Payment Plans, Crowns, Invisalign, Fee For Service, Insurance

Background

When I acquired the practice of Sir Hal Moore, the practice did not have a program in place for payment plans. There are myriad reasons why payment plans can become problems for dental offices, which I will detail below. But, technology has come a long way since the days of having to mail in a check for a monthly payment plan.

“Finally a system that is secure and allows patients to say yes to the care they need.”

Payment plans

When we recently changed our credit card processing company, the new company was able to introduce us to the most modern platform, which uses technically savvy methods of safely storing and accessing financial information. I thought to myself, “Finally a system that is secure and allows patients to say yes to the care they need.” Now, patients who need Invisalign, or extensive restorative work, or root canals and crowns, or 4 quadrants of scaling and root planing can get the care they need.

The way our new system works allows us to securely store a patient’s credit card on our credit card processor’s (Best Card) secure site, where the numbers are immediately upon storage scrambled into a mix of numbers and letters, encrypted so that they cannot be viewed by us (or anyone else) again. This allows us to maintain PCI compliance. PCI compliance is our promise to protect your personal information as it relates to payments. I have explicitly told the staff that I do not want us physically writing down any credit card numbers on paper, nor do I want them stored on our computers in an unencrypted file. This longstanding office policy has meant that we did not have a feasible way to set up payment plans, as many patients would have liked. Until now.

Moving forward, we have a simple way to store and access the credit card of a patient’s choice and set up recurring billing, without having to write down the patient’s credit card and without exposing their financial information to would-be hackers. I have put together some sample documents showing our two main options as they exist today. We have a 4-pay option and a 10-pay option.

Crowns

Let’s take an example where a patient has a severely broken tooth that needs a build-up and a crown. As of July 2018, the cost for the build-up is $294 and the crown is $1250. When teeth break unexpectedly, after chewing ice, a crouton, or biting into a fork, or after a period of undiscovered caries, a patient may not have had time to prepare financially for the immediate $1544 to fix their tooth. So, here is an example where a payment plan sample-crown-payment-plan-contract-2018 would allow that patient the flexibility to receive the care they need today and pay for it over the next 4 months.

Invisalign

Take an alternative scenario, a patient has decided they are finally ready to straighten their teeth. Historically, patients are required to pay for their desired Invisalign treatment completely up front. But, it might be a more approachable treatment if patients could start receiving treatment today and pay for it as we walk through the trays. Here is an example of what it looks like sample-invisalign-payment-plan-contract-2018 if a patient is ready to move forward and would like to make their Invisalign payments over the next 10 months. When we are completing a larger project like an Invisalign case, one thing many patients don’t know is that there is a significant lab fee. So, the initial payment made on day 1 would include the lab fee and small fee for carrying the payments over 10 months.

Fee For Service

Patients are likely better served in a fee for service delivery model where they are able to use their money for the procedures and services that they want. To help patients achieve this freedom and independence to apply their cashflow to the procedures they want without having to wait inordinate amounts of time (saving up) required a shift in my thinking. So, I believe that offering payment plans will attract new patients to the practice who don’t have insurance, but, still want to take care of their teeth. I have heard people ask, “What if I don’t have dental insurance?” So, I really had to start thinking about the reality that payment plans are the answer that allows those independent fee for service patients to say yes to treatment, and not have to pull teeth (extract teeth) that can otherwise be saved by crowns and root canals. It should also allow patients who want to replace a tooth with a dental implant to say yes.

Insurance

What drives decision making? Incentives. We have a growing number of patients whose insurance is covering fewer and fewer procedures. What is happening is that insurance companies are finding new ways to deflect costs onto their consumers, our patients. Take an example where a patient sits down into our dental chair and the insurance company has brought tricks from their medical insurance business and brought it over into dental insurance. Deductibles. When I started practicing 10-years ago, 2008, deductibles in dental insurance were unheard of; the primary reason you did not hear about deductibles is because insurers were not in the business of balking at paying their 50% of $400 for 2 fillings. But, little by little, they try to fool patients by showing them charts of all the things they cover at 80%, 50%, 100%, all the while avoiding paying their share, requiring narratives for simple procedures like single crowns. When an insurance company demands a narrative, they effectively delay payment and hope that many doctors and patients will simply give up, ending with the patient paying for a procedure that they have coverage for or the the doctor writing off significant portions of work that has already been completed and delivered.

The point I am making is that insurance companies incentives are not well aligned with patients. The result of this failing to connect on incentives has driven many patients to abandon their dental insurance altogether. A patient should not pay premiums month after month for years only to find out 5 years later, (when they are finally ready to use it to pay for a crown,) that they don’t qualify for the service. Even though the patients have paid into the system, the money they have paid in is not readily accessible and available to use for the procedures they actually want.

Insurance rarely* pays for sedation, regardless of whether it is conscious sedation (level 1 sedation), general anesthesia, or inhalation sedation with nitrous oxide (commonly “laughing gas.”) My front office staff member says it is a miracle if they pay for sedation (*because it is almost never.) They don’t pay for sedation regardless of the procedure, even if it is being used for the extraction of wisdom teeth.

Closing Thoughts

Austin, TX is a beautiful place to live. It is a beautiful place to practice dentistry. It is not getting any cheaper to live here. I met a man at Fresh Plus the other day who said he is “just barely hanging on,” referring to the ever ballooning costs of living here. These growing trends toward insurance avoiding their contractual responsibilities to patients, cost of living increases, and patients finding it hard to say yes to necessary treatment caused me to rethink my willingness to set up payment plans. So, I am making it known that we are here to help patients receive the care they need.

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