The Dental Insurance and Billing Guru - Dr. Travis Campbell

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Welcome back to the Associates on Fire podcast. My name is Drew Phillips and welcome and I will be the host of today's episode. For those of you who haven't had a chance to check out our Associates on Fire program yet, I'm a CPA and CFO Advisor of Practice CFO and one of the instructors in our Associates on Fire program. Be sure to check us out at www.associatesonfire.com. it's hard to talk about the business of dentistry without talking about insurance and billing, because without them we wouldn't have collections. It doesn't take a business degree to understand the importance of collections. Without collections, we don't have a business. At best, we have a hobby. Today's guest has a reputation in insurance and billing that precedes him. You may know him as the dental insurance guy, or more simply, as Dr. Travis Campbell. I first learned about Travis while browsing a few popular Facebook groups that are open to dentists and non dentists. Travis's name kept appearing in the comments of these groups and all of his comments were responses to questions from people in the industry that were eager to learn about a specific billing or insurance question that either they or someone close to them had encountered in their practice. Each time his name would appear, I would read the question stem and his responses and I kept thinking, wow, you know, this guy is incredibly helpful and insightful. So finally I did something I virtually never do, which is send someone a message on social media that I don't know it all and completely on brand for Travis, he responded at that point. I also browsed his profile for a bit and I realized that he had written a book called Understanding Dental Insurance and in his profile there was a link to the Apple Bookstore. I followed the link and I bought his book. The book was incredibly comprehensive. I mean like A to Z everything that you would really need to know. He also is coming out with a supplementary online version called dentalinsuranceguy.com which is going to be equipped with the necessary forms to implement a lot of the practices that he that he teaches and knows so much about. It has videos to walk you through the educational components. It has links to the various legal articles that support some of the billing practices that we're pursuing or that he's having his clients pursue.

And through this process of getting to know Travis, I actually found out later that he's also a practice owning dentist. And my mind, as you can imagine, was further blown away. Like, how does someone have the time to be both an expert in dentistry and in insurance and billing? Both are extremely complex and intricate worlds. Needless to say, I'm honored that Travis is on the show today and I'm excited for all of our listeners as I'm confident there will be at least one nugget of information that you can take away and deploy at your practice that will translate to immediate improvements. So Travis, first question for you. You're a practice owning dentist, all of the time demands that come along with being a practice owner, how did you carve out the time necessary to learn insurance and billing at a level where most would consider you an industry leading expert on the topic?

Well, I mean, as a practicing dentist, one of the things we have to deal with is how to get paid for what we do. You know, years ago when I started, I didn't know anything about running a business or dealing with insurance or anything. And so the things that caused problems needed solutions. And of course, you know, I spent the first couple years searching for people who'd already come up with an answer and never really found any. I mean, so we had lots of challenges on what to do. And so I had to do my own research basically and had to, you know, research through contracts and state laws and federal laws and you know, find out what it is exactly that we need to be doing. And that's what I put together. And you know, once we started kind of figuring it out, I start getting people to ask me questions about it. And it just, it was almost a natural transition. But you know, I tell people all the time, you know, I'm very good at finding problems and half of them are self created problems.

But I'm one that if I don't find a solution, I'll look for it. So I mean, that's where everything came down to.

And Travis, as I alluded to earlier, you have a brand new product called dentalinsuranceguide.com coming out. It's a new web based platform that helps support the sort of the insurance and billing consulting and other endeavors that you've pursued in the past. Can you. I just wanted you to take a moment and explain to our listeners from your perspective what that platform is aimed to do and, and who would benefit from it.

Okay, so you know, when going through all this, like I said, a lot of it, I was trying to find data and information, you know, guides and what to do, and we didn't find any of it. So what we've put together is an online platform that really contains all of it. You know, forms that we use, links to, laws, you know, how to interpret a lot of things, you know, what to do with your contract. CE courses. It's going to have monthly online Q and A sessions, you know, an entire community platform. It's got everything for insurance. And so if anybody's interested in that, it launches actually any day now. And it'll be dentalinsuranceguy.com that's dentalinsuranceguy.com.

Well, Travis, I know that the book that you wrote is so comprehensive, and I imagine that the website is also going to be as comprehensive. Just curious, what's the style that the website's going to have? Are you going to have a lot of videos and interactive learning content? Just give us a flavor for what that's going to look like.

So the CE courses are video content.

You know, the Q and A sessions will be basically similar to Zoom. There's going to be online Q and A, you know, just standard questions that you can get.

You know, they're really everything. I mean, I know most of us, many of us learn in different ways. And so if you want to read through the articles or, you know, watch the CE courses or come to a live session, I mean, it's got it all. And because I get these all the time anyway, we're going to have a platform for the members to be able to just ask questions of anything they want. And I'm on there all the time. So we can usually get people an answer within, you know, 24, 48 hours. And a majority of what I get asked a lot of times nowadays is here's an eob, here's a denial we got or a problem we have, what do we do? And those are the fun ones for me because, A, they're just. They're like little puzzles. But B, that's sometimes where I come up with some of the newer challenges that people are having, because sometimes I don't see these challenges because, you know, a lot of the ways we work we with insurance, I stopped having a lot of the problems because of what we do. And so it's. It's a good reminder of people who aren't following our systems yet, kind of what's out there.

So can you elaborate on that point a little bit more? Like, so you're saying that insurance is. It almost sounded like they're like the insurance companies are picking on these other practices because they, they know, unlike your practice, they may not know the insurance code and law and they don't have as much experience with that practice, potentially in that practice, proving that they do have similar knowledge that you do. Is that what you were saying?

