60: Billing Insurance, then writing off more than you should with Davey Clay, and Josh Smith

[music] >> Welcome to the navigating dental insurance podcast, where we don't take from insurance [music] companies. Here are your hosts, Mr. Jordan Comstock and Mr. Ben Tuinei. >> Hi. Welcome to another exciting episode of the Say No to PPOs series on the navigating dental insurance podcast. [music] I am your co-host today, Jordan Comstock. I got on the line with me Ben Tuinei. Ben, what's up, man? >> Hey Jordan. Man, busy day. Today is my son's birthday. Uh for those of you that are listening, it's Yeah,

happy birthday to little Welton. It's uh it's November 16th. Yesterday was my wife's birthday and uh last week was Saturday was my father-in-law's birthday. >> Holy smokes. >> The the great thing about birthdays is that uh I get to buy food that uh I want to eat that I know that like last night we had this uh uh [clears throat] low country boil and I went to Costco and got I I cleared them out of all of the king crab that they had. And uh all

of the jumbo shrimp and it was >> Dude, and and you didn't even call me. >> I'm sorry, dude. I mean, you can come over later today, but uh man, our house >> Leftovers, huh? Leftovers. All right. >> Yeah, I I slept like a king last night, you know, it was just crazy. And then, next door, remember that field that I talked about? I mean, you've been to my house. Yeah. They're they're digging the flipping ground. I was I I started looking at it and thought,

"Son of a you know?" It just pissed me off, you know, that Anyway, my wife um she's from she she's from Savannah, Georgia. She's like a she is a bulldog and you know, Georgia bulldog. But, she called the city and just started chewing people out because they had people big [clears throat] trucks up and down the street. No notice whatsoever that they're going to start the construction. Uh ended up contacting the developer and put our name down for the the three lots that are just next

to us. >> [laughter] >> So, you know, I'm I'm sure she's going to force me to buy three of them, but just a quick update there. I know. I know. Anyway, speaking about Georgia, we got some Georgia guys on the line today. Is that right, Jordan? >> Yeah, we do. Yeah, we do. Yeah, we have we have Davey Clay and Josh Smith. Both of them are partners in and owners in dental claim support.com, a service that we think is much needed in the industry. Davey and

Josh, how you guys doing today? >> Great, Jordan. Appreciate you guys having us on today. >> Yeah, how you doing, Jordan and Ben? We appreciate it. >> Hey, it's our pleasure. You know, I love I love the southern accent that you guys are pulling on there and I'm looking at your website and you have you have 912 phone numbers. So, are you are you in the Savannah-Augusta area? >> We are in Savannah. It's our our hometown. >> No way. >> Our Georgia Bulldogs did lose last

week. >> Oh, man. >> We did lose last week. >> Oh, man. >> podcast. >> [laughter] >> You know what really ticked me off is that I'm looking at the college rankings right now. The So, in the AP polls, they're number seven. Well, on on most of them, they're number seven, looks like. You know, and and good old Mark Richt is number two on the AP AP poll down in Miami. You know. >> [laughter] >> Ben, that actually gets me to a point. In your podcast

last week, you were talking to the AR Ninja and y'all used the term insurance bulldog and Josh and I have kind of taken that on. We are bulldogs and we are insurance guys. >> Hey, yes. >> Yeah, yeah. >> [laughter] >> Yeah. Yeah. Y'all got to work on that. >> [laughter] >> I'm going to edit that one out. I don't want to embarrass myself in front of the Jordan Nation. >> [laughter] >> No, you You've it, man. You've got to leave it. It will be good.

>> [laughter] >> Well, cool, man. Well, Savannah, my wife is from Savannah. We're down there What What do they call that right there? The river um >> River Street. >> River Street. Yeah, we go down there and they have some great seafood places there, too. But, love Savannah. That's probably my number one town in the US. I just love going there every year. Except for >> it, too. Yeah, born and raised here. So, it's a it's a good spot. >> Except for Yeah. There's one street

I was looking up on What's that food app? It used to be called Urban Spoon and I think they changed the name. >> Oh, yeah. >> Zomato. >> Zomato. I was looking on that and I found this restaurant that sold low country boil. It was 20 bucks, but it was like 5 lb worth of food. So, I called my father-in-law and said, "Hey, can you meet us at this address?" And it was like on Martin Luther King something. He gets there and I'm there already and

my wife is like, "Uh-uh, I'm not getting out of this vehicle." It is like in the middle of the ghetto. And you know, my my wife is Caucasian-American. She's Scottish Scottish redneck. I don't know exactly what you call her. She's got to something. >> Scottish redneck? >> But, she she's from the heart of Georgia, you know? She's a white American. I pull up to this place and I'm I'm brown. I'm I'm a big Samoan-looking guy and you know, I I I get there and I feel

like I'm at home, you know, in in the heart of the ghetto. And she's like, "Uh-uh, I When you get out, I am locking the door." So, I did and my father-in-law pulled up and the look [laughter] on his face. He's like, "You called us to this neighborhood?" He's like, "We're going to get lynched." >> [laughter] >> Oh, boy. >> But, that was >> guess that about the low country boil was delicious. >> It was. We My wife forced me to wrap it up. She's like,

