Today I received this question from a client, and since all of you will be taking additional precautions as you reopen your offices, I wanted to share it with you.
“I would like to submit to insurance providers for the extra infection control procedures we’re implementing. I don’t know if we should do this or not, but please let me know how you think we could submit and possibly be reimbursed for extra PPE, air quality processes, etc.”
Yes, you can check directly with insurance companies if you wish but remember that your insurance companies pay for services you rendered to, and billed to, your patients. Technically, and realistically as well, the only way you could get paid for the extra infection control procedures you are doing is by billing your patients for those procedures first, which would be done by raising your case fees to cover the overhead of those extra procedures or by adding a surcharge of some sort to your fees. You would have the same result in both cases, a higher total case fee. This would be mute in the great majority of cases because the patients’ lifetime insurance limits are almost always reached so an increase in fee would not result in any increase in insurance payments.
Remember that you can only “submit a charge,” whether supplemental or not, to an insurance company that you have already submitted (billed/charged) to the patient. Remember also that you cannot charge the patient in order to bill their insurance and then waive that fee if the insurance does not pay. Again though, almost all of your patients will use up 100% of their insurance benefit when you submit your regular case fee, no matter what insurance code you use for the supplemental charge. An exception to that, I suppose, might be if you could be successful in getting the patients’ medical insurance to pay, using an appropriate medical billing code. You would still have to bill the patient first though. Whether you bill supplemental charges or not is always up to the doctor but my recommendation is that if you truly must receive extra revenue to cover the cost of additional infection control, etc., your orthodontic case fee should be increased. “Supplemental” fees will just be annoying to the patient/responsible party and especially so given that in the great majority of cases there will be no insurance coverage for those extra charges.
I have already spoken with one doctor who wanted to try billing his patients’ dental insurance for these extra charges. I have written about this issue in the past but an orthodontist billing a patient’s general dental insurance is a great way to lose dentist referrals!
An additional question is whether or not now is the time to be raising fees. If this pandemic issue turns out in any way similar to the recession of December 2007 to June 2009, and I believe that with respect to an orthodontist’s ability to fully financially recover, it will, then the time to raise fees is once you are confident that your new patient flow is back to normal and rising.
Bottom line for me is that I will encourage my clients to absorb any increased costs for now and get reimbursed those increased costs at some point in the future, when our situation is more “normal.” Judging from what we have seen in client offices just in the past couple of days, normal may well come more quickly than we might have thought.
