Assignment of benefits

[Joel M. Eichen]

Assignment Assignment of benefits. An ideal dental practice establishes the policy that all financial obligations are between patient and doctor. You the patient are responsible for fee X. The insurance company may reimburse you X or (X-Y), but you do owe me X. That's the secret of many great practices. The reality is that many other practices work directly with the insurance company, so there develops a multi-tiered "fee schedule." The bottom of the barrel includes practices where the treatment is actually dictated by what is or is not covered. If the HMO insurance company wants to provide coverage for a certain fee per month or a certain cost per procedure, then its time for them to go into the market place and honestly hire dentists. There's absolutely nothing wrong with this. But please be advised that the responsibility for economic loss reverts right back where it belongs: the HMO. There's a simple legislative solution. If legislators state by state, would invoke laws prohibiting the assignment of dental benefits, then every practice would immediately get lots of new fee-for-service patients (just by definition). The patient is rendered treatment, pays for treatment, or is billed for treatment and submits paid bills to the insurance company for reimbursement. No more checks to the doctor. This approach can't work in medicine, because there's few folks who could ante up the cash for a bone marrow transplant. Dentistry is slightly different. That's the key. Medical insurance is an indemnification plan. Dental insurance is . . . . . well, you decide. Dental insurance can be considered a quasi-indemnification plan. More accurately, its really a partial reimbursement plan against voluntary treatment choices. Could it be similar "I'll pay you 80% of the cost of painting your house, up to $1,000.00 per year, if you can verify to me that the house needs painting and it was, indeed done. And I will even forgo the requirement that requires that your house needs painting. That's really between you and the house painter." If the insurance company wants to make the maximum $1500. next year, or $500. a year, or even $3. per month, the house painter really doesn't care. His job is buying the paint and hiring the crew to paint the house. That's it. Not exactly indemnification. This is dental insurance. Of course, this new law ends all the problems of collecting deductibles, coinsurance, all of the phone calls back and forth about coverage, all of the paperwork and puts it all back where it belongs. It returns the administration of the details back to the patient, who has the contract with the insurer. No more lists of doctors who take or don't take your insurance. Its simple. We all take patients. That's our business. It also ends all of this monkey business for your competition down the street who may be siphoning off all of your good patients, even as we speak! Do you agree? Cheers, Joel M. Eichen, D.D.S. Indemnification - insures against predictable loss. That is, there is a 0.05% chance of your house burning to the ground, providing you yourself don't intentionally light the match. I'll pay you 100% of the replacement value, providing you have in place insurance on 80% of the fair market value. Something like that, more or less. Verified bills: requires the doctor's EIN or SSN. I doubt that many doctors would become co-conspirators and submit their signature on an unpaid bill, or would inflate their legitimate fees. It could get expensive! After all, its too simple to create a 1099 type of document at the end of the month or at end of the year. In other words, paid or not, inflated or not, Doc, you owe the taxes. For your own sake, better make sure its paid. Or the tax man will get you!