"We're not sitting here. We're We're going home." So, we took it home. It was 20 bucks and it was literally 5 lb worth of food. Uh too bad I can't go back there. My wife told me I wasn't allowed to go back there cuz it was she just didn't feel safe, but but man, Georgia, I tell you there's so many different pockets of places where you can buy good quality food for cheap, you know. >> We're certainly spoiled by the low country boils and the oyster

roasts and everything we have. >> Oh, that sounds amazing. >> Oysters. >> Oysters, oh man. >> I'm having a low country boil this weekend for the Georgia Kentucky game, to be quite honest. >> [laughter] >> I hope I hope Georgia just comes and just completely demolishes Kentucky. Apologize to anybody in Kentucky that's listening, but uh >> [laughter] >> Yeah, yeah, do that. Do that. >> No, cool. So, so guys, let's let's get right to it and can you tell our audience how you guys got into

just starting Dental Claim Support? >> Sure, Jordan. Uh well, I was actually at University of Georgia and was a risk management and insurance major. Uh, so I ended up going to grad school and in the meantime I needed a job. So, the first job I received was at a dental office verifying insurance. And so, uh next thing you know, managing a practice and uh I hired Josh here under actually and uh so, we work for a group and the group wanted to start a group billing

practice. Our kind of a central billing location. So, we headed that up and ran that. And what we what we found out, we had eight or nine offices at the time, and what we found out that billing was being done we had the everybody had the same software, but yet the billing was being done differently in all eight offices. So, uh we developed the system, came up with that, and uh really nailed down a uh a way of collecting money from the insurance companies. So, that's

that's where we got started and we started going on our own and helped uh dentists around the country with with that. >> That's pretty neat. So, basically what you did is you created a service. So like these large DSOs they have a centralized billing location and I have a few clients that are large well large DSOs primarily solo practitioners that that kind of own it no private private equity and the numbers that they show me on a per practice basis every practice that comes in partners

with them it's quite amazing when they find efficiencies especially when it comes to billing. Like what are what are some of the things that you see you said that you saw things were being different from practice to practice in terms of how they billed. Can you elaborate on some of the examples that you're seeing that that you saw back then? >> Absolutely this is Josh now just every single practice again like David was saying was was being done differently you had you had adjustments being done

being posted improperly um uh different office managers slash billing coordinators that didn't understand really what in network meant versus out of network um and I just remember looking at David him looking at me and we were like we can kind of go out and do this our our own because we knew if we were only in eight offices and we saw that that the differentials in eight offices what's going on in the hundreds of thousands of offices throughout the United States. Um so I mean yeah

when when we saw that it was being done it was even it wasn't just the posting aspect and and adjustments and you know and making sure that fees were entered the right way it was also claim research. We saw that was being done differently. Sometimes there wasn't even any research being done it was just re-submitting a claim and the reason that claim didn't get paid in the first place cuz something was wrong with it. So just re-submitting it's not going to do anything. Um so you

know that's that's one thing we kind of found ourselves on and that's why we really we increased these numbers of every single office mean in the eight offices that we had a lot of them started out around the 85 to the 90 percentile and honestly that's not bad throughout the United States. It's usually around 91, but every single one of these offices ended up being at 99 to 100% when we were go when when when we were basically leaving uh the group that we were working

with. So, to Davey's point and to what he created, it it was a it was a standardized way of doing things and I kind of followed suit and I'm glad I got the opportunity to do it. >> That's pretty cool. >> Yeah. >> Is it pretty consistent in the billing policies >> for your state by state, meaning do you do you find that you learn you have to apply different policy in a new state like even for like a Delta Dental or is it pretty much

across the board everybody should be implementing the same billing practices? >> The system that we run is pretty standard. The only difference will be the fee capping depending on which state the office is in based on whether you can charge if a non-covered services is being charged. Uh whether you can charge your UCR fee or you have to go by the PPO fee on a non-covered service. Um so, that's really the only thing that changes per state when it comes to our system. Now, as you