To some extent, in some ways, yes. So I wouldn't say that the insurance companies specifically target people. I would say on the other end, you are dealing with humans on both sides of the equation. And the insurance companies within general areas typically only have a few reviewers that process claims from all the dentists that are there, which means if they see offices that are constantly sending good claims, they're going to give them more of the benefit of the doubt. And if they see offices that are constantly sending claims with minimal or no data that's supportive of what they're doing, yeah, they're going to probably take another look at those. And so you tend to develop a reputation. And if you developed a reputation that you always have your stuff together, if there's even a question they're going to look at and go, I don't have enough time to deal with this one. I know they've probably got it. I'm just going to click approve and move on. Because unlike what a lot of us want to believe or think.

The reviewers have one or two goals. It just kind of depends on the insurance company. They're either paid by salary and then given a quota. So they have to process so many claims per hour. So that means if some claims are going to take longer, they're not going to want to spend that time. The other side of the coin is some reviewers actually get paid per claim, which means in order for them to make any decent salary, they have to process them quickly. So what it comes down to is for a reviewer, they have to spend less than a minute determining whether a claim should be approved or denied, which means if you send them way too much information, that's not helpful. If you don't send them the right information, that's not helpful. If you send them what I see, a lot of times the wrong information, that's going to end up causing your denial. And so, you know, we just have to realize what the other side of the equation is, because I've got a lot of friends or dentists that I talk to on a regular basis that they work as reviewers, and that's what they do. And, you know, most of them are very nice dentists and often part time and they run their own practice and they do it just for a side income. And you know, oddly enough, you can actually learn something by doing it too. But they're not all out there just to say, oh, we must deny every claim. Really, a majority of them are just out there going, we've got to process these quickly. If you give us the information we want, we click approve and move on. It's not something that they just deliberate and go, oh, I have to, you know, deny so many of them. But at the same time, if you send them lousy information, which, and this is lousy information from their point of view, not necessarily from a dentist point of view, it's going to hold up the claim process for you.

Are most of the reviewers in your experience, are they most of them dentists or former dentists even?

Well, it depends on the company, depends on what side of the review you're on. So. So a first pass, like the first time you send a claim, often with a lot of companies that's either completely automated or with what you consider low level reviewers, basically non dentists, all they're looking for is a checklist. Did you provide everything that they need to process that claim? So, you know, the simple stuff is, unfortunately what still gets missed occasionally is, you know, do you have the group number, do you have the ID number? Do you have the right name, you know, birth date, does everything match up to what that claim is? And then you're looking at, okay, you've got, let's say a perio case, do you have a perio chart? You know, you have a crown case, do you have an X ray or photo? You know, they're looking for the basics. And if you don't have the basics, they're going to deny it. And typically that first line of reviewers are not dentists. They're just looking for the checklist. Now when you finally do get to the point that you do have the information, then, yeah, usually it's dentists and it's if a dentist is going to review the case legally, that dentist has to be licensed in the state that it's being reviewed for. So, yeah, I mean, most of the time when you have a dentist reviewing your claim. Yeah, they have a license in your location.

That was going to be my next question because, you know, you kind of alluded to you having, you know, maybe not you personally, but your office, whoever's doing the billing, has a relationship or maybe somewhat of a relationship that has been developed over time with these reviewers. And I was Curious. I mean, when I think of, like, Delta, right. I mean, that's a nation, that's a nationwide company. I couldn't imagine that you'd get the same person or the same few people every time. But when you say that it's, you know, localized on the state level because of the dental license factor, that does start to make more sense. So, so, so which, in your experience, I mean, how many people roughly, at a. At any given insurance company does. Do you guys interact with? And is it really that familiar?

Well, again, it depends on the size of the insurance company. I mean, there's very small insurance companies all the way up to. I mean, Delta is probably one of the largest. So. And it depends on how many claims are being processed in that state, on how many people they have, but it's going to be a handful of people in most areas. Now, you talk about familiarity. I'm talking about asymptomatic, asynchronous familiarity. You know, they see our stuff, we see their stuff. Do we ever directly talk? Rarely. You know, the only times you're going to directly talk with a reviewer is if you get denied twice and then you invoke your right to actually speak to a reviewer and, you know, kind of figure out what's going on and what needs to be done. And I'll tell you, that one doesn't happen very often. So it's not that there's. I have a relationship with these people. It's just, you know, we. It's an understanding more than anything of, you know, we send good claims and therefore we get the reputation that we send good claims versus an office that sends poor claims. Well, yeah, they're going to get that reputation that they're easy to deny. And, you know, I actually talked to a reviewer just last week or the previous week, and he said he hates having to reprocess a claim or even to speak to another office. Not because he dislikes talking to people. It's a huge waste of time. And he's paid per claim, so he's actually not paid at all to get on the phone and talk to you. Which means when the dentists do get on the phone to talk to you, they're not usually your enemy. They're just trying to get the information. And so. And that's what a lot of times, you know, when I get on the phone, I don't start yelling at them like a lot of us tend to do, because there's anger behind, you know, denial restorations. Yeah, but the thing is that is the person who has the best chance of getting you that approval. You just have to convince them they're not the enemy. They're actually looking for information in most cases. Now granted, yes, there's some few bad apples out there and you know, it is what it is in every industry. But, you know, I found you win more with honey than spice. So, you know, when you're nice to these people on the phone, you're actually going to get a better response because you piss them off. Well, you know, all I have to do is hang up and hit deny. It's not hard on their end. So you do kind of want to, you know, have a semi friendly professional conversation with them.

Maybe you could do us a favor and walk us through an example of a claim that your office would submit. That would fall under the category of a good claim.

