July 8, 2025 • 38 mins
Claims keep getting denied? Here’s a hard truth: it’s probably your fault. But in this episode, Dr. Travis Campbell shares everything he's learned about how to master the insurance game, get your denial rate under 2% and stop wasting hours on appeals.
His insights cover everything from the common reasons SRP claims get denied to the simple step that makes crown approvals almost automatic. We also talk about what insurance reviewers actually want to see in claims, how to avoid surprise patient bills, and what every out-of-network practice should have in their office.
Topics discussed in this episode:
- Why practices are going out-of-network
- The biggest reason claims get denied
- Perio protocols and insurance strategy
- How to overcome the AI problem and get claims approved
- Tips for dealing with insurance reviewers
- The foundational restoration code
- How to reduce crown denials
- Metrics you should track in your office
- How to calculate better estimates
- The Dental Insurance Guy membership
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Paul Etchison (00:02):
I can't believe I'm about to say this, but it is
time to stop blaming theinsurance companies, right, I
know, but in this episode, drTravis Campbell is going to
explain to us why most denialsare actually caused by us, the
dentists.
He has a ton of insight intohow insurance reviewers think,
what they look for in claims andwhat we can do to drop our
(00:23):
denial rate to just under one or2%, and this will help you,
whether you're in network or outof network.
I learned a ton during thisinterview on how to play the
dental insurance game, and Iknow you will too, so don't miss
this one.
Let's get into it.
You are listening to DentalPractice Heroes, where we help
you to create a team andsystem-driven dental practice,
(00:44):
one that allows you to practiceless and make more money.
I'm Dr Paul Etcheson, a dentalcoach, author of two books on
dental practice management andthe owner of a five-doctor
practice in the south suburbs ofChicago.
I want to show you how beingintentional about ownership can
create a practice that supportsyour life instead of consuming
it.
So if you're ready to create atrue business that runs without
you, you're in the right place.
(01:05):
Let's get started.
Hey, welcome back to the DentalPractice Heroes podcast.
Thank you so much for tuning inwith us today.
I got a great interview.
A repeat guest multi-practiceowner down in Texas Got Dr
Travis Campbell on and you mightknow him as the dental
(01:25):
insurance guy he is the one thatyou might have seen on Facebook
that if somebody asks insurancequestion he's got a very
knowledgeable and comes from aplace where he knows what he's
talking about.
And, oh man, is there a lot ofpeople that don't know what
they're talking about?
It seems like, or we're allconfused.
So we're glad you are in ourindustry, travis.
Welcome to the podcast man.
(01:46):
How's things going today?
Travis Campbell (01:48):
Well, thank you , paul, things are going great,
great yeah, and would you agree?
Paul Etchison (01:52):
there is a lot of confusion around insurance.
Travis Campbell (01:56):
Absolutely.
I mean, insurance is complexand I don't think the insurers
really go out of their way tomake it any easier for us, and
unfortunately there's a lot ofmisinformation out there, so it
can be daunting for people.
Paul Etchison (02:11):
How did you decide that this was something
you wanted to get really intodeep?
How did this happen, where yougot, maybe found yourself into
it very deep?
Travis Campbell (02:20):
Well, when I first started, I owned a
practice, I did a startup, andhow we get paid is a big part of
our world.
It, you know, for lack of abetter term, it ticked me off
Kenwood and so I had to findanswers.
So I looked all over the place.
I found answers that did notmake sense or did not actually
match the information I couldfind, and so that's what got me
(02:44):
to look into it is.
I couldn't find anything good,useful, and so I started reading
contracts and researching statelaws and what we can and cannot
do and what the insurers canand cannot do, and then a lot of
people just start asking mequestions about it.
Paul Etchison (02:58):
I feel like there's a big push right now.
I see it on the internet withDelta, where a lot of people are
going out of network.
And I have dropped Delta andyou know it was the right time
for my practice.
We were at capacity where weneeded to do something with our
capacity and all we could do wasthin our herd.
So we got rid of our lowestpaying plan.
But I can tell you, I stillhave Delta patients and I'm
(03:22):
still working with insurance andI think a lot of people think
that you get out of network, youdon't have to worry about that
anymore.
What have you seen in theindustry?
Travis Campbell (03:30):
So I mean it's an interesting trend because
pre-COVID 95% of offices were innetwork with at least one
company, delta usually beingthat one company, I would say.
Now the number is probably moreabout 90%.
So number of out-of-networkoffices have more than doubled.
The interesting trend is I'mseeing that people are starting
(03:51):
to, instead of drop Delta last,actually drop Delta first
because of their fees thataren't increasing.
Well, at least with umbrellas.
All the other companies areplaying ball.
So that's been an interestingkind of flip in the industry.
Paul Etchison (04:06):
Yeah.
So if someone's getting out ofnetwork, and whether in or out
of network, how can we play theinsurance game better so that we
can be reimbursed more?
Travis Campbell (04:16):
Well, I mean, the number one thing is realize
you know there's a lot of thingsinsurance companies are at
fault for.
The one biggest challenge I seeis, you know, does complain
about denials and honestly, inmost cases the denials are our
fault more than the insurer.
So we've got to understand ifsomething's just purely not
(04:36):
covered, you're going to get thedenial and you're going to have
an upset patient if you didn'tunderstand at the front end that
it was just never going to getpaid to begin with, because it's
the surprise bills that causethe most upset ever.
So it's learning.
Either, you know, get goodverification, get good breakdown
of benefits so that you don'thave these surprise bills and
you can give your patient a goodestimate in or out of network,
(04:59):
and then realizing for servicesthat are covered, making sure
you document in a way that theinsurer wants.
Whether or not you like the waythe insurer wants, it's a
different story, but document inthe way the insurer wants and
then you don't get denials.
I mean crowns, scaling and rootplanings are probably the most
common complaint that I ever see.
And yet most claims I seethey're denied because I get
(05:19):
them sent to me every day almostand I saw why they denied it,
sent to me every day almost andI saw why they denied it.
So you kind of see it from bothsides and realize if you want
to win the game you just have tolearn how to do a little bit
better documentation, whichclinically takes an extra like
60 seconds, and then you justavoid the denials to begin with.
Paul Etchison (05:36):
Now, when somebody gets a denial, I mean
we'll often if practice ownerssometimes we've got to write the
narrative.
I mean these are things that myteam does for me.
I signed them, but I rememberin the beginning this was
completely foreign and new to me.
And it go through the process.
We do two quads, then we havethem back two weeks later and we
(06:13):
do the other two quads and thenmaybe it takes another 30, 60
days for the claim to recloseand come back or get denied.
And now at this point we're sofar removed from that procedure
that we're saying, okay, well,maybe the insurance is going to
make this look like this was ourfault, that it wasn't a
necessary treatment, and thatwe're now over diagnosing.
So now we've got an upsetpatient and now I'm going to
think twice next time.
(06:33):
I think somebody's perio,that's not perio.
So what advice would you havefor dentists in that regard?
Travis Campbell (06:39):
I mean, you probably hit the nail on the
head of probably one of theworst things that insurance
plays this game with is, yeah,it makes dentists second-guess
themselves on completelylegitimate procedures.
And so you know, if you look atthe most conservative approach
AAP, ada, say what 70 to 80% ofadults have perio or some form
(07:01):
of perio.
And yet if you run by allpractice management softwares I
mean they all say the same thingis practices tend to only treat
about 6% of their patients.
Well, let's say, every patientthat doesn't show up in your
office has perio.