know, there's Delta Dental for almost every state. There's, you know, different Blue Crosses. So, what what the difficulty of the insurance world is is always changing. So, every policy is always changing. Every plan is different. So, not one plan is like another or not one insurance company is like another. So, their their EOBs look different, uh the checks look different, uh the plans all look completely different. So, what we have to do is, you know, we're always learning stuff on the go as well. Policies are

always changing. Uh employers are changing to United Concordia, Delta Dental, or MetLife, you know. So, it's it's always a constant grind of learning and evolving with with the insurance companies and not allowing them to continue what they do and installing payments. So, that's our job. Uh and that's what we do is kind of not argue with the companies, but we're going to make sure that the dentist is getting paid for what they produce. >> Cool. Very cool. If you were to guess the the common pitfalls

for the average dental practice when it comes to billing, claims billing, or claims support in general, um what would what what do you think are the top three issues? Three things that maybe insurance most practices just need to stop doing. >> Uh number one would be data entry. Data entry is huge. Uh we see this daily uh in the many offices that we have, you know, we're all all through the all the different states, and uh it seems to be a common underlying issue. Uh data

data birth entered incorrectly, social security numbers entered incorrectly, ID numbers entered incorrectly. Um so that's that's number one. Insurance verification is number two. Uh not verifying the patients you know, the the patients don't necessarily know what they have and what they don't have. Uh they think they have all, you know, they get two free cleanings a year. We know that's not true. You know, it it costs money to get those cleanings. Um but verifying that they actually have what they say they have. You know, don't

take their word for it that I have Delta Dental, you know, which Delta Dental? You know, I need to know you know, we need some verification done there as well. Uh and then the other the third thing is just that claim follow-up. And what what we've have found is that that's not being done consistently throughout the country, honestly. Um that the off the office has a team in place or a person in place in their office, and maybe they're too busy doing other things. You know,

as you all know, talking to insurance companies is not easy. It takes time. It takes you're sitting on hold non-stop, you know, you're different websites and this and that, but um you know, what we've developed is that system to where we're not [clears throat] relying on the insurance company to give us incorrect information. We're going through and making sure that we're not just going to resubmit a claim if they tell us it's not on file. We're going to find out, you know, why is it not

on file? What can we do to get it paid sooner than later? You know, uh we're not going to let it go 30 days without getting a phone call asking, you know, why isn't this been paid yet? What's going on with it? Do Can I appeal it? What do I need to do? So, it's just those three things, though, are hindering offices from getting paid from the insurance companies. >> Got you. Thanks for the tips, yeah. Um I I got a question for you guys. So,

how do you handle uh denials? For instance, treatment treatment was necessary, but in- insurance denies the claim. >> Appeal, appeal. Um >> Appeal, appeal. How do you Walk us through that? >> literally appeal anything and everything. All insurance companies work a little bit different with appeals. Some have different Some have to mail, some you can e-claim, some you can reference the old claim number with a new narrative. But, you know, what we always try to tell our dentists is the more information, the better. If you

know you're doing an intricate case, write down a very intricate note. Um Note, kind of take advantage of that opportunity. Help your biller out in a sense. Um you know, we're we're in systems throughout the United States. Therefore, a lot of times with our doctors that, you know, really take it seriously, we can copy and paste a narrative and kind of, you know, scoot it on to the insurance company. But, in other cases, you know, you really need a detailed uh breakdown as to what happened.

And a lot of times, though, with with some denials, they're just denying it to deny it. Um I mean, I don't want to harp on insurance companies, but you know, sometimes they you know, that dental consultant might have gotten out of bed and and just didn't feel good that morning. Therefore, he he didn't want to process any claim. >> No, absolutely, yeah. >> You got to follow up on it. And you just have to stay on top of it. And a lot I would have to

say that we've got around a 95% appeal denial or overturned appeals. Um >> That's pretty cool. That's >> That's awesome. >> Because, you know, develop your templates. You know, make sure things work. You know, you have to Every case is treated differently, but, you know, stay on top of it and there are certain things that can be appealed that people don't know about. Um you know, you can have a uh fixed partial denture downgraded to just a removable. Um and when that happens, you know, office

managers, billing coordinators, everybody needs to know, send in a basic narrative, send in why that patient didn't want that removable. They'll need they have to process that. I mean, yes, it's an alternate benefit, but it doesn't say anywhere in that patient's plan that they can't have a fixed partial denture. So So, send in an appeal, you'll get you another $1,000. Um you know, these are things we try to stress throughout the dental community. You know, we don't we're coming on here to try to open up