So a good claim is clear and concise. You know, for instance, I've seen some claims that for crowns, for instance, you know, they send off the claim, they send 20 different photos and X rays, they send a narrative that's two pages long. You know, a reviewer doesn't have time to go through that. They're going to look at it and they're going to look at the first couple photos and X rays and often if you've got that many, some of them are not all that helpful. And they're going to deny the claim. That's it. I mean, they're not going to spend five minutes reviewing all the junk you sent them. That's not concise. On the flip side, I mean, I've seen claims for grounds that they send a pre op PA that, you know, doesn't actually look that bad. They talk about it being cracked, they talk about doing a buildup even though the X ray doesn't really even show where you would put that buildup. And then they expect approval. I'm like, well, you got to give them a little more information. You know, a good photo, a good X ray and a short basic narrative. Something that's easy to run through quickly. And that's, that's really the name of the game. You know, I get claims all the time for Perio. I mean, it's number one denied claim. And yet the data that's sent, it doesn't even follow basic standards of how we diagnose Perio for one. But for two, there's nothing on there that says, oh my gosh, this patient actually needed the treatment. They just send the data and expect the insurance company to say yes. And well, yeah, that's what we Want, that's not how it works. And so just with a little more information, you know, again, what you're trying to do is take somebody who's never seen this patient, never seen this person, knows nothing about them, and say this was their problem that demanded the treatment that we did. That's it.

In your office.

Do you have standardized narratives for commonly used code so that they are concise consistently? And not just concise consistently, but the verbiage is similar so that the reviewers are able to process it quickly?

As you, as you mentioned, yes and no. So, I mean, one challenge that happens and another reviewer sent me this all the time because he's like, this office keeps sending me the same narrative for every crown that they do, period. And like, obviously that doesn't work. It's like sending the same X ray for every tooth that you work on. It's just not going to work. Now what we do, like in my office and we've got it online, it'll be on that platform as a download. We have a narrative form. It's just a checklist more than anything. And it's check the problems, circle the areas and you're done. It takes like 10 seconds, 15 seconds to fill out. But now you have a clinical crown narrative. Now we do it as a checklist so that I don't have to go in there and write everything or remember what's important. I just find what's on there like a menu and check it and circle it. That's it.

So the minutes, you may be selecting different things from your exhaustive menu, but the menu's the same.

Yep, absolutely. And yeah, I mean, it's probably got 30 things on there that you can pick from, but it's the same basic 30 things. I mean, it's not like, you know, unlike what most of us want to believe, dentistry is not rocket science. Why we do dentistry is important. But, you know, a crown only has a few reasons why we do it. You know, it's decayed, it's fractured, it's painful, whatever. Perio only has really one reason we do it. There's clinical attachment loss. So all you got to do is provide that information and then, you know, that's a majority of it. So, no, I don't spend, you know, minutes on end writing narratives.

Well, I mean, it sounds way more efficient than the, than the two page narrative that you mentioned earlier.

That is, that is very way more efficient. Well then, so maybe switching maybe. Actually, let's stick on the Perio piece for, for a moment because I do Find that. I mean, everyone, any practice management consultant out there is gonna. Probably one of the first things they're gonna try and talk to you about is, is increasing your perio and within your hygiene department. And so what. What are things that. What are some of the common challenges that you see? And why is Perio some of like the number one area for rejected claims?

Well, the thing that always amuses me is the first time anybody comes up with a hey, here's a Perio case. You know, it was denied. What's the problem? People ask for X rays. I'm like, why? X rays don't show almost anything in early stage Perio? And yet it's discussed all the time. It's on EOBs. X rays are near useless. What's important is the perio chart itself. And yet most of us, oddly enough, don't know how to fill out a barrier chart completely. We do pocket depths, and that's all we do. And I'm like, well, okay, where's the actual damage? Where's the actual infection? Where's the bleeding? Where's all the problems? And yet that's what we send the insurance company. So now I'll say personally, some of this comes from. I had a great education, a lot of things in dentistry at school. Perry was not one of them by any means.

Most of what I learned of Perio I learned after dental school, which is sad, but it is what it is. Majority of us either are still practicing and never were taught Perio 30, 40 years ago. And even a lot of us who graduated fairly recently doesn't mean our Perio program was very good at the documentation side. So that's the most important thing is learning what is it that you actually have to document with Perio, but also making it to where it's visible again to anybody who's never seen that patient. If you send a periochart with a bunch of four millimeter pockets and that's all you send. Well, are the gums swollen? Is it actually a bone problem or is it just a gum problem? There's too many questions that are left open on that. And that's why a complete periochart makes a big difference.

Know how to, you know, properly do Perio charting is. It does feel slightly outside of, like the scope of your, your insurance courses. But just question, do you have something around in your, in your, on your new online platform that goes over how to Perio chart correctly or if. And if not, where. Where can someone go and find that information?

Absolutely. That's One of the CE courses I do. I mean, part of it's, you know, what to send to the insurance company, but the other parts and very basic, the basic superio, you know, how do we diagnose it, what's the documentation, what's necessary to be in there, purely from an AAP and state board point of view. But once you have that, that's what the insurance company wants to see. They want to see the data, they want to see the proof. And again, it now it's kind of sad, just for the industry itself. Most of the claims that I get sent to me where dentists are like, you know, this claim got denied. They needed perio. And I look at the X rays, I'm like, well, yeah, maybe look at perio chart. I'm like, well, probably, but you're missing half the data that should be there. There's nothing that proves it. If you have all the data, it proves it.

And so that's often what I do when I look at these claims that Dennis send it sent out. And they're frustrated for good reason. But the data they present to me as a dentist says, yeah, I can potentially see a situation where this would make sense. But what I can't see with what they submitted is a definite. And it's not that I'm disagreeing with the fact that they did the work, it's disagreeing with the documentation that's presented. That's the biggest thing. It's all about communication. You, you know, if I look at my life and my wife and I think, I love you.

Well, that's not going to do much. I mean, yeah, she likes the good looks, but she wants it said, it's the communication, and she wants it in more than just I love you. Occasionally she wants a little bit more detail. Well, the insurance company isn't much different. They don't just want to sit here and see, yeah, we did this treatment. They want to see why we did this treatment and have a little bit of supporting evidence for it.

Well, that makes complete sense to me when you put it that way. In your office, do your hygienists do most of the perio charting or do you participate in that to some extent?

Well, in my experience, and again, this comes from the training I had in dental school. Most hygienists are far better at documenting the hygiene and perio side of things. In dentistar.