So of the ones that do show up,it actually ends up being about
40%.
Is what an office should betreating with something other
(07:23):
than a prophy.
Now, that could be be morefrequent, or it could be SRP or
whatever.
Well, there's a huge disconnectbetween 6% and 40%.
And so what are we doing to thepublic?
I mean, we're not treating oneof the most rampant diseases on
the planet Well as an industry.
That's kind of a horrible thingon our end.
And yeah, insurance has a bigplay, because if you can't get
(07:46):
your SRP claims paid, thenyou're going to second guess
whether or not you're going todo it in the first place, which,
yeah, I mean, is a huge problem.
I can say we do about 300 quadsof SRP a year.
We get denied on maybe one ortwo of them, and those one or
two the patient's already paidbecause we already knew it was
going to get denied.
We were just trying to see ifwe could push the envelope a
(08:07):
little bit.
But it's all documentation andit's completely different now
than what we were doing 15 yearsago when we were getting all
the denials.
Paul Etchison (08:18):
Yeah, that's amazing Because I feel like I
mean, I'm just all anecdotal itdefinitely is more than two
quads or two patients at myoffice.
It's a ton of them.
I mean, we have a box.
We have a box for denied SRPclaims.
We have enough of them tocreate a box.
So what is the documentationthat we're missing out on?
(08:40):
And what's reasonable?
Because we all went to dentalschool and we've all filled out
a perio chart.
And what's reasonable?
Travis Campbell (08:58):
Because we all went to dental school and we've
all filled out a perio chart andwe've filled it out to dental
school guidelines doing FGM andbleeding at sites and all these
things.
And you can spend a lot of timecoloring a perio chart.
So what is the say?
We all and that's the sad partis actually most of us don't
document.
According to the way that atleast most dental schools teach
it, 90 plus percent of theclaims I see denied that come
across my reports.
There's no general margins,there's no bleeding.
On probing, I mean there'snobody who would say that's
(09:19):
adequate and yet it's such acommon thing to just put in
pocket depths.
I'm sure you know the same.
You can't diagnose on a pocketdepth.
You have to diagnose on trulyclinical attachment loss.
So that's the first thing ismake sure you actually have a
complete chart.
The second is photos.
I mean I don't know about you.
When I first started, internalcameras were expensive.
(09:40):
They were four or five $6,000 apiece.
But now they're a few hundreddollars a piece and you can have
them in every operatory and youcan use them for literally
every patient and photos make amassive difference.
I mean that's the biggest thing.
What's better than anynarrative you could ever write A
picture, and then the lastthing is to realize most claims
(10:01):
nowadays, at least the firsttime it's sent, is completely
processed by an AI, and for mostof the major carriers it's
processed by an AI that'sreading your x-rays, and so
there's some subjectivity toprobing.
There's some subjectivity toeven angulation on the x-ray and
there's subjectivity in whereyou start that measurement, from
(10:24):
the CEJ to where's the level ofbone damage, and so you're
going to have issues with that.
If you have a lower end orearlier stage case, your
narrative has to be that muchbetter and you probably should
be circling and marking up thatx-ray to show what it is that
you're seeing.
(10:44):
I mean, in some cases you'vegot to realize these reviewers
the information they get is notnecessarily the same quality as
the information we send out,because we send all electronic
claims but they get theresolutions removed.
Sometimes they're printed andthen copied.
I mean they get all sorts ofcrazy stuff, and so sometimes
it's just not better data.
How many of these?
I mean they get all sorts ofcrazy stuff, and so sometimes
(11:04):
it's just send that better data.
Paul Etchison (11:05):
How many of these ?
I mean, is it normal that we'retalking to like that initial,
like that they're going to reachback out and say we need more
information, or they're going tosay they deny it and you're
appealing, Like is that a normalprocess or is that an
indication that we aren'tsending the right information
the first time?
Travis Campbell (11:22):
I mean that's a great question For crowns.
In most cases I say it's notsending the right documentation
to begin with For SRPs, unlessyou have an AI in your office
that is actually doing themeasurements for you and you can
send that.
On the claim, then I would saythat, sadly enough, a lot of SRP
claims you're going to expectto have to deal with.
(11:43):
One appeal you're going toexpect to have to deal with one
appeal.
Paul Etchison (11:45):
So how do we balance the?
I mean, filling out a fullperio chart like we did in
dental school takes time andtaking a lot of photos takes
time.
How do we find that balancebetween what should we do on
every single patient and whenshould we do it versus?
Are we just doing too much forthese outliers that may just get
denied every now and then andjust deal with that?
Travis Campbell (12:07):
I'm very process driven.
I like efficiency, I likethings that are easy.
So the way we look at it islet's find what the worst
insurance company to work withis, find the level of
documentation they want and thendo that for everyone and
therefore you never have tothink about it.
And then do that for everyoneand therefore you never have to
(12:27):
think about it.
And the documentationrequirements yeah, they take
extra time but, like I said, forCrown it's maybe an extra
minute, for SRP it's maybe anextra five minutes, but then you
save your front team hoursworth of work and you get your
collections and you don't dealwith pissed off patients and
everything else.
So it's just keeping somethingthat's simple for the team.
When you're dealing withdenials every week or every
(12:50):
month, then, yeah, it's worth itto change and you have a box of
them.
Yeah, but the difference betweena little bit better at
documentation, which and let mego back to say this is always
entertaining, because I havepeople that ask why are we doing
this for insurance?
Technically, actually, you'renot doing it for insurance,
because what happens when thepatient comes back and says well
(13:11):
, doc, my tooth didn't hurtuntil you touched it.
Correct level documentation,you put up the picture, the
conversation ends.
I mean, it's a no-brainer.
Show the decay, show the damageWith SRPs.
Honestly, patients aren't goingto really understand most of
what we're dealing with on thatend.
But if you ever have amalpractice claim or a state
board complaint, that level ofdocumentation is going to
(13:34):
protect you far better thananything else.
Paul Etchison (13:37):
Yeah, we just had one of my associate partner.
She had to be part of adeposition.
She was not the dentist beingsued, but she was the second
opinion one of the otherdentists that the patient had
seen afterwards and she had saidthe level of documentation they
were asking and the detail thatthey went through her notes
(13:57):
line by line, was it scared thehell out of her.
And she said I think we need todocument way more than what
we're doing.
And after hearing her story ofwhat they were asking her, my
God, like I'm looking at mynotes, being like man, I hope
nobody does anything to mebecause I don't think I have
this level of documentation andI think I don't know if this is
right.
But I think, like the numberone lawsuit is is it undiagnosed
(14:22):
perio?
It's up there, yeah.
Travis Campbell (14:24):
Depends on what year you're looking at.
It's almost always undiagnosed.
Perio wisdom teeth withcomplications, implants with
complications I mean those areyour top three.
Always Keep in mind, the levelof documentation I'm talking
about is not that much more froma written point of view.
It's a lot more from a visualpoint of view, because I mean,
one photo is worth more clinicalnotes than you could ever write
(14:47):
.
So do I spend?
Are my clinical notes asdetailed as others?
I've seen no, but they hit onthe specific points insurance is
looking for, which is usuallythe why you're doing treatment.
And yet most of the time ourclinical notes think of it
through what you write.
It's the how you do it.
Well, nobody cares how you didit.
(15:08):
Nobody's arguing the how you dosomething when you're getting
in a lawsuit or when you'regetting in a board complaint or
when you're getting insurance tofight things.
Their number one thing is whyyou did it.