doors for new office managers, realize that there there are ways you can kind of beat these insurance companies and and just play the They're playing a game with you, you got to play it back. >> Yeah, it's it's kind of interesting. [clears throat] I read um oh gosh, Melissa, this our latest episode, the one that we posted yesterday, we had Melissa back on the show. >> Yeah. >> And uh she she posted an article on her Facebook page, which was kind of interesting. It was written

by a Dr. Milton Packer, um a medical doctor, posted November 8th, 2017, on med medpagetoday.com. The interesting [clears throat] thing about this article is he I'll just summarize it for you. He was asked to lecture at a local meeting. I don't know exactly where where he what state he's in. Um so he went and there were about um 25 physicians in the room. Uh the the average age for the physician was he he guessed maybe above 70 years old. So it was an it was an

older group of physician. >> Above 70, you said? >> Above 70, yeah. And and after the meeting, he found out that they were all retired. None of them were actively involved in patient care. >> So yikes. >> Yeah. So he started to ask them questions, you know, why why are you guys here? And they said, [clears throat] well, we work for insurance companies. And you know, we we want to we want to know what the latest and the greatest is and and and Dr. Packer is

thinking, well, that's great, you know, they want to we can well we I can convince them that they need to cover certain drugs that keep on getting denied. Um but the interesting thing was is that they were there to learn how to continue to deny claims. >> Yes, deny [laughter] claims. >> Wow. >> Yeah. And this >> That's the name of the game to make a profit in the insurance industry. >> it's so interesting because in later in the article it says that their their main

focus as um medical insurance consultants, medical doctors that are insurance consultants, is that their whole goal is to deny claims in an effort to save the system. Like in their words they're saying, you know, we we have to save the health care system by forcing people to not use their insurance as often as as people are. And they actually get paid bonuses every time they meet um every time they meet a certain denial percentage, you know. So, this Dr. Packer just gets frustrated and walks out

of the room and he says that, you know, he he was the the lecturer, but that day he was actually the student and it was very eye-opening to him to kind of find out how the the the the retired doctors uh view medicine from the perspective of not being in the practice of submitting uh claims for patient care. So, anyway, what you guys do is pretty fascinating cuz I think I think more people in the industry need to pay attention to this issue. But I I

want to steer things in a different direction here. So, you have a business called Dental Claim Support. Um I have a ton of clients and I've I've recommended to them that they should they should be working with a company that does this for a living because I've seen the benefits uh I can name many many big big practices that most of the listeners know that use a third party to help with claim support. So, so give give to me like sort of the one of the

biggest reasons why or at least share with our listeners why it's important for them to consider an outside firm to handle claim support. In this case, dental claim support. >> You know, the a lot of people and and I would agree with Milton Packers statement that you know, you know, 100% that's what they're doing and they're always trying to find ways to deny things. And the and getting to your next point is that the dental office doesn't ever you know, most of them don't ever follow

up on those denials. So, the insurance companies are winning. You know, they're they're beating the the dentist because the staff isn't following up on those claims and on those denials. So, that's again the number one reason to outsource it to somebody that does this for a living. You know, because that's what we do on a daily basis. You know, and >> You guys have it down to a science. >> Exactly. And you know, and I would say to another point is don't wait too long. You

know, don't wait till your insurance aging report is unattainable. You know, when or you know, we get new clients and we're having to write off timely filings left and right because they waited too long. You know, and >> What what what's too long? Give us an example of that. >> Well, most I'll say most dental plans have a one-year timely filing limit on the claim. >> Okay. >> So, that means that if you haven't filed it and got it to them within that one-year time period,

you're going to have to write that claim off. Now, as you know, insurance companies are always changing and I think it's Emaritus now has I don't want to >> Yeah, anybody listening, the there's a 90-day timely filing at Reliance Standard, Emaritus, and most Medicaids throughout the United States. >> Yeah, most Medicaids do have a 90-day timely filing period. So, if you don't get that claim to them within 90 days or or follow up on it, you know, if you think you sent it to them and

you maybe sent it to the wrong person, you have some data entry problems and that validation error didn't go through the clear your clearinghouse, it most likely didn't get to them within that 90-day period and they're not going to pay on those claims. >> Have you >> So that's the big thing. >> Yeah, sorry for cutting you off. Have Have you run into a situation where that the office has been submitting, submitting, submitting and the insurance company says, "We need this, we need that, we need

this." The office already submitted that information and then the next letter they get was, "Oh, you've you've you've missed the window to submit the claim, the timely filing." >> Oh my gosh, that's what you were saying to us. >> Yes, we have. >> You know, that and that was one of the reasons that Josh and I got started was because one of the first very first offices that we got in, you know, the doctor said, "Oh, we don't need you. My My person here is doing

