Which is the better system?

Joseph R. Yudin, DDS

Brattleboro, Vt.

I am moved to respond to the "Viewpoint" by Dr. Jerry Chernik in the September issue.

Dr. Chernik bids a sarcastic "good luck" to those offices going "insuranceless." He and his office manager are convinced that this is suicide. Perhaps I can provide some insight as someone who has actually done this, so that others may not live in fear of this horror.

After seeing my accounts receivable steadily rise and my staff spend more time on insurance administration, it became clear that there was something wrong with our picture. I had read a few articles about the insuranceless concept and made a decision to implement this in my office. We stopped accepting assignment of benefits in March of this year. However, we chose to continue to participate with Northeast Delta and would continue to accept assignment for this coverage.

My staff and I decided together to formulate a plan to educate our patients about the problems associated with assignment of benefits. With the help of a local marketing firm, we worked up some patient-education materials and began to distribute them to our patients, informing them of a starting date (approximately 90 days later).

We did have a stroke of luck when some of our patients who work in the newsroom of the local newspaper took this information and decided it would make a good story. They called me and interviewed me, and two days later, there was our story on the front page, above the fold. OK, so it was a slow news day. But it did provide us with terrific publicity. I loved the headline: "Dental Office Tired of Insurance Haggling." Then we were fortunate when a few locals decided to write letters to the editor condemning my actions. My responses were swift, sharp, and truthful. To summarize, I wrote that the insurers have handed us a model that works for them and not for the providers. We were finished choking on that model and decided to spit it out.

We stressed that we wanted to direct our attention to excellence in dentistry and move away from the inordinate amount of time and energy spent on insurance administrative work.

I typed up a sheet of FAQs so that when patients called to ask about our policy change, we were prepared with answers. Of course, all calls were handled cheerfully and professionally. We sent some of these sheets to the patients and left some in the reception area. We made it clear that no one was taking anything from them - their insurance remained the same and we remained participating providers. We explained that we expected payment at the time of service and that they would be provided with a completed insurance form, documentation as needed, and a copy of the form for their records. We told them they could pay their bill with a credit card if they wished and most likely would be reimbursed by their carrier before the first billing cycle has closed.

We found that the patient`s dental claims were indeed more promptly paid when he or she sent them! And (here`s the best part) our fees were paid more promptly when the patient paid them!

The result: Our credit card usage has skyrocketed and accounts receivable has plummeted. We`re actually getting paid for our work as we do it. What a concept! The doctor treats you and you pay the bill. If you have insurance, you get reimbursed. Life is good once again. We lost perhaps 200 of our 4,000 patients, but new patient calls remain the order of the day.

I practice in a small town in Vermont that is very blue-collar and very conservative, but I am convinced that it doesn`t matter where you practice. If you want to change how you work, package it well, inform and educate your patients, stay professional, and don`t let emotions dictate your responses to the inevitable questions.

I would add here that we did continue to participate with Northeast Delta. In our marketing paperwork that explained our new financial policy, we also made the point that the Northeast Delta contract states "patient copayment is due at the time of service." We are following the portion of the contract that states that we will accept assignment, and the patient has the responsibility to pay the balance promptly. Our Delta Dental patients are now far more compliant on payment issues.

Two interesting observations:First, our patients without insurance thought it seemed somehow unfair that those with insurance got the benefit of having us administer it and felt that some of their own fees went toward that. Second, most of the trepidation on the patient`s part had to do with "form phobia." Once the patient found out that the claim form just needed to be mailed, all was right in the world again. We reassured patients that we could still help them with any insurance questions that might come up and have done so.

My practice consists of three general dentists, a part-time periodontist, and 13 hygiene days per week. My office manager happily went to part-time, and my two receptionists take turns having afternoons off.Postage costs have dropped dramatically, as have the number and size of delinquent accounts. Gross and net are both up.

Our patients are educated about who owns the insurance policy. Seeing the claim form, mailing it in, and cashing the benefit check has convinced them that their dental office really has nothing to do with their insurance.

A side benefit I have observed is that we are now slightly less busy than we used to be; the pace is less frantic and more moderate. We occasionally have some empty slots in our schedules, but I remember the times before our policy change. We were burned by patients (and insurers) on a fairly regular basis. We were working at a breakneck pace, but not always getting paid. Now the only times we don`t get paid is when we don`t work. Which is the better system? We use our "down" time to read, talk, have a cup of coffee, learn from each other, have relaxing chats with valued patients, and do some staff training. Are you too busy cutting trees to sharpen the saw? We used to be, but this has changed. Our level of efficiency has reached new heights.

Recalling Dr. Chernik`s article, he states his fees for molar endo ($900), crown buildup ($250), and PFM crown ($850). Maybe health care is more expensive in Alaska, but it seems to me that fees this high perpetuate the concept that people need insurance to have good dentistry. Maybe even with insurance, $2,000 on one tooth is beyond reach. These fees are almost twice what mine are.

I have plenty of work, and I like it. I like people, and I like to help them. In this particular case, my fees would still have had me making more per hour than my divorce lawyer - and he`s the best in the state.

It`s nice that Dr. Chernik has become independently wealthy in dentistry, but I think his attitude and his fees are telling people that they need insurance to have good dentistry. We, as a profession, would benefit if we distanced ourselves from the insurance industry. This is a good first step.

I encourage anyone who wants to learn more about going insuranceless to contact me, and I will share my experience and patient-education materials with them.