So that's the focus is it needsto be on the why you did what
you did, not how you did it orwhat you did.
Paul Etchison (15:27):
Let's pivot a little bit here.
We talked about Perio.
What about crowns?
I'm interested to hear aboutwhat we can do to get less crown
denials.
And then I'd love to hear whatyou've heard about the new code
with the mini buildup code.
I don't know what it is, butI'm guessing you do.
Travis Campbell (15:43):
Okay, I'll deal with that one in a second
because that one's fun, but I'mguessing you do.
Okay, I'll deal with that onein a second because that one's
fun.
So what will we deal with withcrowns?
It's all visual.
Again, it's all visualdocumentation.
Now we do have a standardnarrative sheet that's like a
menu that we check off things.
That makes things really easy.
The other thing is the visualsyou got to think about.
(16:04):
The insurance company and thereviewer want to see what we saw
clinically while we're workingand yet most of what we send is
before we even look at a toothor touch the tooth, you know.
So if you have a patient comesin with an obviously broken
tooth with a massive hole in it,nobody's going to even question
(16:25):
that claim.
But when you have someone comein with a restoration that's
failing completely obviously andyet on an x-ray looks fine, you
got to change how you documentbecause you want to show the
damage.
You want to show it where youcan see the worst case scenario.
You can truly figure out whereyou actually said, yes, a crown
(16:46):
is needed, which is usuallyafter the restoration's out.
So it's a huge difference onthe when you document more than
necessarily the, what you'redocumenting, plus to think about
.
You know you're trying to getpast that AI, because if the AI
flags your claim, my guess ismost insurance companies that
get sent to a department thatall they have is a little bird
(17:08):
that goes deny, deny, deny, deny.
So you've got to get past thatAI.
Well, a restoration on an x-rayto an AI looks fine, and so
that's the problem.
It's where it's at leastentertaining.
I'm not necessarily sayingeverybody needs this, but it's
wildly helpful to have one ofthose x-ray AIs in the office,
(17:28):
because then it shows you whatthe insurer is seeing, and if
it's saying I don't see theproblem, then you know the
insurance AI is going to turn itdown immediately and you're
going to have to deal with anappeal, if nothing else, to get
to an actual live dentist.
And at that point it's the.
Did your photos and everythingactually document truly where
the damage was and what it was,or is it just a picture before
(17:49):
you even started?
Paul Etchison (17:50):
so if we're taking a picture of a mid
procedure tooth and this issomething I do and I think I
know what you're going to sayabout this but I I have moved my
camera angle to be like no, no,yeah, right there, take it, hit
it and then my assistant hitsit, because I don't like hitting
the button on that thing,because I feel like it can move
sometimes.
But it's like setting up theperspective.
(18:11):
It's like photography rules youdon't have the horizon go
through somebody's neck ifyou're taking a portrait of them
.
Is that?
What you recommend doing isactually looking and realizing.
That's more than just taking apicture.
Travis Campbell (18:30):
You're absolutely right.
It's showing what you see, andthe challenge is, photos are
two-dimensional objects.
I mean, they sort of have alittle bit of depth perception
to them, but they don't have aton.
They're not a 3d picture,they're not a 3d graphical image
and so, yeah, you're going tohave to sometimes change the
angle, and that's some of whatwe do with our training.
There's an online video we'vegot that I've put together that
has shown here's multiple viewsof the same tooth, and do you
(18:54):
see how these three picturesbarely even show it versus?
These two are okay, but thisone's the best because you just
change the angle slightly justso that you can see what it is
that you're seeing clinically.
But the other thing is don'toverwhelm the reviewer.
The reviewer has very limitedtime to look at the case, so you
(19:15):
never want to send eight photosfor a crown.
At most, you send two or three,just the ones that truly
highlight what it is.
You want them to see what theywant to see so that they can
approve your case.
Now you asked about the minibuildup for lack of a better
term and the quote new code.
The code for the foundationalrestoration, which is what
(19:36):
you're talking about, actuallycame out in 2014.
So that's why I laugh is it'snot a new code, by any means.
Paul Etchison (19:45):
Oh, it's a new code in my office.
I don't know where the hell itcame from.
Travis Campbell (19:49):
It's a 2014 code.
One of the bigger challenges Isee with our complaints is
insurance companies saying abuildup is inclusive to the
crown.
That shows up on denials a lotFor one, we've got to realize
insurance companies.
It's probably sadly going totake a lawsuit to do it, but the
(20:10):
way they word things iscompletely inappropriate.
That's one of them.
To claim that a buildup is partof a crown or inclusive to a
crown is completelyinappropriate.
No one clinically would agreewith that whatsoever.
What they're trying to say andwhat I get people think about is
let's reinterpret insurance.
(20:30):
When you see something thatsays this is inclusive of a
crown, what the insurancecompany is really saying is
there's not enough documentationto prove that you needed a
buildup and that you did abuildup a true buildup, a 2750
or 2950.
Up a true buildup a 2750 or2950.
Therefore, we're asking formore documentation so that it's
not a 2949, which is that minibuildup.
(20:53):
That's what they're asking for.
They're asking for moredocumentation.
So every time we've ever seenthat, we've gotten the insurance
to pay it, but it requires ahigher level of detail.
Paul Etchison (21:02):
Basically, so when the insurance says it's
inclusive to the crown, are yousaying that's not a plan
specific thing, that's a claimspecific?
Somebody said no, that wasn't agood enough need for a buildup.
Travis Campbell (21:13):
It is poor communication.
So I've got lots of reviewersI've talked to.
They're actually fun people.
They're not the enemy.
The one thing to realize whenyou're ever talking to a dentist
reviewer number one is they'renot the ones who originally
denied your claim.
That's a whole different set ofpeople.
Usually the ones you actuallytalk to are a higher level of
people that usually have beenwith the company longer, and
(21:35):
they are yelled at when theydeny claims that end up in
appeals.
The other thing, though, ismost of them truly want to help,
and a lot of them dislike whattheir insurer is doing, but they
have limitations on what theycan do, and they can only make
recommendations that follow thepolicy language.
So if the policy languagestates that they need certain
(21:59):
levels of documentation, theycould completely agree with you.
The case is necessary, but theycan't sign off that insurance
should pay for it unless youmeet those criteria, and so the
criteria they're looking for isusually what's the amount of
damage that is missing on thetooth?
The number one thing thatpretty much help makes every
insurer like a crown is there'sa missing cusp.
(22:21):
I mean not every tooth we workon that needs a crown has a
missing cusp, but missing cuspis like the almost guaranteed
holy grail of getting crownspaid.
But if you have that and youhave the documentation, the
photography and the notes thatsay that, you're pretty much
going to get past almost everydenial issue on crowns.
Paul Etchison (22:39):
Yeah, that's interesting to think about.
Is that because we always thinkthis is this evil person that
has jumped ship?
They used to be one of us andnow they're not one of us and
now they're over there?
And I think if you talk to them, if we actually spoke to them
about what they see, it would bevery similar to if you talk to
somebody who runs a dental laband they'd say you should see
the crap that people send to meand get upset about, like the
(23:03):
quality of the impressions orthe quality of documentation,
and then they're upset that theycan't get things approved.
And it's not maybe that theperson's mean and just wants to
screw you over.
They literally don't have whatthey need for their job.
Like, put yourself in theirshoes.
I love that.
Travis Campbell (23:17):
Dentists don't usually like to hear this, but
if you're having a majorchallenge with denials, more
than likely it's on you, morethan likely it just means you
need better documentation.