a fantastic, you know, a fantastic job." And we said, "Okay, well, let's take a look cuz your numbers are not where they maybe need to be." And what we found was the person, you know, the doctor would check in on the first of the month, their insurance aging report, and the person would just refile the claim and she would refile it five and six times at a time, you know, each. So every time the doctor would go to look the day before, they would just refile

the claim. So it'd go off into the aging report. Uh, so what I found was they weren't actually doing anything to change the claim, you know, they were just refiling the same exact claim with the same errors every single time. Um, so the insurance company still going to just They just denied it six times, you know, as opposed to getting the right information. Um, but yeah, you know, the the biggest thing with with that, um, Ben is is getting an NEA and having that NEA number,

the national electronic attachment number, so that when they say they don't have what they have, all you have to do is is give them that seven or eight digit number and they can pull that straight out of their system and say, "Oh." You know, and that happens all the time. We never got what you sent, we never got what you sent in. You say, "All right, check this NEA number." Oh, automatically they found it out of thin air in their system. So when they say they

don't have it, most of the times they do. You just got to know how to get them around to find it. >> Yeah, I I like that. I think [clears throat] I think you kind of overlooked that we even with, um, some previous podcast episodes how important that NEA number is. So thanks for hitting on that. I totally agree. >> I've seen Yeah, I've never heard that before, so. >> [laughter] >> In most office managers, when we ask, we kind of do a little orientation with

them and we say, "Are you using you know, what clearinghouse are you using? And are you using NEA?" And when I get the I don't know what NEA is, that kind of scares me that that that they're handling the claims for that office and they and they don't know about sending claims electronically or they don't know who their clearinghouse is. And you know, that's the clearinghouse is the middleman that's getting you paid or that you're sending your claims through that's dispersing those claims to the insurance

company. So, knowing the ins and outs of your clearinghouse and knowing how to use NEA are going to significantly increase your collections. >> Yeah, thanks for that explanation on um on the NEAs. I think that's that's very important. Um what about secondary claims? I excuse me, secondary insurance. How how do you deal with that? What's your policy there or ideas? >> Uh well, I mean, secondary insurance is it's more and more common in every single office now. You know, for a while, most people just had

a primary plan, but you know, recently, it's more and more people are going to have dual insurance and some people even have tertiary insurance, which is pretty crazy when it comes down to it in the dental world, but I mean, you just have to stay on top of a lot of times you can get a little bit more reimbursement. Um when you send it to secondary insurance, you always need to include the primary EOB whenever you're sending in a secondary claim. Um every secondary claim, regardless

of what primary paid, is going to make their own determination based off of the claim itself. Um you always need to send in attachments. Uh if it's a major service or any other service that needs attachments, send them with it. Um but you do see how you do see more reimbursement. You know, it does help a patient out uh depending on you know, what their premiums are and whatnot. All that can be broken down, but it does help out patients to have dual insurance. Uh mainly

when it comes to frequencies, um you know, you can get that third cleaning in a year. You can get that third or even fourth cleaning or examine a year because that's when your secondary insurance will pick it up. Primary is usually only going to pick up two of those in a given year. So, that's when it does help. Um and but one thing to understand about secondary insurances they're not always just going to one one of them pays 50% of the claim, the other one pays

the other 50% total in for the total amount paid. They have what's called a non-duplication clause. Um and most insurances have this non-duplication clause. So, uh I know that um when it when it comes to fee schedules being put in and um insurances if you're participating with insurances, one's going to have a different fee associated with that procedure than the other. Sometimes, you know, one's just going to have have a smaller fee. They're only going to pay, say, you know, on a crown 50% um of

that fee. You know, so if you're sending in a $600 crown and Delta Dental's your primary, they're going to pay $300. Uh if Guardian's your secondary and they have a lower fee, they might not even send you anything because Delta already sent $300. So, if Guardian's fee was lower and they only pay, you know, $250, they already think that Delta's paid or they know that Delta's paid more than what they would have already. It's kind of it's difficult to explain on a phone call. With that

being said, um non-duplication is a big deal and I think that's where there's a there's a misconception with uh patients. They just think, "Oh, I've got dual insurance. It's all going to be paid." But it's that's not always the case and it's up to the office um to kind of, you know, patient educate. Let these Let these patients know exactly um what what what their ins- what their insurance constitutes and what they can expect from it. >> Yeah. So, so basically in your example there, 50%

that $600 amount the policy for Delta's 50% coverage. Um let's say Delta pays 200. And Guardian's uh policy also says 50% coverage. So, what you're saying here is that Guardian will will likely default to their fee schedule when they process their portion of that that $600 bill. Is that Is that what you're saying? >> You got it. They're going to They're only going to base their coverage or their payment off their own fees. >> So So >> So, if they have a lower fee schedule and