You know, one of the instructors I remember, he was great, loved him, but he said, you know, I didn't become a dentist to become a gum Gardener like, okay, yeah, I get it. I want to fix teeth so we don't put the passion into the gums that typically a good hygienist will. And therefore the things you're passionate about are going to be the things you put more focus on and naturally you're going to be better at. And so can I periochart? Well, sure. My hygiene is going to do it better with less discomfort to the patient. She's going to do it quicker just because it's what she does every day. I mean it's no different than I take out lots of teeth. I've gotten very good at taking out teeth. I enjoy taking out teeth. I enjoy helping people with the fact that we can get them out of pain. But when I first started taking out teeth, it wasn't so fun because it took a lot more time and effort and I had to think through it and everything else and patients were in the chair a lot longer. Well, it's a lot more fun process for me now. It's a passion and it's a lot better for the patient. But it's because I take out teeth literally every day now. I don't do root canals every day and I'm sure a lot of general dentists can appreciate this means root canals aren't necessarily the most fun thing I do all the time. I, if I could give them up, I probably would, but they're needed procedure and you know, the few times I do them, yeah, we can do them. It just takes a lot longer than necessary. Or I can send them my endodontist who's going to do them two or three times quicker than I am and have a better experience for the patient and yeah, probably do a better job with it now can we come up with the same result in the end? Most likely they're just going to do it a lot more efficient than I am because it's what they do every day. Same thing with the hygienists.

Exactly right. Maximize people's strengths. So let's talk about some other areas that you're that you've noticed from your experiences. Maybe more on the consulting side that could help maybe answer some of our listeners questions that they may be having.

So fun. One that just came up, you know, on social media side recently is, you know, a dentist who did a crown and the patient walked out without painting. And of course we I've seen it all. And by the way, when I start these stories I always tell people, my first book was all about my failures. I mean, so nothing I talk about is ever against the dentist, it's usually me remembering, yeah, I screwed this up just as bad, if not worse. So none of this is like, oh my God, I'm just better than everybody? No, I screwed it up harder, faster, you know, worse than everybody else. And therefore I just learned to not screw up as much.

Well, I speak for everyone. We appreciate you writing down your mess ups and sharing them with us all.

Yeah. So you know, we've had patients come in and they have every excuse under the sun after the treatment of, you know, I forgot my credit card or you know, can I get your check post dated or, or I'll just call you back with it, or they just walk out. I mean, period. So it's oddly enough, you know, if you have a collection issue you might want to look at, when are you collecting the money? I have a colloquial response that's fairly crude just because it's memorable. Is money in hand before ass in chair. Don't put the patient in the operatory to do treatment on them until they've paid you, period. It's just that simple. Because if they paid you before you work, well, they can't walk out without paying. But here's the thing, and this is what my team talks to patients about all the time. And it's true for a majority of them, when you're done working in their mouth, it's not necessarily the most pleasant experience in the world. Unless you knock them out. Well, if you knock them out, they're not paying you at the end of the visit, so they've got to pay you at the beginning. Well, because it's not the most pleasant thing in the world when you're done, usually the patient just wants to leave and go home or go to work or whatever else is in their world at that day. So they don't want to have to stop at the front desk to now deal with money.

They want to leave. So how about you take care of all that paperwork and financial stuff first? It's more protective for the office, but the patient also leaves the office. Not talking about money. Well, what's the thing that we remember as humans? No matter what the experience, you remember the beginning, you remember the end, but most often it's the end that you remember more than anything. So if you remember at the end, hey, I got nice work, it looks good. I got to see it in the mirror. I feel like my teeth come together and function like they should when I'm done. And then I get a walkout. They don't want the experience at the end always to be financial.

And yet all the time we hear patients think, well, my dentist is all about the money. Well, the question is, are you creating that situation by always putting money at the end? And that's what they remember.

So collect money before the patient's in the operatory.

Absolutely, absolutely. I think that, that that strategy works. I mean, I wish it was as easy as hey, client, please do this. And then bam, that's implemented. But you're right, you know, there are some of the issues that I, that for, for, on my side that I see quite frequently is.

Insurance verification, you know, struggles just not being able to do that quickly and efficiently so that they can get the right amount of money from the patient at the time of service, or in your case, before the time of service.

Do you, do you have any, any tips on how people can be better on the verification side?

Well, I mean, there's two basic ways to do verification. You either get very basic details and take a lot of guesses, which is quick but not as accurate, or you can spend a good amount of time getting a thorough breakdown, go through all the basic codes that you do and get all the nuances of what each plan has. Now, everybody knows that, you know, there's preventive, basic and major, and typically it's covered at 180 and 50. But then there's a million different exclusions under every policy. You know, certain things are covered under frequency limitations and certain things are covered or aren't covered even though it's the same code. You know, there's exclusions for what they will and won't pay for. So you've got to have all that information because that's what changes, you know, employer to employer, you know, policy to policy. A lot of these aren't even rules for the insurance company. They're rules for that specific employer who wanted to maybe increase or reduce the premium costs. And therefore the insurance company just throws in extra exclusions if the employer wants to save money. So we've got to know what all those exclusions are. So there's two ways of doing it. You get all the data and therefore you get a really good estimate. You can be super confident with it.

Or if you don't have the time effort to do that, you can outsource it and get that same information if you have a good company that will do it well, or you get very limited information and then just assume worst case scenarios in every situation.

Because here's the thing. What do patients, what is the easiest Way to make a patient upset after the fact.

Oh, oh, hey, patient, you owe me more money.

Yes, exactly. And so how about you always estimate to where you never have to have that conversation again now. Yes, that's a little easier said than done.

I was going to say that's example more complicated.