Paul Etchison (23:28):
I'm just curious.
When we look at our practice,we can look at metrics like our
cancellation rate, our reappointrate.
Are there any sort of metricswith denials, or how many crowns
should go through withoutbuildups and how many crowns
should go with buildups, Stufflike that that we can look at
and see are we meeting ourbaseline and do we have a
problem that we are unaware of?
Travis Campbell (23:50):
Um, I mean that comes from so many different
angles.
It's a great question.
So I mean, first you got tothink about, while most offices
have a fairly average patientpool, every office is different
crowns per patient population orX number per year or anything
(24:14):
like that.
I would say the biggest thingis just going back to the
original training that most ofus had for what's needed for a
crown.
Is there more than 50% of truestructure missing?
Probably need a crown at thatpoint.
Is there pain upon release ofbiting pressure?
(24:34):
Well, that's correct too.
Sundar, you need a crown.
Is there posterior root canal?
You need a crown.
Is there a missing cusp?
You probably need some kind offull coverage restoration.
So those are kind of thediagnostic things.
If you want any From a, here'sanother one that came up.
That was interesting too.
Someone two years ago sent methis letter that said they were
(24:55):
doing too many three, four andfive surface fillings in the
posterior.
I looked at the number ofcrowns he was doing.
He was doing more three, fourand five surface restoration
fillings than he was doingcrowns by a large amount.
And the insurer was just seeingit, as most of us don't do this
many large surface fillings, sosomething's wrong.
(25:17):
Now the insurer probably wantedit to be stop sending as many
surfaces.
I actually told him becausewhen I saw the number of crowns
he was doing, I said the insureris actually telling you you're
underdiagnosing crowns Again,it's just the game to play is
what are they looking for andwhat's another way to
potentially look at it.
(25:40):
So yeah, there are somechallenges with are you
diagnosing things correctly?
Are you too conservative or tooaggressive?
You're going to have an issueeither way.
Insurance companies, I mean,they go by statistics and so if
you're doing way too many or waytoo few of something, you're
going to stand out and not in agood way.
But that's the outlier 5%.
Paul Etchison (25:57):
Yeah.
Travis Campbell (25:57):
The other 95% of us.
That's not the issue at all.
The only true metric I wouldtell people to look at is well,
I guess there's kind of a couple, but the number one is
collection rate.
An office should have minimum99% collection rate.
I mean there's almost no reasonnot to.
The number one reason I seechallenges is lack of correct
(26:20):
collection upfront.
The second one is how weestimate.
Now I find a lot of offices andteams tend to like estimating
in a way that makes it seemeasier or better for the patient
on the front end, but theproblem is that means a lot of
times on the back end we'rehaving to tell them they owe
more.
The best way to estimate is ina way that the patient is never
(26:41):
out of pocket more money thanyou told them.
They can be out of pocket less.
Credits are easy to give backand nobody complains when you
give them money back afterwards.
They only complain when you tryto collect more.
And so you know the averageoffice that I've seen is
somewhere around 25% of patientsthat have to be billed
something after their insurancecomes in.
(27:02):
That needs to drop below one.
Paul Etchison (27:04):
So how would a dentist do that?
Do you recommend changing thebenefit coverage amounts that we
calculate, or that's one way ofdoing it, absolutely it's.
Travis Campbell (27:15):
I would say every office is slightly
different in this on where theyare.
So my recommendation is everytime you have a surprise bill
you have to tell the patientthey owe more money after.
That should be your red flag tofigure out why and estimate
everything when that scenariodifferent the next time.
So if that is, you had anestimate that insurance is going
(27:37):
to pay 80% but for whateverreason they paid 70, yeah,
change your percentage to say 70next time.
The number one concern isdowngrades.
Now downgrades are so commonthey're 80, 85% of policies
right now.
So I tell people, if you don'thave a full, complete breakdown
of benefits where you know everysingle code and what's
(27:58):
downgraded and not you knoweverything, assume it is and
assume they're going to pay forthe lower service.
So I mean, we all knowcomposites a lot of times pay
you as amalgams Great.
Estimate the amalgam paymentfor your composite filling and
then you will have a betterestimate unless you're
absolutely certain there's nodowngrade.
You know porcelain crowns tendto get paid at worst case
(28:21):
scenario as base metal crowns.
Always estimate that Implantsand bridges a lot of times will
get downgraded to partials Ifyou're not absolutely certain
they're going to pay for theimplant, assume they're only
paying for the partial.
You do that.
You solve a huge number ofissues right there Now at a
network.
On the network, the number oneis try to create a blue book.
You know you've got, you're outof network, right it sounds
(28:43):
like?
Do you have a blue book?
Paul Etchison (28:45):
We didn't at first and, oh man, did we need
it.
It's different.
Yes, it changed everything.
Yeah.
Yeah, we figured it out, butyeah, we didn't have it for a
good five, six months going intoit, and it was.
We learned a lot.
Travis Campbell (28:56):
For those who don't know, a blue book is just
a fee schedule of what insuranceis going to pay as their UCR,
which is not the office fee.
That's their magic hidden fee.
What are they going to pay toan out-of-network office?
So you've got to look throughevery claim and start keeping
track of those fees and once youhave them which is sad that
insurance won't give it to youbecause the only people that are
really suffering are thepatients Once you have it, then
(29:19):
you can estimate pretty closely,very similar to what you could
in network.
But you have to have that feeschedule.
Paul Etchison (29:24):
Yeah, it is really sad too, Because it does.
It screws them over, butthey're never going to look bad.
The insurance companies don'tlook bad, we look bad?
Oh no, of course not.
We had.
I'll just share and I know a lotof listeners have heard this
story before but when we wentinitially out of network with
Delta, we had some patients thatpreventative was covered 100%.
We said, great, here's our UCR.
We've never used UCR for thesecoats because our cash patients
(29:46):
would pay our cash price ormembership plan and nothing else
mattered in the PPOs.
So we were getting on a hygienevisit, billing out $500,
telling it was covered 100%.
They cover 100% of theirallowable amount and they get
reimbursed.
So they paid us $500 and thenthey get a check from their
insurance carrier for like $130,$150.
(30:06):
And that would tend to piss meoff very much if I was in the
patient's shoes and I completelyunderstand that.
And what was crazy about thatis I didn't catch wind that this
was even happening until aboutfour months into it.
So what was I doing, Right?
Yeah, I take a lot of blame forthat, but we figured it out.
And then we built the blue bookand figured out that game.
(30:27):
But that was a first for us.
Travis Campbell (30:28):
Yeah, absolutely.
And again it comes down tocorrect verification, correct
fees and correct breakdown ofbenefits.
If you have that, you solve somany issues right there and then
, which is why collections againshould be 99% as a minimum.
Yeah, it'll ebb and flow everycouple months, which is why the
best way to do it is at least doquarterly tracking of it,
(30:50):
because if you go less thanthree months you have too much
ebb and flow and the number cango up and down a little too much
.
You do at least a quarter andthere usually is very stable for
offices across the country.
And the last thing is what'syour denial rate?
And denials meaning not thelike expected first-line SRP
denials.
I'm talking about denials thatyou have to deal with more than
once, or you know, like crownsthe first time denials are then.
(31:13):
Or denials on your basicservices where a lot of times it
was just you didn't know therewas a limitation.