Delta Dental's paid 50% and Guardian has the same coverage at 50%. Um and Delta Dental's, you know, you got a higher fee, Guardian might not send you anything because they're like, "Oh, you already received 300. We would have only paid 275, so we're not sending you anything." >> Got you. >> That's the non-duplication clause. >> So, the key The key >> that's where you come in. Everybody wants higher fees. >> Right. Yeah. >> Exactly. >> Yeah, we'll we'll we'll kick the insurance companies in the ass

for you and get them a higher fee there, but >> [laughter] >> key question here. So, let's say that Let's say if Delta's 600 Delta's in the primary position, they pay 200, Guardian pays zero because their crown allowed amount is 400, you know? And so, they think that the 200 that was paid was sufficient, you know, that that that covers their 50% portion. What what what does the office Do they Are they entitled to collect another $100 extra on top of, you know, the other 300

In In this case, 400 from the patient to balance bill it up to 600 or >> No. Uh by law, uh you have to take If you're in network with both of these insurance companies, you have to take the lower of the fee schedule. >> Got you. >> So, that patient would get that extra to the $400 Guardian fee. So, that's when that, you know, additional insurance would actually help the patient. No, Guardian's not making a payment, but there is going to be a write-off to

$400 as opposed to the write-off only to $600 for Delta Dental. >> See, I thought I knew this, but I'm I'm glad I'm talking to you because this Just this reinforces the um the expertise. I mean, I I'm in insurance every single day, but I hear so many different things uh from office managers and from uh insurance companies as it pertains to the question that I just asked. It In my opinion, I I always thought that if you're in-network and the insurance carrier chooses to use

a lower fee schedule, well, their fee schedule, there's really not a whole lot you can do unless you negotiate that fee. So, you've just completely um answered a question that has been looming in my head for the last 10 years. You know, I probably had the answer before, but you know, this is the reason why, folks, you need to talk to people like uh like uh Dental Claim Support is simply because there's just so many things you think you know that are probably not 100% correct.

So, thank you, Justin and Dave, for for sharing that. >> Yeah. Yeah, so cool. So, I got a question for you guys. Uh sounds like you guys do a lot, you know, when it comes to service uh for dental practices. Do you guys replace um current staff members when a practice signs up with you guys? >> [clears throat] >> We honestly like to say that we don't. Um now, the the practice needs to have some similar sort of front desk. You need to be able to

to be patient-focused. You need to be able to enter in insurance. And And again, we like we said, data entry. Make sure patient Make sure the patient flow works. But other than that, yeah, we pretty much handle everything else. You know, we're making sure those that uh claims get to the insurance. We're making sure they process. We also post payments. And we do your insurance aging report. That is what takes up the most time in an office. So, you know, what we always like to say

is that you know, we're here to take time take that other time away from from from the office manager that's in a sense wearing too many hats. >> Yeah, they're spread way too thin. >> and too much. Uh it it's it's really helped our our our main testimonials, and the good ones are people that kind of they pretty much hit on why we started this. We have been in the office. I've been an office manager. I've also been in in a centralized billing department. I know

the both the uh the best of both worlds. And what happens is a lot of times that phone is ringing. That uh A is in front of you. You're You're presenting treatment to a patient. You're explaining insurance to a patient. You don't have the time necessarily to be calling on all these claims. Not to mention when you're on hold for 30, 45 minutes to get something done. So, that's where we come in. And it's also again done at an expert level and it's done daily. And

another thing that happens with an outsourced billing company such as us, we work when you're not there. Um you know, if you got internet going on at your office, we're logged in and we're working. I mean, it's it's just that's just the way it works. And just because you're off doesn't mean the insurance company is closed. And we're able to call on claims. We're able to still collect money, post money while you're away at vacation having a good old time. So, that's that's another benefit of

what we do. And it's not just one person. When you go with Dental Claim Support, you're going to have four or five different billers billers on your account any given day. So, >> Yeah. I I like that. You get a lot more support in my experience using a company like yours. Key key question about in-network versus out-of-network. So, we have clients, many of them, that are exiting PPO participation. >> Likewise, yeah, we have those, too. >> They're going out-of-network. And what we see, like a good

example is MetLife. To me, MetLife is one of the easier plans for for offices to go out-of-network with. But we have a friend up in Pennsylvania. Uh she dropped MetLife and the claims are just crazy different. I mean, they're they're not what we've we usually see. For instance, one of the EOBs came back and says that the patient had a $25,000 annual maximum. Um the allowed amount on the cleaning didn't reflect what the office billed. It was a completely different allowed amount. Uh and then there

were and then the percentage coverage, of course, was based upon that allowed amount. And I've never really seen that with MetLife in the history of offices being out-of-network with MetLife. You I'm sure you see these things from time to time as well. So, what so so when you have offices that you're working with that are transitioning out of network, do you see irregularities that could possibly be a mistake in how MetLife may be processing those EOBs? Does that make sense? >> Yeah, it does make sense.

