Sample Financial Guidelines

March 1, 2019

Financial Guidelines for our Practice

 

We, the team of _____________ (insert name of practice) agree not to initiate treatment on any patient until a valid financial agreement has been made.

 

Valid Financial Agreement:

 

Patients with Dental Insurance:

 

  • Obtain a copy of patient’s dental insurance card, if available, along with all information necessary to verify coverage.

  • Confirm benefits with insurance company to obtain patient specific benefit information,to include waiting periods, maximums and deductibles used, frequencies met and other plan limitations.

  • Calculate estimated insurance and patient out of pocket investment, as per the terms of patient’s policy.

  • Inform patient of full fee for treatment, prior to quoting estimated insurance benefits.  This will help insure the patient understands he or she is responsible for the entire fee, not just the portion that isn’t covered by insurance. Never say the words “all you have to pay” or “your insurance will pay” unless you are prepared to write off the difference.  This applies even when the Doctor is participating with the plan, to cover any treatment that may not be covered by their plan or in those instances where you learn afterwards that the patient’s coverage had actually been terminated prior to treatment being rendered.  (Note: On rare occasions the carrier may not be aware of the patient’s coverage being cancelled until after they have verified coverage.)  All notifications to the carrier to terminate coverage are retroactive, so in these cases the provider could be left holding a balance due. This is why it is so important to stress to the patient that they, not their insurance carrier, are ultimately responsible for the full fee for treatment incurred.

  • Inform patient of estimated patient portion, never guaranteeing insurance will pay as estimated.  Always let patients know that “insurance is an estimate, not a guarantee of benefits”, and that “actual insurance benefits will be determined by their insurance company as claims are processed by them”.

  • Prior to accepting assignment of benefits, make sure the plan honors assignment to the provider.

  • Have patient sign insurance release and authorization form(included later in this unit).

  • Have patient sign treatment estimate, which will include the terms of the financial agreement (how & when their balance is to be paid).  Place the original in the patient’s file, and give a copy to the patient.

  • Emergency patients: Inform the patient of the fee for the problem focused exam and any necessary x-rays.  Let the patient know that after the Doctor diagnoses treatment necessary they will be informed of their estimated co-payment for this treatment.

 

 

All Patients:

 

  • Courtesy savings allowance if treatment plan paid in full at start of treatment.  This office will honor a 5% savings (never say discount) for payment in full by personal check.  This savings will not apply to payments made by any other payment method.

  • Payment in full or estimated patient portion (for patients who have insurance) is due at the time services are rendered, unless other arrangements have been made in advance.

  • Inform the patients of payment methods accepted; i.e. personal check, Master Card, Visa, Debit, American Express, Discover etc.

  • Verify name and signature on Credit Card or personal check by obtaining a copy of a photo I.D. such as driver’s license or state I.D. card.

  • For larger treatment plans offer the opportunity to make monthly payments via our partnership with (Care Credit?) or (Lending Club Patient Financial Solutions?), etc.  Let the patient know they can fill out a brief application and apply for interest free financing or extended payment plans using one of these to help make their dentistry more affordable.

  • Do not offer to extend “in house” financing to patients. We are not a bank, and as such we cannot afford to finance patient’s care.  This is not to say that there are not exceptions, but this is solely at the discretion of the Doctor and/or Office Manager.  Never, under any circumstances, go outside of these guidelines without obtaining prior authorization!  

 

 

 

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