I had somebody this week sendme already that they got denied
on fillings because they didn'trealize there was a waiting
period and that fillings wereconsidered basic and that the
waiting period was for basic butnot for diagnostic, and so the
insurance paid literally nothingon a $1,500 claim and they were
(31:37):
like what do we do and I'm likeyou're probably not going to
collect all that $1,500, becauseI don't know how you describe
that to a patient to get them topay for something that would
have been 100% covered otherwise?
Paul Etchison (31:46):
Right.
So pretty much, just look andsee what's happening, get the
pulse on your practice and takea little deeper dive into what's
going on and why, and you'llprobably figure something out.
Just ask enough questions.
That's what it's like doingone-on-ones with your team.
If you feel like your practicehas no problems, you're not
talking to your team.
There's things going on.
(32:06):
So talk about dental insurance.
Guy man, I love what you'redoing because there's so many
people now we're struggling tohire with dental experience.
And it was hygienic, and thenit was, and now it's every
position, it seems, and it'sjust the labor force thing.
And there's so many of us thatwould love to go outside of
dental, but we just don't have agood resources for learning the
(32:29):
dental insurance side.
So we want to find people withexperience.
What does Dental InsuranceGuide provide to dentists and
what have you put together?
So we want to find people withexperience.
What does Dental InsuranceGuide provide to dentists and
what have you?
Travis Campbell (32:40):
put together Because I've looked at your
program and I love it so good.
Well, thank you.
So it's an online trainingprogram that has courses
everything from basic toadvanced that can take anyone
from where they are now to beinga quote expert in filing and
managing insurance claims.
So it doesn't matter wheresomebody starts with.
And the fun part is we evenadded this year, you know,
filters to say what is the levelof experience that this course
(33:04):
kind of deals with, and sosomeone who's new can deal with
all the basic courses first andkind of get that low level
understanding before they moveup, versus someone who's coming
with experience can go in thereand start at maybe the
intermediate or the advancedlevels.
And the great part is it's amembership, it's not a paper
video.
It makes things easy for people.
And there's almost 50 coursesnow and a new one that comes out
(33:28):
every month, and then I'm onthere answering questions almost
every day.
So there's a Q&A feature, andthe funny thing on the Q&A
feature is I think I get moreteam members to actually ask me
questions because their doctorsgive them access to the portal.
Then I get doctors askingquestions.
Well, to your point, you don'tknow what these things are
dealing with because the teamwants to try to insulate you,
(33:49):
because they know you're busy,and so they're trying to deal
with the insurance stuff.
Well, giving them access tosomeone who can answer their
questions has been huge for alot of offices as well.
Paul Etchison (34:00):
Yeah, I could see that the mini insurance buildup
or the mini buildup that's beenout since 2014.
Is there like people talkingabout this or am I like the last
to come to the party, Like whydid I just hear about this?
Travis Campbell (34:19):
Well, I will say you know more than most
because you even knew there wasa second code.
Most of the time when I evenask people, when we're talking
about buildup denials, who knowsthere's actually two codes for
buildup?
It's maybe 5% of the room thatusually raises their hand and
most of them I see my book ontheir desk.
So there's a reason they knewit.
So yeah, I mean it's a verycommon question because most
people don't read through acoding book.
I mean I will say you probablyhave to take a couple of
(34:40):
caffeine pills or something todo this.
But years ago I picked up acoding book and I read it cover
to cover.
Now it was boring, but youlearn a ton and you realize
there's so many codes that weshould be billing out that we're
not, or codes that we should bebilling different than what we
are to get better results.
Paul Etchison (35:00):
Where is Dental Insurance Guy?
Where do they find moreinformation?
Check out your courses andeverything that you offer.
Travis Ca (35:05):
Dentalinsuranceguycom .
That's great.
I like complexity, you know.
Paul Etchison (35:09):
Yeah, yeah, great , great domain.
Well, man Travis, thanks somuch, man.
It was a really great episodeand I know, gosh, sometimes I
have guests on and I'm justasking questions for the
listeners, but this was a lotfor me.
I mean, I learned a ton and Iknow if I learned a ton,
everyone listening learned a tonas well.
So, man, I love what you'redoing in the industry.
That's someone who really gotdeep into the insurance and just
(35:30):
a very not the most fun subjectto become well-versed in, but
something that is such a largepart of our practices.
It's amazing we don't know moreabout it and I just love that
you put something together, anice program for dentists.
So thanks for taking some timeout of your day and coming on
the program and, man, I hope Ican have you back sometime in
the future.
Travis Campbell (35:49):
Awesome, it was a pleasure to be with you here,
paul, again.
I can't believe I'm about to say this, but it is
time to stop blaming theinsurance companies, right, I
know, but in this episode, drTravis Campbell is going to
explain to us why most denialsare actually caused by us, the
dentists.
He has a ton of insight intohow insurance reviewers think,
what they look for in claims andwhat we can do to drop our
(00:23):
denial rate to just under one or2%, and this will help you,
whether you're in network or outof network.
I learned a ton during thisinterview on how to play the
dental insurance game, and Iknow you will too, so don't miss
this one.
Let's get into it.
You are listening to DentalPractice Heroes, where we help
you to create a team andsystem-driven dental practice,
(00:44):
one that allows you to practiceless and make more money.
I'm Dr Paul Etcheson, a dentalcoach, author of two books on
dental practice management andthe owner of a five-doctor
practice in the south suburbs ofChicago.
I want to show you how beingintentional about ownership can
create a practice that supportsyour life instead of consuming
it.
So if you're ready to create atrue business that runs without
you, you're in the right place.
(01:05):
Let's get started.
Hey, welcome back to the DentalPractice Heroes podcast.
Thank you so much for tuning inwith us today.
I got a great interview.
A repeat guest multi-practiceowner down in Texas Got Dr
Travis Campbell on and you mightknow him as the dental
(01:25):
insurance guy he is the one thatyou might have seen on Facebook
that if somebody asks insurancequestion he's got a very
knowledgeable and comes from aplace where he knows what he's
talking about.
And, oh man, is there a lot ofpeople that don't know what
they're talking about?
It seems like, or we're allconfused.
So we're glad you are in ourindustry, travis.
Welcome to the podcast man.
(01:46):
How's things going today?
Travis Campbell (01:48):
Well, thank you , paul, things are going great,
great yeah, and would you agree?
Paul Etchison (01:52):
there is a lot of confusion around insurance.
Travis Campbell (01:56):
Absolutely.
I mean, insurance is complexand I don't think the insurers
really go out of their way tomake it any easier for us, and
unfortunately there's a lot ofmisinformation out there, so it
can be daunting for people.
Paul Etchison (02:11):
How did you decide that this was something
you wanted to get really intodeep?
How did this happen, where yougot, maybe found yourself into
it very deep?
Travis Campbell (02:20):
Well, when I first started, I owned a
practice, I did a startup, andhow we get paid is a big part of
our world.
It, you know, for lack of abetter term, it ticked me off
Kenwood and so I had to findanswers.
So I looked all over the place.
I found answers that did notmake sense or did not actually
match the information I couldfind, and so that's what got me
(02:44):
to look into it is.
I couldn't find anything good,useful, and so I started reading
contracts and researching statelaws and what we can and cannot
do and what the insurers canand cannot do, and then a lot of
people just start asking mequestions about it.
Paul Etchison (02:58):
I feel like there's a big push right now.
I see it on the internet withDelta, where a lot of people are
going out of network.
And I have dropped Delta andyou know it was the right time
for my practice.
We were at capacity where weneeded to do something with our
capacity and all we could do wasthin our herd.
So we got rid of our lowestpaying plan.
