Treatment PRO: A Business Approach: Up Grade, Down Grade: What’s your Product Grade?

Isn’t the “business” of dentistry reaching a level of insanity? I can hardly contain myself these days. Doctors trying to upgrade their patients to better products and services while insurances, more specifically employer groups, are downgrading, standardizing, and lumping procedure codes to reduce benefits and premium costs. And who pays for it? The patient? The Doctor? It’s both! And who benefits? I hope that goes without saying.

Perfect Example:

A colleague of ours, down the street from where I practice, told me he got cut off as a PPO provider by one of the major insurance players. For years he has always given his patients a choice when it comes to crown restorations regardless of insurance coverage. This dentist understands crown technology, its varying costs, and how to offer choice to his patients. That’s right! He gives his patients the choice as to the type of all porcelain crowns they want in their mouths. If they just want what the insurance covers, in goes an aluminum oxide restoration. If they want a zirconium, cerec, or other technologically advanced crown, it’s going to be an additional out-of-pocket expense added to their co-pay.

What a concept! A value added service not covered by insurance. No more suffering from “codes and fees blindness, and give-it-away-itis”. Or so he thought. What happened next has happened to me several times, only with a different outcome. One of his patients called their insurance company and asked why they don’t cover the upgrades for more expensive restorations. I’m sure you’re ahead of me now. The story goes as follows:

The Holy One of Claims Review

The “Holy one of claims review” called him, and said,

“Why doest thou upgrade our clients to more expensive crowns and charge them for it? Know ye not that thou must give it away freely?”

Our good colleague replied,

“Oh Holy one of claims review, if an off-shore zirconium crown costs $95, and a U.S. zirconium crown costs $170, and better yet, a U.S. zirconium elite type crown costs $285, all differing in cosmetic and structural quality, should not my patient, your client, be given the choice and financial obligation as to what goes in their mouth? Is this not a cosmetic upgrade, of which, by your own contract, the patient pays an additional fee determined by me?”

Of which the “Holy one of claims review” said,

“There is one code, one description, and one fee for an all porcelain crown, and whatever thy lab cost, thou should and must partake in your back shorts. Better yet, thou should not offer my clients choice, for they need not know what they chew with!”

Our good colleague replied,

“Oh Holy one of claims review, hast thou not read thy own contractual commandments? It is written or implied value added services, cosmetic upgrades, and such are to be billed out on a fee-for-service basis. Should not common sense prevail with patient choice, especially when they are willing to pay for advanced products and services?”

The “holy one of claims review” then said,

“If thou or our client chooses a more expensive product, it is only because thou has imparted forbidden knowledge of truth to our client! Our client need not be given such truth and choice, as the basics are good enough. Never-the-less, if they desire technology, thou must give it to them.”

Our good colleague, with sound business sense, replied thus,

“No business on planet earth would, or should, be told to lower their moral business values by grabbing their ankles. Thou, oh holy one of claims review, are a rear end orifice with no business sense”

The Right Way to Upgrade: Treatment PRO

After hearing my frustrated colleague relate the above story, I couldn’t help but laugh. I told him that he should have left off the final statement, appeased the “holy one of claims review”, and just continued upgrading. That is exactly what I have done for years. I’ve told the claims experts that I have no problem having the patient come back in and cutting off the hi-tech crown and replacing it with the cheaper one. That phrase usually ends the conversation in a favorable way.

It wasn’t more than two weeks from the above story that another colleague of ours across town had the same run in with the same person from the same insurance company. The difference? He had attended one of my advanced case presentation seminars, and he was prepared. Needless to say, he was not removed as a provider because he was trained on how to handle the situation. The Treatment PRO system gives doctors the necessary marketing documents and consent forms to empower their patients with technological choice for need-based and cosmetic dentistry. And when patients are empowered with choice, new profit centers can emerge.

In conclusion I want you to think about the following: What would happen if the patient called their insurance carrier and told them they were going to have us place a more expensive crown, filling, post, implant, or whatever in their mouth, and that they were going to pay the additional upgrade fee, regardless of what the insurance was going to pay. I’ve done it, and it’s amazing how quickly they say, “sure, no problem, just remember, we won’t cover the additional cost”! What are they going to say, “we’re dropping your coverage”? Or, “You will no longer be a client of ours?” Your patients are more than willing to pay for technologically advanced products and services when given an informed choice. And it should be “their” choice.

It’s your dental business. Defend it! Once you have sold the benefits of higher quality products and procedures with the assistance of the Treatment PRO system, push back, but remember, nice matters.

Till next time.

Dr. Rob

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