And uh these plans, they're all plan specific. It's not necessarily MetLife doing the wrong thing or processing the claim incorrectly. Um again, a common thing that that that a lot of patients don't understand is they go, "I have 100% coverage for my preventive work." But that's just 100% of that plan's allowable. So even if you're not in network >> It's confusing. >> Yeah, MetLife could you know, just take it this way. Their allowable is $60 for a cleaning. You're not network, you charge $100 at your

office. That patient's going to come out of pocket $40. But to them they go, "Oh, well I get 100% uh coverage on preventive work, which is my cleaning. I shouldn't owe anything." And you go, "No, they only pay off their own allowable fee." Does not matter if you're in network with them or not or if you're if you're not network, they're still going to pay off their own fee. Now again, again it's plan specific. Some employers might purchase a better plan. They might pay a little

bit more for the plan and that's when MetLife might have a higher allowable based off an out-of-network fee or if you send 100, they might pay 95, they might pay all 100. That's when it all depends on the zip code where you are. Um you know, and that's again where you would come in more of it. It's just one of those situations. So yeah, it's it is it is plan specific. >> Got you. Yeah, thanks for Thanks for clarifying that. It It's just interesting to me

that uh a a practice in New York City dropping [clears throat] MetLife and then a practice in Chico, California dropping MetLife and they can they can see two completely different things on how the claims are paid. Um so so the employer specific plans that are drawn is usually a result I I I I guess the the leading factor as to why the claims are different from state to state to state is what you're saying. >> Correct. You got it. >> Cool. Thanks for clarifying. >> Awesome.

Yeah. >> Yeah. So, [clears throat] uh do you guys you guys offer like consulting or training services for the practices or do you guys do it on house and don't do you help them educate get educated, I guess? >> We do. That's part of our little claim support aspect, you know, it's the first thing an insurance agent reports and we have a little claim support. Um and you know, we do we help out with that. Listen, if if if we can help the office to understand

how to put patients in the correct way and understand, you know, what needs to be done on their end, it only makes our jobs easier, too. And it's peace of mind for the doctor. They're collecting what they're producing. You know, they've got 100% collections. Everybody's happy. We've seen these doctors implement bonus systems, uh create another operatory because they're doing so well. We've had offices that have bought another practice and been like, "Hey, I'm so thank God you guys are here because now you all can just

take over my billing at square one." So, it it's it is important. You know, we we do need the front desk to to be held accountable for certain things, but yeah, absolutely. We work absolutely directly with the front desk, but if we do see that things aren't going along the right way, we definitely let the doctor know. I mean, this is the doctor's business. Let's Let's Let's be honest about it. They They're They are business owners. Um and >> Yep. >> most dentists don't have a

business degree. Therefore, they might need a little bit of extra hand when it comes to running the business. So, they're they're going to need that help. Absolutely. >> [clears throat] >> Cool. >> Awesome. >> And And I'm assuming you're all you're HIPAA compliant and all that, you know, with in terms of if an office wanted to reach out to you. You're You're You're good to go there as well. Um >> Absolutely. Yeah, that's that's all covered in contract and the whole nine yards. >> Number one

being [clears throat] HIPAA compliant. >> Do Do guys Do you guys affiliate with with patients? For instance, um call on statements and things of that nature if there is any you know, any any type of patient communication involved? Do Do you do any of that? >> We don't, Ben, and that's kind of, you know, we what we opened up with was the insurance bulldog part. You know, they are an You know, he he can, you know, they handle the patient side. Our main focus is that

insurance side. So, you know, that's that's where we are experts and that's where we're going to come in and really hammer down and get get your aging report under control and get your system in in line. So, no, we And that's where we come in with the team with the with the front desk and, you know, train them on what they should be collecting up front and how to collect that money from the patient. >> Yeah. No, I think that's Oh, sorry, Ben. >> No, no,