But I can tell you, I stillhave Delta patients and I'm
(03:22):
still working with insurance andI think a lot of people think
that you get out of network, youdon't have to worry about that
anymore.
What have you seen in theindustry?
Travis Campbell (03:30):
So I mean it's an interesting trend because
pre-COVID 95% of offices were innetwork with at least one
company, delta usually beingthat one company, I would say.
Now the number is probably moreabout 90%.
So number of out-of-networkoffices have more than doubled.
The interesting trend is I'mseeing that people are starting
(03:51):
to, instead of drop Delta last,actually drop Delta first
because of their fees thataren't increasing.
Well, at least with umbrellas.
All the other companies areplaying ball.
So that's been an interestingkind of flip in the industry.
Paul Etchison (04:06):
Yeah.
So if someone's getting out ofnetwork, and whether in or out
of network, how can we play theinsurance game better so that we
can be reimbursed more?
Travis Campbell (04:16):
Well, I mean, the number one thing is realize
you know there's a lot of thingsinsurance companies are at
fault for.
The one biggest challenge I seeis, you know, does complain
about denials and honestly, inmost cases the denials are our
fault more than the insurer.
So we've got to understand ifsomething's just purely not
(04:36):
covered, you're going to get thedenial and you're going to have
an upset patient if you didn'tunderstand at the front end that
it was just never going to getpaid to begin with, because it's
the surprise bills that causethe most upset ever.
So it's learning.
Either, you know, get goodverification, get good breakdown
of benefits so that you don'thave these surprise bills and
you can give your patient a goodestimate in or out of network,
(04:59):
and then realizing for servicesthat are covered, making sure
you document in a way that theinsurer wants.
Whether or not you like the waythe insurer wants, it's a
different story, but document inthe way the insurer wants and
then you don't get denials.
I mean crowns, scaling and rootplanings are probably the most
common complaint that I ever see.
And yet most claims I seethey're denied because I get
(05:19):
them sent to me every day almostand I saw why they denied it,
sent to me every day almost andI saw why they denied it.
So you kind of see it from bothsides and realize if you want
to win the game you just have tolearn how to do a little bit
better documentation, whichclinically takes an extra like
60 seconds, and then you justavoid the denials to begin with.
Paul Etchison (05:36):
Now, when somebody gets a denial, I mean
we'll often if practice ownerssometimes we've got to write the
narrative.
I mean these are things that myteam does for me.
I signed them, but I rememberin the beginning this was
completely foreign and new to me.
And it go through the process.
We do two quads, then we havethem back two weeks later and we
(06:13):
do the other two quads and thenmaybe it takes another 30, 60
days for the claim to recloseand come back or get denied.
And now at this point we're sofar removed from that procedure
that we're saying, okay, well,maybe the insurance is going to
make this look like this was ourfault, that it wasn't a
necessary treatment, and thatwe're now over diagnosing.
So now we've got an upsetpatient and now I'm going to
think twice next time.
(06:33):
I think somebody's perio,that's not perio.
So what advice would you havefor dentists in that regard?
Travis Campbell (06:39):
I mean, you probably hit the nail on the
head of probably one of theworst things that insurance
plays this game with is, yeah,it makes dentists second-guess
themselves on completelylegitimate procedures.
And so you know, if you look atthe most conservative approach
AAP, ada, say what 70 to 80% ofadults have perio or some form
(07:01):
of perio.
And yet if you run by allpractice management softwares I
mean they all say the same thingis practices tend to only treat
about 6% of their patients.
Well, let's say, every patientthat doesn't show up in your
office has perio.
So of the ones that do show up,it actually ends up being about
40%.
Is what an office should betreating with something other
(07:23):
than a prophy.
Now, that could be be morefrequent, or it could be SRP or
whatever.
Well, there's a huge disconnectbetween 6% and 40%.
And so what are we doing to thepublic?
I mean, we're not treating oneof the most rampant diseases on
the planet Well as an industry.
That's kind of a horrible thingon our end.
And yeah, insurance has a bigplay, because if you can't get
(07:46):
your SRP claims paid, thenyou're going to second guess
whether or not you're going todo it in the first place, which,
yeah, I mean, is a huge problem.
I can say we do about 300 quadsof SRP a year.
We get denied on maybe one ortwo of them, and those one or
two the patient's already paidbecause we already knew it was
going to get denied.
We were just trying to see ifwe could push the envelope a
(08:07):
little bit.
But it's all documentation andit's completely different now
than what we were doing 15 yearsago when we were getting all
the denials.
Paul Etchison (08:18):
Yeah, that's amazing Because I feel like I
mean, I'm just all anecdotal itdefinitely is more than two
quads or two patients at myoffice.
It's a ton of them.
I mean, we have a box.
We have a box for denied SRPclaims.
We have enough of them tocreate a box.
So what is the documentationthat we're missing out on?
(08:40):
And what's reasonable?
Because we all went to dentalschool and we've all filled out
a perio chart.
And what's reasonable?
Travis Campbell (08:58):
Because we all went to dental school and we've
all filled out a perio chart andwe've filled it out to dental
school guidelines doing FGM andbleeding at sites and all these
things.
And you can spend a lot of timecoloring a perio chart.
So what is the say?
We all and that's the sad partis actually most of us don't
document.
According to the way that atleast most dental schools teach
it, 90 plus percent of theclaims I see denied that come
across my reports.
There's no general margins,there's no bleeding.
On probing, I mean there'snobody who would say that's
(09:19):
adequate and yet it's such acommon thing to just put in
pocket depths.
I'm sure you know the same.
You can't diagnose on a pocketdepth.
You have to diagnose on trulyclinical attachment loss.
So that's the first thing ismake sure you actually have a
complete chart.
The second is photos.
I mean I don't know about you.
When I first started, internalcameras were expensive.
(09:40):
They were four or five $6,000 apiece.
But now they're a few hundreddollars a piece and you can have
them in every operatory and youcan use them for literally
every patient and photos make amassive difference.
I mean that's the biggest thing.
What's better than anynarrative you could ever write A
picture, and then the lastthing is to realize most claims
(10:01):
nowadays, at least the firsttime it's sent, is completely
processed by an AI, and for mostof the major carriers it's
processed by an AI that'sreading your x-rays, and so
there's some subjectivity toprobing.
There's some subjectivity toeven angulation on the x-ray and
there's subjectivity in whereyou start that measurement, from
(10:24):
the CEJ to where's the level ofbone damage, and so you're
going to have issues with that.
If you have a lower end orearlier stage case, your
narrative has to be that muchbetter and you probably should
be circling and marking up thatx-ray to show what it is that
you're seeing.
(10:44):
I mean, in some cases you'vegot to realize these reviewers
the information they get is notnecessarily the same quality as
the information we send out,because we send all electronic
claims but they get theresolutions removed.
Sometimes they're printed andthen copied.
I mean they get all sorts ofcrazy stuff, and so sometimes
it's just not better data.
How many of these?
I mean they get all sorts ofcrazy stuff, and so sometimes
(11:04):
it's just send that better data.
Paul Etchison (11:05):
How many of these ?
I mean, is it normal that we'retalking to like that initial,
like that they're going to reachback out and say we need more
information, or they're going tosay they deny it and you're
appealing, Like is that a normalprocess or is that an
indication that we aren'tsending the right information
the first time?
Travis Campbell (11:22):
I mean that's a great question For crowns.
In most cases I say it's notsending the right documentation
to begin with For SRPs, unlessyou have an AI in your office
that is actually doing themeasurements for you and you can
send that.