It is and it isn't. It's the same thing as that narrative checklist we talked about. It's having your menu, it's having your, you know, what is it that you need to always think about? So, for instance, you know, most of us know downgrades. You know, composites often get downgraded to amalgam. Well, if you don't know for certain whether it's getting downgraded, assume it will be. Because there's a lot of policies that do that, you know, often night guards aren't covered. Well, if you don't know for certain, assume it's not. You know, if you are doing a crown and you don't know whether you need a buildup, assume in the treatment plan a buildup is necessary. If you don't know where the extraction is going to be, surgical or simple, plan it as surgical. Because here's the thing, it's easy to go to the patient at the end and go, hey, by the way, the estimate went lower. This. The damage to your tooth wasn't as bad as originally expected or insurance paid more than they told us they would pay. Awesome. Patients are happy. Patients are never upset when you tell them they have extra money if you frame it correctly. Now, if you say we screwed up in your estimate and therefore we have extra money for you, well, yeah, okay, well, they're probably going to be happy they have extra money. They may or may not like you because you said you screwed up. And yet we do that all the time. You know, know what the number one thing I hear all the time and I always try to coach offices out of this line. It's an insurance estimate only. What did you just tell the patient? We don't know what the hell we're doing. It's an unknown. And therefore, what do people like? Unknowns.

Medical or, you know, or a dental office. That's for sure.

And financial tabooed. So unknowns are bad. So the rule we always go by is if you aren't 99.9% certain something's covered, because again, we'd never be 100% certain, then you better be lowering how much insurance is paying until you are 99.9% insurance is going to pay that amount or more.

If you do that, you will not have collections issues, you will not have to send out statements, you will not be dealing with upset patients other than you have to point 1% of the time. And you can easily go to the patient with your estimate and go, look, I'm very confident in this estimate. I don't need a predetermination, I don't need to waste the time and effort. This is what you know your out of pocket is going to be or in the back of your head or less. Now obviously you don't want to say that because then the patient wants to pay less. You just say, look, this is what it's going to be with the understanding that if I'm wrong, I'm wrong in the patient's benefit and they end up with extra money at the end. Great.

So Travis, do you have sort of this menu as you, as you, as you mentioned for, for this particular piece on your new platform as a quick guide?

No, it's. But throughout the CE courses I have, yes, it's embedded in there. Although it may not be a bad idea to create a quick list.

Yeah, I mean, I probably could do that at some point, but like I said, a majority of it's just knowing and they change all the time knowing what it is that insurance won't cover in even 10% of the cases. And if you don't know it, then put it on there. But yeah, I mean, I probably could come up with a list.

So let's talk about non covered services for a moment because it's, I mean everyone is. I'll say this, most people in the GP space especially are always interested or curious about the application of non covered services, the legality around non covered services and then how to incorporate them into their practice the right way.

So what a lot of people don't understand or don't know clearly is there are 39 states that have laws protecting against the insurance company setting the fee for service that's not covered. Now, the challenge a lot of us have is that we don't understand what non covered means. Non covered doesn't mean that they didn't pay for it. Non covered means that the policy will never pay for it. That's the basic idea. So the one that comes up all the time, and I mean I see it like every week somewhere online, is when a patient hits maximum. Well, when they hit their maximum, the service is still covered. There's just no budget left. So it's still covered. Service that's still in network rates in 37 of those states.

Now, there's a couple states that it truly does mean not reimbursed, but it's very few and far between as a general rule across the country. Either you don't have the laws to protect you or, or a covered service is still a covered service even if a patient hits maximum. Now, what's important about this though is if it's not a covered service, if there is no situation in which that insurance company will pay for that service, example cosmetics, then you can charge full fee and you should charge full fee.

And that's the challenge I see a lot of offices have is they always want to give the patient the write off and yet they don't have to. Well, and when it comes down to it, if you think about it, I know for us, you know, I don't do the same crown work in the back that I do the front. In the back, I want something that can absorb the shock of 200 pounds of occlusal pressure. You know, I'm going to probably do zirconia or metal or gold in the front. Well, some zirconia is now can be pretty, but most of those aren't. And so we've got to do something that's a little more cosmetic. Well, the more cosmetic stuff has a higher cost. And a lot of times when I'm doing interior work, we're using a lab that is going to do a much better job with. The aesthetics is going to come with a higher cost as well. Well, that higher cost shouldn't be one that the office absorbs. That higher cost should be passed on to the patient. And that's a non covered cost on top of the crown. So that's the thing that a lot of us need to realize is, you know, when you're doing upgraded services or when you're doing things that aren't covered, yes, you should be charging more and yes, the patient should be paying more regardless of your network affiliation. I would even say fee for service offices, unless their fees are just so high that they don't care. But it comes down to that, you know, are your fees so high that absorb everything that every patient is paying more than they should? Because 20% of your patients have this increased, you know, cost on your end or should you just separate out that extra cost for only the patients that need it? You know, gold crown, for example, a lot of labs are going to charge you two or three times as much because gold's not cheap. Zirconia is cheap.

Well, the patient should be the one absorbing the extra Cost plus, here's the upside. That gold crown is probably going to last them two or three times longer than any horse and crown you can possibly make them. So it is a true benefit to the patient.

This is definitely one area that.

I can only really speak for my clients and their experiences because those are the ones that have been shared with me the most. But this is still, even as you've kind of described the crown situation, one that they still struggle with because the materials that they're using, zirconia, gold, metal, other metals.

They feel that in the, in the insurance contracts themselves that those particular materials are a part of this cover benefit. And so differentiating, you know, this upgrade relative to what's covered is, is still a challenge. And so maybe you could just speak a little bit more toward, toward that particular struggle for them and maybe alleviate that.

Hopefully alleviate is probably not going to help well, be complete because, hey, this is one I usually spend an hour or two talking about. I mean, I have a CE course purely around upgrades and it's like an hour long. But the basics is a read your contract, because every contract has within it the ability to do upgrades. And actually it kind of tells you how to do them. The basics are you just have to get approval from the patient. That's really it. The patient has to know, is this upgrade optional? What does the upgrade entail and what's the cost if they sign up for that, you're good in or out of network. You're not restricted from providing the patients a better option. It would actually be unethical, legal, immoral to not offer better service.

