Sheri's Solutions: 'You should not take the patient'

2015 03 31 16 23 41 686 Doniger Sheri 2015 200

"If you don't take the insurance, you should not take the patient."

Sheri B. Doniger, DDS.Sheri B. Doniger, DDS.

How many times have you heard this before? A very disgruntled patient, or patient's parent, who had two benefit claims denied because of uncovered service called to berate my business manager. Our team sent dental claims into both the primary and secondary benefit companies that were stated on the patient's record. One company claimed payment was the other's responsibility. The other company finally denied the fee as a noncovered item.

This patient's father was transferred to me to diffuse the situation. Rather than diffusing, however, the patient became angry and said it was our responsibility to bill the "insurance" company and not his to pay. He continued to say we were sending information to the incorrect benefits company (in fact, the contact information provided was correct). Finally, he said we should not take patients who are not covered.

Our office does have protocols in place to assess a patient's information regarding their dental coverage. We had contacted both companies before treatment and received back the member benefit and eligibility status reports.

“It is important to discuss the financial and benefit coverage with all patients.”

According to the documents, his daughter was covered. The disclaimer is always present: Coverage is not guaranteed. It did not matter what we said or how it was said, this father was irate and it was our fault that we saw the patient. He ended his tirade with me with "I don't want to talk to you anymore."

Business managers are the front line of the practice. When patients are upset, they usually get the brunt of the shouting and disrespect. As we all know, it is important to discuss the financial and benefit coverage with all patients. Additionally, if there are any rebilling fees, these need to be noted. Patients tend to sign the forms at their initial visit and never refer back to them. In this situation, the father was not present when his daughter was brought into the office, but we did have subsequent phone calls -- all very negative.

As a practitioner, I know we do our due diligence when it comes to explaining dental treatment and professional service fees. This was the first call on Monday morning. The week will only get better!

Sheri B. Doniger, DDS, practices clinical dentistry in Lincolnwood, IL. She is currently president of the American Association of Women Dentists and editor of the American Association of Women Dentists "Chronicle" newsletter. She has served as an educator in several dental and dental hygiene programs, has been a consultant for a major dental benefits company, and has written for several dental publications. You can reach her at

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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