On the claim, then I would saythat, sadly enough, a lot of SRP
claims you're going to expectto have to deal with.
(11:43):
One appeal you're going toexpect to have to deal with one
appeal.
Paul Etchison (11:45):
So how do we balance the?
I mean, filling out a fullperio chart like we did in
dental school takes time andtaking a lot of photos takes
time.
How do we find that balancebetween what should we do on
every single patient and whenshould we do it versus?
Are we just doing too much forthese outliers that may just get
denied every now and then andjust deal with that?
Travis Campbell (12:07):
I'm very process driven.
I like efficiency, I likethings that are easy.
So the way we look at it islet's find what the worst
insurance company to work withis, find the level of
documentation they want and thendo that for everyone and
therefore you never have tothink about it.
And then do that for everyoneand therefore you never have to
(12:27):
think about it.
And the documentationrequirements yeah, they take
extra time but, like I said, forCrown it's maybe an extra
minute, for SRP it's maybe anextra five minutes, but then you
save your front team hoursworth of work and you get your
collections and you don't dealwith pissed off patients and
everything else.
So it's just keeping somethingthat's simple for the team.
When you're dealing withdenials every week or every
(12:50):
month, then, yeah, it's worth itto change and you have a box of
them.
Yeah, but the difference betweena little bit better at
documentation, which and let mego back to say this is always
entertaining, because I havepeople that ask why are we doing
this for insurance?
Technically, actually, you'renot doing it for insurance,
because what happens when thepatient comes back and says well
(13:11):
, doc, my tooth didn't hurtuntil you touched it.
Correct level documentation,you put up the picture, the
conversation ends.
I mean, it's a no-brainer.
Show the decay, show the damageWith SRPs.
Honestly, patients aren't goingto really understand most of
what we're dealing with on thatend.
But if you ever have amalpractice claim or a state
board complaint, that level ofdocumentation is going to
(13:34):
protect you far better thananything else.
Paul Etchison (13:37):
Yeah, we just had one of my associate partner.
She had to be part of adeposition.
She was not the dentist beingsued, but she was the second
opinion one of the otherdentists that the patient had
seen afterwards and she had saidthe level of documentation they
were asking and the detail thatthey went through her notes
(13:57):
line by line, was it scared thehell out of her.
And she said I think we need todocument way more than what
we're doing.
And after hearing her story ofwhat they were asking her, my
God, like I'm looking at mynotes, being like man, I hope
nobody does anything to mebecause I don't think I have
this level of documentation andI think I don't know if this is
right.
But I think, like the numberone lawsuit is is it undiagnosed
(14:22):
perio?
It's up there, yeah.
Travis Campbell (14:24):
Depends on what year you're looking at.
It's almost always undiagnosed.
Perio wisdom teeth withcomplications, implants with
complications I mean those areyour top three.
Always Keep in mind, the levelof documentation I'm talking
about is not that much more froma written point of view.
It's a lot more from a visualpoint of view, because I mean,
one photo is worth more clinicalnotes than you could ever write
(14:47):
.
So do I spend?
Are my clinical notes asdetailed as others?
I've seen no, but they hit onthe specific points insurance is
looking for, which is usuallythe why you're doing treatment.
And yet most of the time ourclinical notes think of it
through what you write.
It's the how you do it.
Well, nobody cares how you didit.
(15:08):
Nobody's arguing the how you dosomething when you're getting
in a lawsuit or when you'regetting in a board complaint or
when you're getting insurance tofight things.
Their number one thing is whyyou did it.
So that's the focus is it needsto be on the why you did what
you did, not how you did it orwhat you did.
Paul Etchison (15:27):
Let's pivot a little bit here.
We talked about Perio.
What about crowns?
I'm interested to hear aboutwhat we can do to get less crown
denials.
And then I'd love to hear whatyou've heard about the new code
with the mini buildup code.
I don't know what it is, butI'm guessing you do.
Travis Campbell (15:43):
Okay, I'll deal with that one in a second
because that one's fun, but I'mguessing you do.
Okay, I'll deal with that onein a second because that one's
fun.
So what will we deal with withcrowns?
It's all visual.
Again, it's all visualdocumentation.
Now we do have a standardnarrative sheet that's like a
menu that we check off things.
That makes things really easy.
The other thing is the visualsyou got to think about.
(16:04):
The insurance company and thereviewer want to see what we saw
clinically while we're workingand yet most of what we send is
before we even look at a toothor touch the tooth, you know.
So if you have a patient comesin with an obviously broken
tooth with a massive hole in it,nobody's going to even question
(16:25):
that claim.
But when you have someone comein with a restoration that's
failing completely obviously andyet on an x-ray looks fine, you
got to change how you documentbecause you want to show the
damage.
You want to show it where youcan see the worst case scenario.
You can truly figure out whereyou actually said, yes, a crown
(16:46):
is needed, which is usuallyafter the restoration's out.
So it's a huge difference onthe when you document more than
necessarily the, what you'redocumenting, plus to think about
.
You know you're trying to getpast that AI, because if the AI
flags your claim, my guess ismost insurance companies that
get sent to a department thatall they have is a little bird
(17:08):
that goes deny, deny, deny, deny.
So you've got to get past thatAI.
Well, a restoration on an x-rayto an AI looks fine, and so
that's the problem.
It's where it's at leastentertaining.
I'm not necessarily sayingeverybody needs this, but it's
wildly helpful to have one ofthose x-ray AIs in the office,
(17:28):
because then it shows you whatthe insurer is seeing, and if
it's saying I don't see theproblem, then you know the
insurance AI is going to turn itdown immediately and you're
going to have to deal with anappeal, if nothing else, to get
to an actual live dentist.
And at that point it's the.
Did your photos and everythingactually document truly where
the damage was and what it was,or is it just a picture before
(17:49):
you even started?
Paul Etchison (17:50):
so if we're taking a picture of a mid
procedure tooth and this issomething I do and I think I
know what you're going to sayabout this but I I have moved my
camera angle to be like no, no,yeah, right there, take it, hit
it and then my assistant hitsit, because I don't like hitting
the button on that thing,because I feel like it can move
sometimes.
But it's like setting up theperspective.
(18:11):
It's like photography rules youdon't have the horizon go
through somebody's neck ifyou're taking a portrait of them
.
Is that?
What you recommend doing isactually looking and realizing.
That's more than just taking apicture.
Travis Campbell (18:30):
You're absolutely right.
It's showing what you see, andthe challenge is, photos are
two-dimensional objects.
I mean, they sort of have alittle bit of depth perception
to them, but they don't have aton.
They're not a 3d picture,they're not a 3d graphical image
and so, yeah, you're going tohave to sometimes change the
angle, and that's some of whatwe do with our training.
There's an online video we'vegot that I've put together that
has shown here's multiple viewsof the same tooth, and do you
(18:54):
see how these three picturesbarely even show it versus?
These two are okay, but thisone's the best because you just
change the angle slightly justso that you can see what it is
that you're seeing clinically.
But the other thing is don'toverwhelm the reviewer.
The reviewer has very limitedtime to look at the case, so you
(19:15):
never want to send eight photosfor a crown.
At most, you send two or three,just the ones that truly
highlight what it is.
You want them to see what theywant to see so that they can
approve your case.
Now you asked about the minibuildup for lack of a better
term and the quote new code.
The code for the foundationalrestoration, which is what
(19:36):
you're talking about, actuallycame out in 2014.
So that's why I laugh is it'snot a new code, by any means.
Paul Etchison (19:45):
Oh, it's a new code in my office.