But at the same time, yes, the patient still gets a discount for, say, the crown, the D2750 or, you know, the crown code is, you know, they still get their discount for that. They just don't get a discount for the upgrade. Because usually, at least for us, upgrades are really the cost that we pay. If we're going to pay more for the gold alloy, that's what we pass on to the patient. If we're going to pay more for the cosmetic lab, that's going to charge me more per crown, well, the patient's going to pay that difference. Not making a profit on the upgrades. I'm just offering better care that the patient can choose or not choose to take. Now then you get into the laws of, you know, how to avoid fraud, which means you basically have to treat everybody the same. You get into laws on, you know, you've got to inform the patient, you know, you've got that Fair dealing law. You've got to let people know ahead of time that there's a cost. You can't just say, oh, by the way, you did this gold crown, we're seeing it today, it's going to be another $200. We're. Well, that's not fair to the patient. You got to tell them up front because they may or may not choose that added service. So there's a lot of nuance involved with it, which is kind of where I go into the legality, I go into the rules, I actually go into contract language. But the general idea is, yes, there are lots of things that we do that are optional upgrades that cost us more and therefore those additional optional upgrade costs should be passed on. It's not much different than if we have like we rent space. Most of us, we lease. Well, the cost of running that space, like electrical, you know, sewage, water. Well, the landlord's not going to pick those up. They pass those costs through to the client. Same thing for us. If we use more water, we pay more. If we use less power, we pay less. It just, it's pass through cost.

I like that analogy. I do.

What is a baseline for you, at least the way that you define it, regardless of how anyone else would see this.

What is the baseline for a cover? Like, let's talk posterior, Just something that's the most common. What's the baseline for a posterior unit? And then so anything above that baseline in your in from the way you would define it is an upgrade.

Zirconia.

It's a strong, it's a strong restoration. It can be thinner, it's white, which is what people want. And it's the lowest cost crown material at most dental labs and often by a significant portion. And technically you can do zirconia in the front, may not be the prettiest thing in the world, but it'll be white, you know, tooth colored, whatever you want to call it. But there's obviously varying levels of zirconia. Full zirconia is fairly inexpensive. It's easy for a lab to make. You know, layered zirconia cost more. Well, therefore have the patient pay more for the layered zirconia. But technically you can provide a patient. Well, I mean, you can provide a patient a gold crown. You can provide a patient an amalgam. It's not the prettiest thing in the world, but it'll be functional. You know, anything above the cost of amalgam, like composite, the patient pays for, even if the insurance company is not going to pay for the cost of a composite. The patient's responsible for the difference in the amalgam fee. And the composite fee, it's similar to an upgrade is the patient wants something cosmetic, they're going to pay a little bit more for that. And if they want that amalgam in the front tooth, okay, fine, put it in there. If you do amalgam, and I don't know about most offices, but I actually get patients that come to me as new patients and like, and it's not a question, it's like a statement or a command. You don't do amalgam, right? You don't do silver fillings. I'm like, no, I don't. Because I don't think I could convince somebody in my area nowadays to get amalgam. But there's people in other areas where they don't care. They just want the cheapest thing. Great. I mean it's not a bad material from a dental point of view. You can argue, you know, other sides, but as a dental material, it's the best thing out there. Well, other than gold, but gold's kind of gotten cost restrictive. So yeah, I mean we gotta understand that dentistry at its basics is cleaning your teeth, filling in holes and taking out teeth. That's it. Outside of that, everything else, unfortunately, whether we want to admit it or not, is elective.

And so we've got to think about that as a basics because yes, a lot of us want to believe that dentistry is just a necessity of life. Does it make life better? Absolutely. Do people want to go without dental care? Typically not. But yes, somebody can live without their teeth now. Quality of life is going to change and everything else, but technically you can survive without teeth. You can't survive without, without your heart, you can't survive without your brain. So you know, physicians have a lot of things where it is a life threatening difference. Dentistry, we have very little life threatening issues. Remove the infection, no matter how that is. That may mean a root canal and crown, that may mean a simple extraction. But the basic idea is very, a lot of what we do is optional upgrades.

Does that make sense?

Oh, it makes complete sense. I'm just digesting and you know, and I can't wait to, to this topic. Obviously I could talk about this for, for a long, long time. I'm just, I'm excited that a. To hear the way that this more. I know it's more brief than, than your course is and, but even, even this was, was super helpful, not just for me, but for everyone that's going to listen to this and I'm excited to watch the videos that are a little bit more in depth as well, because I know that just based on this short little comment, you know, commentary that we've had, that there's going to be a lot of rich information in there that everyone could, could put to use if they understood it correctly or at least understood it the way closer to the way that you do. And, and I love that you've, you've gotten so deep into the LE Legal piece as well and like you're actually connecting certain facets of this whole process to the legal jargon and acts out there in the world that help protect dentists and the use of these things. Because, I mean, I think that there's always, dentists didn't get into the business of dental to worry that the law behind was going to be coming after them for some reason. Right. It's just, just nobody wants to feel that way. We pay our taxes and we do things the right way. We're morally, ethically sound. And that's. So it's important, I think that everyone understands that the legal side as well. So I'm glad that you did that.

And there's a good point about this is outside of legal, what is law? What are laws usually meant to do? They're meant to support a basic morality of society. Now, granted, you can define morality different ways, but if you treat people well, then typically you're not going to end up with a lot of legal issues other than the fact there's a lot of regulations with paperwork needs. But outside of that, if you treat people well and you have their good intentions for their care, you're going to avoid most of those issues. The rest of it is the details, the paperwork, the documentation, what you need to do to make sure you dot your I's and cross your T's. But that's the details and that's where, yes, they're important to know what these regulations state. They're important to read your contracts or at least have somebody show you the important clauses in the contracts, which is kind of, I highlight these all the time. You know, it's important to actually know more than what the people around you are telling you. Because unfortunately, like you said, a lot of people don't get into dentistry with the idea that they want to be contract lawyers or that they want to know everything or they even want to read the 50 page contract. No, they get into dentistry to provide help for patients. I did too. Like I said, a lot of learning this was as a side effect of having to deal with the insurance side. But the more I learned, the easier it got. The more I learned, the easier it was to communicate with the insurance company and to get what I wanted, which was them to pay me for the service and for the patients to pay correctly for the service. So, you know, it's important to at least understand.

