Special Considerations and Tricky Situations

1. A common misunderstanding for patients is that there is no need for a consult or evaluation.  It sounds like the referral has told them they have all they need for surgery.
   1. For these questions, consider the language:  “ I understand that you saw your dentist for this issue.  It is important to have a pre-surgical consultation with the surgeon prior to scheduling surgery or anesthesia.  This is necessary to ensure proper treatment and protect your safety”.
2. Quoting fees – Billing told them to quote the range of $200 to $500 for pathology due to costs being determined by the length of time spent with the surgeon.  This leaves a lot of room for questions.
   1. Regarding the cost of office visits/consultations:  “Office visits range from $200-$500 depending on the complexity of your case and the amount of time needed to properly evaluate your concerns”.
3.  Fee for D9612 and explaining to the patient about what this involves and if this is necessary or required.
   1. “Additional medications are often used during surgery for prevention of swelling, infection, or other conditions.  When these medications are required and administered during surgery, there is a fee associated with it”.
   2. 9610- $175; 9612- $360
4. Fee of 99070 and what this is for.
   1. 99070 is a code for special equipment, supplies or materials which are necessary for your treatment.  The fee for this is $69
5. Fees for 3rds they quote $200 and if it is $180, patient is happy.  Is this acceptable?
   1. A consultation for most office visits that are dental in nature is $180.  Other consultations (medical in nature, complex) start at $200.  It is acceptable to overquote if unsure.
6. After 3^rd no show, collecting down payment.  Sometime and sometimes not.  What should they tell the patient?
   1. Habitual no-show patients should be handled by the PCC
7. Why we don’t take the medical insurance but yet they have been referred to us by their doctor for pathology?
   1. In oral surgery, some conditions are considered dental in nature, and some are considered medical in nature.  We are network providers for numerous dental plans, but remain out-of-network for medical insurance plans.  We can help you with filing claims to your medical insurance as needed.
8.  Consults same day surgery – referrals often tell the patient surgery will happen.
   1. In cases where a patient is scheduling same-day surgery, we can often accommodate this request. It is dependent on several factors including the complexity of their case, their medical history, and other factors.  Sometimes, surgery cannot be done in the same visit. While same day surgery can be planned and anticipated, the final judgement call regarding the safety and appropriateness of proceeding with surgery on the first visit is reserved for the doctor.  This can be communicated to the patient upon scheduling.
9. Prebooked surgeries before consult - sometimes this is done by the office and pushes other appointments further out.
   1. If the office schedules a patient for both a consultation and a separate, later surgery appointment, it is at their discretion and is appropriate. There is no reason to anticipate that a pre-booked surgery appointment is not going to keep.
10. Explaining OOP at consult and surgery costs and how they are different.
    1. There is a charge for consultation and any diagnostic services at the initial visit.  Often, there is insurance coverage for these services, but not always.  The surgery is a separate service, and carries it’s own associated fees which will be estimated and communicated in advance.
11. How to handle the referral office when they are pushing for same day surgery and the office tells us that the patient will call back to pay.  Many times they do not call and it is doubtful that they were ever told.  Sometimes the patient is not even aware that they were planning to do same day surgery.  We may need help from Melissa.
    1. If the patient is present in the office when the referral calls to schedule the appointment, it may be appropriate to have the patient on the phone to communicate.  If not, then send a message to our in house call center to have them reach out to these patients to make sure they have pre-op instructions as well as information about any surgery deposits due.
    2. Melissa can communicate with referring offices about scheduling same-day treatments.
12. If a patient is pushing for information about the cost of treatment, we can give them some very general information, limited to a range of UCR fees for removal of 4 3rds only. Use with discretion.
    1. “ Every patient’s surgery is different, and the cost of surgery and anesthesia varies based on the complexity of the treatment, position of the teeth, how many teeth are being extracted and more.  In addition, every patient’s dental plan covers treatment differently.  I cannot provide an exact fee estimate, but I can tell you that for most patients, the total cost of wisdom teeth surgery before any dental plans come into play can range between $3500-$5500.  These fees can vary widely case by case, and your estimated financial responsibility is determined by your dental plan.  If you need a detailed estimate of cost, and how your dental plan will contribute, we recommend coming in for a separate consultation where you will receive a detailed treatment estimate”.
    2. Alternatively:  “ I cannot quote an exact fee for treatment, but I can connect you with the doctor’s treatment coordinator, who may be able to give more information”.

13.    If a patient or referring doctor calls and says their patient has an urgent need, please connect with the PCC to get them scheduled as an add-on.  If you cannot reach the PCC, connect with the in-house call center or check-in.

14.    Always try to connect with the person in the office that you need via teams for simple communications. If you need to transfer a call and they did not pick up, teams message them. They will not always be able to pick up the phone if they are in the middle of working with a patient directly, but they can often respond via teams or at least receive the information about an urgent need.  If you cannot get the PCC on the phone, you should try our in-house call center or check in.