Divorce Can Be a Good Thing

In late December Congress passed the “No Surprise Medical Billing Act of 2022” which establishes new federal protections against surprise medical bills effective January 1, 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose. It requires dentists to disclose that their practice is out-of-network with the patients’ dental benefit plan prior to treatment and includes specific patient rights for disputing out-of-network balances. And, if patients are self-pay or choose to pay for care without using their benefits plan; the new rules make sure patients receive a “good faith” estimate of how much their care will cost - before they get care. (https://www.cms.gov/ nosurprises/Ending-Surprise-MedicalBills)

Feelings of frustration with patients who ignore your teams’ efforts to collect delinquent balances can initiate actions to “get even by ruining their credit”. You should be aware of changes in 2020 to Utah Code requiring creditors to receive a notice of a “negative credit report” which they would reasonably expect to adversely affect their ability to obtain or maintain credit. This notice must be delivered to a creditor within 30 days of submitting a negative credit report. If you assign past due accounts to collection agencies or attorneys, you should be aware of their procedures for submitting negative reports to a credit reporting agency. The Statute can be found:

(https://le.utah.gov/xcode/Title70C/ Chapter7/70C-7-S107.html?v=C70C7-S107_2020051220200512)

Bottom Line: A new year is a good time to review and update your practices’ financial policy and revenue cycle process.

Dr Scott Theurer ADA Delegate

Why am I talking Divorce in a dental publication? Sometimes a divorce is the best option to maintain sanity and dignity. I’m specifically talking about a needed divorce in your dental practice. Divorce by definition is, “separate or dissociate (something) from something else”. Some of the other words used to describe a divorce are: dissolution, separation, disunion, break up, part company, sever, repudiate and many more. It has become more apparent (especially since the pandemic has increased overhead in dental practices) to look at your practices and decide where a Divorce is needed.

As we discuss dental concerns with dentists across the state, there is almost always one common area of frustration and complaint. This is especially true for Utah dentists and their dental team members. This is a common concern across the entire dental community nationwide. The complaints stem from dealings with insurance companies and their handling of a patient’s dental benefits. Almost universally, the most frustrated dentists are those that have signed up to be Preferred Providers for various dental benefit companies. As a PPO provider, you have agreed to accept lower reimbursements for your dental services to your patients that have that particular dental benefit plan. You have signed a contract to “play by their rules” and policies. You have given the insurance company the power to decide what you receive in reimbursement for your dental services.

Since this is the #1 frustration nationwide, why do we not more often “Divorce” ourselves from this frustrating and sometimes abusive relationship??? Many frustrated dentists look to the ADA or UDA to solve their insurance company complaints. Although the UDA and ADA continue to do many things to fight insurance interference, the organization cannot prevent you from signing up for an abusive or frustrating relationship. The ADA and UDA has worked on several pieces of legislation in recent years to help ease the frustration of dental offices on the dental benefit plans frustrating behavior. But really the best solution to your dental benefit frustrations is to “File for Divorce”. Obviously, I’m talking about divorcing from PPO plans.

Divorcing all the PPO plans you have signed on may be an end goal. But dropping them all at once might be too much adjustment to a single practice. But dropping your most frustrating plans will almost automatically bring you less stress and frustration and most likely you will see increased profits from your dental services provided. We have seen this unanimously across the state, those that have dropped a few plans have been happier and more profitable. It has been 100% unanimous for the past several years. A patient or two may be lost in the process, but the majority of patients want to stay with their dental office choice. Especially, when you discuss with the patient, how they would want you to do your best dentistry and use the best materials. And explain that is not possible with some dental benefit plans.

If you suffer from frustrations due to PPO plans in which you have signed on to be a provider, maybe it’s time you consider “Filing for Divorce”. It is time for you to realize the problem cannot be solved by an outside organization. It needs to be solved by not agreeing to participate in the fee reimbursement reductions and to the “rules” of the game they dictate. Since you have signed the contract to be a PPO provider, only you can get out of the contract terms. The ADA and UDA cannot change the legal and binding contract you signed.

Dr Val L Radmall UDA Executive Director