An intermediate level of all of this. And I say intermediate because, say majority of times people think they're doing really well and know a lot, but when they actually see the details, they're like, oh my gosh, I actually didn't know much of anything, which is where I was years ago. And that's where the book comes in, that's where the training platform comes in, is to show people there's a lot more to insurance than you probably think.

So, you know, the important part is knowing what you don't know, you know.

That'S of course, I mean, knowledge. The more knowledgeable you are, the more you realize and more humble that you become because you know how big and this world actually is across the board, not just with insurance. And I think that was a really, really important point that you just made there. Do you feel that the reason insurance gets a bad rap in the dental market is from this lack of knowledge? Because I think after, not just after speaking with you, but, you know, some other people in the space, some other dentists that have maybe closer to that intermediate understanding, that when you have that understanding, insurance isn't something that you should be afraid of necessarily. It can really help to support a practice both from patient flow and then when you have the right understanding, you can implement the right, you can collect the right amount of money that you're supposed to, as opposed to it being a negative or a detraction from, from your practice. And I'm just. Do you have any thoughts around that sort of element in the space?

Oh, yeah, absolutely. So, you know, I'm not here to defend insurance companies. I mean, there are some shady things that they do. There are some shady people that work at the insurance companies. But again, that's no different than every under industry. There's bad dentists, there's shady dentists, there's unethical dentists, but that's not the majority. The majority are people who truly want to do well in their job and help others. That's, it's almost human nature. So you gotta look at it as, yes, learning more, which is usually the biggest thing about learning, is how to communicate with the insurance company. And yes, ideally the insurance Company should cater to us. That would be the ideal goal, but that's never going to happen. So we can either beat our heads against the wall, and I don't know about you, I don't like headaches, or we can learn to better communicate with them to get what we want. And I'm not telling people to do this for the insurance company's sake. I'm telling them to do this for their own sake. Because if you learn to communicate better in all relationships, it's improved. But specifically with insurance, it gets you what you want. Less denials, less claims, less paperwork, less issues and more money. Now, and that's, I mean, we do dentistry to, yes, help patients, but also make a life for ourselves. I mean, we don't go to work for work's sake for most of us. I mean, some of us are a little, you know, I'm sure there's some out there. Yeah, I mean, there's a few. But, you know, we work to support our lives and therefore what we do needs to be reimbursed. Now, whether that's by the patient or insurance, that's about the policy. That has nothing to do with us. It's about what the employer chose and negotiated. So, you know, the important part is knowing what it is that you need to do. And that's why I tell people all the time, you know, again, I don't like headaches. So I just see it as a game. You know, it's a game of what does the insurance company want? What are the rules involved, what are the strategies involved? I talk about all the time. It's like a game of chess. You know, I can play chess with my 7 year old daughter and she can play the game with me, but she will never beat me at chess unless I let her win. Not because she's not smart, she's actually pretty intelligent for her age. But she doesn't know the underlying strategies, the advanced tactics. She doesn't know the detailed rules of the game. She just knows the basics. Most offices, most team members, most dentists are at that level. They're at the very beginner level of I know how to play the game, even though a lot of them don't even know they're playing a game. But I know how to play the game. I know the basics and that's it. Therefore, here's the thing. Can you ever win a strategy game with just the basic level of knowledge?

Man, you are just on fire with the analogies and metaphors today. I am loving it.

No, here's the Thing easily. No. There.

Yeah. Now me again against my daughter. Yeah, I'm always winning unless I let her win. And yeah, I let her win. But against a grandmaster, I'm a lose because I don't know as much as they do. Well, the thing is, when you call the insurance companies, the people you talk to, in their defense, they were never trained in legality. They don't read the contracts themselves. They just have a list of what they were trained. That's what corporate America does for good or for bad is what it is. They're trained on their specific section. Their specific section is very tight. It's narrow. So when you call them for questions, if you call them for a question, typically people you talk to outside of what is the breakdown information of the policy or what are the, the internal rules of the insurance company, what are they going to reimburse? You're not going to have somebody who has good intimate knowledge of that question. And yet, as a human.

Who wants to be helpful, they're going to try to provide an answer. But here's the thing. How often are you going to be right when you are guessing at an answer?

Very often you're going to be wrong. And that's what we find all the time. It's funny. I had, and I do this as a joke. I mean, I still love the girl. She just, she worked for, for a number of years. She worked for Inch, you know, she was our insurance coordinator. She was on the phone with insurance companies all day long. Well, her last day, I remember, is she threw down the phone yelling at it. Oh, my God, why can't you stop lying to me? For the third time, this phone call, and she hung up on him. And she stormed out of the front of the office, took a break, and she quit. She just couldn't deal with the insurance stuff. Well, here's the thing. It's not that the person on the other end was lying to her intentionally. They just didn't have the answers. I mean, that's what it came down to. And they didn't know what they were talking about. And they tried to give answers that ended up being wrong because she would ask them the same question multiple ways and get different answers. And you're like, you obviously don't know what you're doing. So when you have these conversations, you've got to realize there's a narrow focus at which you can ask a question, actually get a good answer. And that's why calling the insurance companies with questions outside of what's the breakdown often is detrimental. To the office. And that's where a lot of this misunderstanding comes from.

Wow, that's a. Yes, wow.

