, we should question. We should think thoroughly for ourselves.

43:09
We, my mom used to always say this to me growing up to our me and my siblings um

43:16
when we'd make a stupid mistake and she would always say, "And if Johnny jumped off the roof, would you follow?" And it begs the question like, "If somebody

43:25
else is doing something stupid, should you just do it too just because somebody else did it?" And I think we do that a lot in teams. We tend to go, "Oh, well,

43:32
if they say, well then, okay, let's let's do that." And so these are two very experienced people that were like both of y'all, neither one of you slowed

43:42
down to actually think through this. You I don't know why you didn't, but you just blindly moved forward with the

43:49
assumption this estimate was accurate when y'all both know there's no way it's accurate. And even if we can't figure out why it's inaccurate, we should have

43:58
paused and gone, we've got to at least manually manipulate this estimate.

44:04
dentrix isn't pulling it correctly, but we can go and manually manipulate that treatment estimate to at least show patient portion on on the zirconia

44:12
crowns. At least do something or pause long enough to go dendritics can't figure this out. Maybe we've got to do a

44:19
pre-estimate on this. Even though pre-estimate doesn't isn't the beall end all, but it's like if we know nothing and we can't figure out anything, then

44:27
maybe we pause and do a pre-estimate to both of these. But these are experienced people that made this mistake. And so

44:34
you and I were like, okay, first and foremost, we've got to address this and encourage especially the treatment

44:41
coordinator, if something looks wrong, do not move forward. Do not move forward on this. So that was like number one.

44:52
But I think right behind that was we've you and I were like, how can we prevent this from happening going forward?

44:59
Because what if treatment coordinators out of the office and one of the RDAs is stepping in to present this estimate?

45:06
How can we ensure that they are pausing to go, hey, what on this estimate should I be looking at? What are the red flags,

45:14
so to speak? Because not everybody's going to have that default reaction of going, "Yeah, this estimate's wrong." Because the experience isn't there. So,

45:22
I think one classic example we see with that all the time is, and now I feel like I see it far less because my RDAs

45:30
have been with me for a while now, but we call for say a sealant estimate. Yeah.

45:34
And the front throws something together and the RDA takes it and now they're presenting, oh yeah, your sealants are covered, whatever. Luckily, if there's

45:42
like a hygienist involved or something, one of my lead hygienist, like she'll take these things and she'll like like you did, she'll just glance at it and go, I know this is wrong. just a quick

45:49
glance and she's like, "I'm not even the front desk person. I don't deal with the insurance, but I can glance at this and within five seconds, no, this is not

45:59
correct." And it's because she knows that usually primary seals aren't covered, preolar seals aren't covered or she knows that,

46:07
you know, these are receals or whatever it is. How did front miss? Well, they missed it because they're checking in,

46:15
checking out, phones are ringing, they just print with Dentric spits out whatever. So, does that mean somebody didn't input the data right to begin with on the coverage tables? Probably,

46:24
possibly. Well, was that person who, you know, did you ask the right questions when you were calling to verify? So, if

46:31
we had newer team members or whatever the situation may be, but if it's like, do you cover sealants? Yes, we cover them. Okay. If you've never worked in

46:39
pedes, maybe that's all you needed to know for adult general practices. But if you work in pedes, we know you've got to

46:46
ask the specific question for all of those. Like, is there an age limit? Is there a frequency limit? Is there like it's not just black and white? Yes or no? Are sealants covered?

46:56
There's a lot more. And that's just for sealants.

46:59
So, I think in that case, we've all kind of had to learn to go look at the estimate. Yeah.

47:06
Glance at it. Does it seem like it makes sense? So I think one of our takeaways from this was we should have a list of

47:14
things that we are training the RDAs on to say hey these are things that even as you guys are looking at this and you

47:22
need to be looking at it is did did you really like did the doctor really call out a I don't know a

47:30
doo on B when we all talked about and you sat chairside and you knew that was a M on A. Why does that say DO1 B? Like

47:39
where did that go? Anyway, pause and look. Yeah.

47:43
And so we're making a sheet now where we're going to have like a little things that should alert you.

47:49
Yeah. Almost highlighted things on an estimate like if your eyes don't know where to fall, here's a little cheat sheet on look at at least these codes

47:58
and evaluate do those look accurate because that's where we see the most mistakes on estimates. And like to your point, I think the other thing I want to

48:06
add on it is the whole um yeah, like does it make sense that patient portion would be zero, right?

48:12
Find me an insurance now other than Medicaid, any insurance now that the patient portion should be zero or very, you know, Yeah. And that's rare.

48:21
So are we all taking a moment to pause and to think about that and then what can I do to equip my team to say these are the ones that you're going to get

48:30
into trouble with? something like um an amalgam downgrade or a composite downgrade to amalgam fine like but that

48:37
should affect it 50 bucks 100 bucks 20 bucks whatever it is right we're not talking about a zirconia crown that is

48:44
like $400 that we're thinking that the p that insurance is going to cover all the way that's not something that's going to be covered all the way and if at least

48:52
we know that then we're pausing before we present that estimate to the parent correct even though the parent knows it's just

49:00
It's an estimate, but it does. I think we've beat that dead horse, but it does get in the ballpark.

49:05
Yeah. Cuz we weren't in the ballpark at all. Right.

49:08
I can see why this parent is upset. Yes. Yeah.

49:12
Upset or confused or just like, "Y'all are wrong." Yeah. Yeah.

49:16
Y'all are the idiots, not me. And not insurance. You're the idiots.

49:20
Um I'm going to cut us off here because I feel like we have so much more to say on this. I would say the key takeaway on

49:27
this is it is worth checking with your team to make sure they know how to read estimates and to determine what looks

49:36
off with this estimate or does this estimate seem accurate? Why or why not?

49:40
And then I think build a resource. We're going to build one that we'll make available um most likely through the

49:47
July digest and then we'll potentially have it on the hub as well where you at least teach your team on what are the

49:55
things on this estimate to at least keep a wary eye on. Um so I think a cheat sheet would be helpful even for your experienced people. These are two

50:03
experienced ladies on your team that made this mistake and so we've got to have some kind of reference point for our team to help them know how to read

50:11
these estimates. we did to the treatment coordinator. We did come back the day you were in the office and we said to her like, "How how did this happen?" You

50:19
know, I already questioned you. This happened on your watch. How do And she I think that was her response was like, "Well, I sent it to the biller and she's

50:27
the one who was supposed to look into it and that's what she does all day every day." So, I just assumed it was right. I did think it was odd, but I was like,

50:34
"Okay, cool." And I moved on. And so, we talked to her about, "No, you need to pause. It's not like you're going, "Are you sure? What are you doing? whatever.

50:42
No, but it's just kind of like, hey, this seemed odd to me. Pause and just ask. Yes.

50:46
And so, um, I think hopefully she will because I think she knows I'm tempted to make you pay half. There is a consequence to this.

50:55
Yeah. It and and it's beyond the dollar amount. It's a broken relationship with the parent now. Potentially, this kid is

51:03
out of regular recre because of the situation. Like, it's a multi-layered impact. And again, I think we we miss that sometimes with those estimates.

51:12
They are important. It doesn't mean they have to be 100% accurate, but they do require or demand our attention. They

51:19
should demand our attention and our effort on them. Okay, so we'll pause here and we'll pick it up because there's still a lot more.

51:27
Oh my gosh, there's so much more. So stay tuned.

51:31
Thanks for joining the conversation today. We hope that you are comforted in knowing that you are not alone, but we also hope that you're walking away with

51:40
some really great tips and tricks to try in your practice.

51:44
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