I like that. I like that. >> So do I. >> Yeah. >> [laughter] >> Go ahead, Jordan. Go ahead. >> I I was going to say I think it's always important for the staff to maintain a good relationship with the patients and and and the insurance companies are the ones that need to be, you know, put in line and and and uh supported with the service like what you guys do. So, I think it's awesome. Sorry, Ben, you can you can talk now. That was that's

what I wanted to say. >> No, no, I I was going to say I I I like that, too, because there are some some groups that do patient communication. And >> [clears throat] >> often times what you're telling the patient and then what what the office doesn't know, it kind of causes conflict on their end. >> Absolutely. >> In terms of not being on the same page. So, I think that's pretty cool. That's a that's a unique policy that you have there. >> Yeah. Cool. Well,

you guys this has been this has been such an awesome episode, I think. You guys what are what are some final thoughts you guys may have for our audience about about your service and what what you guys can do to help them. >> I I don't know. I think one thing that we'd like to just kind of share is we've been there. We know that insurance can get you bogged down, but and insurance can be very intricate and it might only get more intricate as we

go, but there are ways to beat insurance companies, and I think we just want people to know that there is light at the end of that like insurance tunnel, so to speak. There are, you know, there are ways to to to combat what what we deal with daily, and we can help offices do that, and you know, sometimes you look at an age report and you're like, "Wow, there's no way. I There's no way I can do this." But, you know, sit down, grind it out,

make it happen, and everybody ends up being happier. >> My biggest thing would would be to tell all the dentists listening or and office managers to to run your insurance age report numbers. Uh run your over 30 day, and then divide it by your zero day, and we want the number to be around 10 or 11%. You know, uh when we when we get new clients, you know, they're at the 60% range. They're at 80% range. Uh and we we you got to be in that

10 10% range over 30 days. Only 10% of your claims should be over 30 days. And don't wait till they're, you know, over a year old to start calling on them, you know, cuz you're not going to get those paid. You got to get You got to get those claims paid, and you got to call on them to get to get them paid. So, that'd be my my advice is is run your numbers, know your numbers, and uh and don't wait too long. >> Yeah, you're

the dentist. Take control of your practice. >> Cool. >> Yeah. >> You're producing 1.5 and say net production of 1.2 due to some write-offs, don't be happy with just collecting a million dollars. I mean, a million dollars on 1.2 is 83%. That's not a good rate. You're You're You're leaving $200,000 out there, and yeah, you're still collecting a million dollars. That's a lot of money, but now, you you can you can do a lot better than that, you know, be willing to change, and kind of

take control of the situation, understand your own numbers. >> Cool. Love it. Hey, two things real quick here, uh Davey and Josh. Uh can we share your contact information if anybody's interested in reaching out to you or want to learn more? >> Uh sure. >> Go ahead. Go ahead. >> Our number is 912 355-6100, and our website is dental claim support.com. I can be reached at dclay, d as in David, c l a y at dental claim support.com. >> Awesome. Excellent. Thank you guys. And then

so what we will post that information in the show notes as we always do for our for our guests. So if any of you are driving or listening and you you want more information, one nice thing about their website is that when you go to dental claim support.com, you can go to the filing tips and there's a bunch of great resources there. How to appeal a claim, protect your dental office from fraud, the benefits of outsource outsourcing your billing, how to avoid delays and denials, things

like that. Questions that we get on a daily basis that I think these two are better equipped to answer. And then the last thing I I I this is just a fun request. Georgia Georgia scores a touchdown. >> [snorts] >> They >> [laughter] >> you know, it's it's kickoff time, you know. They kick off the ball. Can you give us your best Georgia Bulldog bark? >> [laughter] >> Oh man, I guess we kind of have to. >> Okay, so that that was that was that you,

Josh? Or was that you, Davey? >> It it was. It was. >> Okay, so so we want one from we want one from both of you at the same time. You ready? >> [laughter] >> Oh man, you're putting us ON THE SPOT. >> TOUCHDOWN. >> I'M SAYING GO DOGS. >> Go dogs. >> [laughter] >> How's that? >> [gasps] >> What Hey guys, thank you so much for being on the show today. It was fun and yeah, we'd love to have you guys on again if you're

interested in that. >> Absolutely. >> But in the meantime, we we want to highly recommend to our listeners to reach out to you both and Uh uh hope that the Georgia Bulldogs have a great rest of 2018 and a great Excuse me, '17 and a great 2018, but [laughter] uh thanks again, guys. Thanks for being on the show today. >> Yeah, thanks, guys. >> Yeah, we really appreciate it. >> Thanks a ton for having us. We really appreciate it. >> Thank you. >> [music] [music]