Hearsay, right? I mean if you're, if you're operating from a limited scope and you're trying to give advice on something that's outside of your scope and then that's now gospel for that office and it was completely wrong to begin with. And I can't imagine what the systemic issues that that's created across multiple practices that they're connected with too. I mean, that's interesting point. If we're looking at, if you and I know that you like puzzles, right? And if you're coming into an office and this is a brand new puzzle and they, they have maybe some, some sort of strategic like direction in the, the clinical style in which they practice. Do you come in and offer, do you try to build the, build the billing aspects around their clinical strategy or do you try to tailor their strategy a bit to accommodate best billing?

This is where I heard this long ago and I really pulled into it. I don't ever consider myself a consultant. That's the idea I've seen as a consultant. They come in with a strategy and they get you to follow that strategy. Now in a lot of ways it's not a bad thing. It's. There are some good things that literally can only be done one way or two ways. I come in as a coach, I take what they're doing and improve it. My job has never been to change completely what a dentist does. My job is not to change the identity of the office. My job is just to bring functional systems that work within the framework of what they want to do. So I mean, I get this bad rap because I talk about insurance all the time that I'm pro in network. Well, I mean, yeah, I'm in network, I make it work. But I have lots of people I talk to dentists that coach that are out of network or fee for service. So I don't care. My goal always is to say, okay, what kind of office do you want? Let's find a way to make that work. If you are a dentist that loves the relationship building and wants to spend extra time with people and wants to develop those deep seated relationships, great, do it. You can't be a network because it takes too long or you can be like me. And I would say probably a majority of dentists type A personality very much. I want to, you know, fix things and move on. And I'm an introvert. I don't have the energy to put to create that kind of relationship. So for me it's easier to be a network because I don't have to deal with the stuff that drains me emotionally.

So yes, there's multiple ways to do it. It's just find the way that works for you. And I've got situations on both sides of the fence. I've got fee for service minded dentists that fail because they want to be in network and it doesn't work, they take too much time. But I've seen the opposite approach where you've got in network minded dentists, dentists that do not do well with these relationship building concepts that have gone bankrupt buying or transitioning to a fee for service office because they don't know what they're getting into. So it's always yes, tailor it to the person or the office or what they need or want. And the challenge is sometimes the owner doesn't know what that is because they've never had to think about it. And so yes, that's the number one thing I do is I ask questions. Whenever I have somebody ask me how do we fix this? Well, if it's a simple question then yeah, I'll fix it. But if it's a how should we in a value basis do something? I've got to know more about them and what it is they want more about them and what's their personality, what will match, what will work. You know, it's very similar to, you know, when you market, you're not going to market veneers and invisalign to a bunch of 80 plus year old patients. Could you get some of them? Sure. But the majority of them are going, I'm not going to be around long enough to make it worth it. Why are you talking to me about this? Very similar. I'm not going to, you know, market to a bunch of 20 year olds about replacing teeth with implants. They got all their teeth, they don't care. So it's the same thing of you got to get the message across of what it, who's the person you're talking to? And that's what I do as a coach is I find out who they are and I just make them better at that. So does that answer your question?

I run into this all the time where you want to help tailor and build someone's dream as they define it. But because of, you know, so maybe it's their lack of experience or education in certain areas, you know, they, their, their vision's sort of incomplete. And so you and I think what you were saying is you almost guide them by asking questions and then helping them through that discovery process and then create a mold together that supports the maybe partly their old vision, but now coupled with their new perspectives. And I think that that is very important. So, yes, that definitely answered that question. Travis, honestly, you're one of the most fascinating people to talk with, and that is not an exaggeration at all. I know we're running short on time here. Do you have any last words that you would like to share with our listeners before we head out for the day?

I'll say this, it's something I posted recently. It's something I wrote about a long time ago.

When we ever talk about, whether it's on podcasts or social media or whatever, people only tend to get the positives. We don't put our worst face forward, we put our best face forward. And so a lot of times we hear people being successful.

And it makes us feel off.

So the main thing to understand is I never want a dentist and owner, you know, somebody runs a business to think, well, that office is making more money than me, collecting more, therefore I'm not as good, or therefore they're better. Neither of it's the case. Success is not defined by how much money you collect. I would even say success is not defined by how much money you take home. Success is defined, and I've never found somebody disagree with this, by the freedom in your life that you have. We have freedom of time and freedom of money. So yes, we need to collect and take home enough money to give us the freedom to make the choices we want financially. But we also need the freedom of time to do what it is that drives us, whether that's spending time with family, taking vacations, doing extreme sports, whatever it is. Every one of us is different on what we want to spend with our time. And too often I see offices that.

Are collecting more than they need, but their life is drained by them spending too much time at work. Or even more often than that, they're spending too much time at work because they think it's going to make them more money and it's not. And so now they're hurting themselves on both sides of the fence.

Success is about making your personal life run everything, and having your business support that or your career support that. And that's the key, and it took me years to figure that one out, is you need to define your life first, whatever that is. So years ago.

I made less money, but I also worked more. Now I take like five weeks of vacation a year because that's what I want. I go to CE courses, like, every month because it's fun. I get a lot out of it. But I didn't get there by doing what everybody does. I got there by trying to find the most efficient way to do things. And therefore, when I'm working, I'm highly productive, and therefore I don't have to work as much from a time point of view, and it works. And therefore, I can work two days a week, I can work five days a week, whatever it is, to reach my financial goals, and then have the rest of the time for me to do what invigorates me. So that's the thing I want people to think about.

That's one thing I admire about you. I really do. You have created this great sort of life balance, obviously, the way that you would define it, but.

It'S refreshing to see. And one of the points of this show is to sort of pull back the veil and create this environment where the person that you've heard through the rumor mill that's doing X amount of collections that you were like, wow, shocked by that they're doing so well, but to allow everyone to have the knowledge to do whatever they want to and operate in any capacity that they want to operate in. So I think that your last comments there really resonated with that message, and I just want to sort of reemphasize. That's. That's the goal here. And. And you being on the show is a big part of that. So I really appreciate your time today.

My pleasure. It was good talking with you, Drew.

You too, Travis.