I don't know where the hell itcame from.
Travis Campbell (19:49):
It's a 2014 code.
One of the bigger challenges Isee with our complaints is
insurance companies saying abuildup is inclusive to the
crown.
That shows up on denials a lotFor one, we've got to realize
insurance companies.
It's probably sadly going totake a lawsuit to do it, but the
(20:10):
way they word things iscompletely inappropriate.
That's one of them.
To claim that a buildup is partof a crown or inclusive to a
crown is completelyinappropriate.
No one clinically would agreewith that whatsoever.
What they're trying to say andwhat I get people think about is
let's reinterpret insurance.
(20:30):
When you see something thatsays this is inclusive of a
crown, what the insurancecompany is really saying is
there's not enough documentationto prove that you needed a
buildup and that you did abuildup a true buildup, a 2750
or 2950.
Up a true buildup a 2750 or2950.
Therefore, we're asking formore documentation so that it's
not a 2949, which is that minibuildup.
(20:53):
That's what they're asking for.
They're asking for moredocumentation.
So every time we've ever seenthat, we've gotten the insurance
to pay it, but it requires ahigher level of detail.
Paul Etchison (21:02):
Basically, so when the insurance says it's
inclusive to the crown, are yousaying that's not a plan
specific thing, that's a claimspecific?
Somebody said no, that wasn't agood enough need for a buildup.
Travis Campbell (21:13):
It is poor communication.
So I've got lots of reviewersI've talked to.
They're actually fun people.
They're not the enemy.
The one thing to realize whenyou're ever talking to a dentist
reviewer number one is they'renot the ones who originally
denied your claim.
That's a whole different set ofpeople.
Usually the ones you actuallytalk to are a higher level of
people that usually have beenwith the company longer, and
(21:35):
they are yelled at when theydeny claims that end up in
appeals.
The other thing, though, ismost of them truly want to help,
and a lot of them dislike whattheir insurer is doing, but they
have limitations on what theycan do, and they can only make
recommendations that follow thepolicy language.
So if the policy languagestates that they need certain
(21:59):
levels of documentation, theycould completely agree with you.
The case is necessary, but theycan't sign off that insurance
should pay for it unless youmeet those criteria, and so the
criteria they're looking for isusually what's the amount of
damage that is missing on thetooth?
The number one thing thatpretty much help makes every
insurer like a crown is there'sa missing cusp.
(22:21):
I mean not every tooth we workon that needs a crown has a
missing cusp, but missing cuspis like the almost guaranteed
holy grail of getting crownspaid.
But if you have that and youhave the documentation, the
photography and the notes thatsay that, you're pretty much
going to get past almost everydenial issue on crowns.
Paul Etchison (22:39):
Yeah, that's interesting to think about.
Is that because we always thinkthis is this evil person that
has jumped ship?
They used to be one of us andnow they're not one of us and
now they're over there?
And I think if you talk to them, if we actually spoke to them
about what they see, it would bevery similar to if you talk to
somebody who runs a dental laband they'd say you should see
the crap that people send to meand get upset about, like the
(23:03):
quality of the impressions orthe quality of documentation,
and then they're upset that theycan't get things approved.
And it's not maybe that theperson's mean and just wants to
screw you over.
They literally don't have whatthey need for their job.
Like, put yourself in theirshoes.
I love that.
Travis Campbell (23:17):
Dentists don't usually like to hear this, but
if you're having a majorchallenge with denials, more
than likely it's on you, morethan likely it just means you
need better documentation.
Paul Etchison (23:28):
I'm just curious.
When we look at our practice,we can look at metrics like our
cancellation rate, our reappointrate.
Are there any sort of metricswith denials, or how many crowns
should go through withoutbuildups and how many crowns
should go with buildups, Stufflike that that we can look at
and see are we meeting ourbaseline and do we have a
problem that we are unaware of?
Travis Campbell (23:50):
Um, I mean that comes from so many different
angles.
It's a great question.
So I mean, first you got tothink about, while most offices
have a fairly average patientpool, every office is different
crowns per patient population orX number per year or anything
(24:14):
like that.
I would say the biggest thingis just going back to the
original training that most ofus had for what's needed for a
crown.
Is there more than 50% of truestructure missing?
Probably need a crown at thatpoint.
Is there pain upon release ofbiting pressure?
(24:34):
Well, that's correct too.
Sundar, you need a crown.
Is there posterior root canal?
You need a crown.
Is there a missing cusp?
You probably need some kind offull coverage restoration.
So those are kind of thediagnostic things.
If you want any From a, here'sanother one that came up.
That was interesting too.
Someone two years ago sent methis letter that said they were
(24:55):
doing too many three, four andfive surface fillings in the
posterior.
I looked at the number ofcrowns he was doing.
He was doing more three, fourand five surface restoration
fillings than he was doingcrowns by a large amount.
And the insurer was just seeingit, as most of us don't do this
many large surface fillings, sosomething's wrong.
(25:17):
Now the insurer probably wantedit to be stop sending as many
surfaces.
I actually told him becausewhen I saw the number of crowns
he was doing, I said the insureris actually telling you you're
underdiagnosing crowns Again,it's just the game to play is
what are they looking for andwhat's another way to
potentially look at it.
(25:40):
So yeah, there are somechallenges with are you
diagnosing things correctly?
Are you too conservative or tooaggressive?
You're going to have an issueeither way.
Insurance companies, I mean,they go by statistics and so if
you're doing way too many or waytoo few of something, you're
going to stand out and not in agood way.
But that's the outlier 5%.
Paul Etchison (25:57):
Yeah.
Travis Campbell (25:57):
The other 95% of us.
That's not the issue at all.
The only true metric I wouldtell people to look at is well,
I guess there's kind of a couple, but the number one is
collection rate.
An office should have minimum99% collection rate.
I mean there's almost no reasonnot to.
The number one reason I seechallenges is lack of correct
(26:20):
collection upfront.
The second one is how weestimate.
Now I find a lot of offices andteams tend to like estimating
in a way that makes it seemeasier or better for the patient
on the front end, but theproblem is that means a lot of
times on the back end we'rehaving to tell them they owe
more.
The best way to estimate is ina way that the patient is never
(26:41):
out of pocket more money thanyou told them.
They can be out of pocket less.
Credits are easy to give backand nobody complains when you
give them money back afterwards.
They only complain when you tryto collect more.
And so you know the averageoffice that I've seen is
somewhere around 25% of patientsthat have to be billed
something after their insurancecomes in.
(27:02):
That needs to drop below one.
Paul Etchison (27:04):
So how would a dentist do that?
Do you recommend changing thebenefit coverage amounts that we
calculate, or that's one way ofdoing it, absolutely it's.
Travis Campbell (27:15):
I would say every office is slightly
different in this on where theyare.
So my recommendation is everytime you have a surprise bill
you have to tell the patientthey owe more money after.
That should be your red flag tofigure out why and estimate
everything when that scenariodifferent the next time.
So if that is, you had anestimate that insurance is going
(27:37):
to pay 80% but for whateverreason they paid 70, yeah,
change your percentage to say 70next time.
The number one concern isdowngrades.
Now downgrades are so commonthey're 80, 85% of policies
right now.
So I tell people, if you don'thave a full, complete breakdown
of benefits where you know everysingle code and what's
(27:58):
downgraded and not you knoweverything, assume it is and
assume they're going to pay forthe lower service.
So I mean, we all knowcomposites a lot of times pay
you as amalgams Great.
Estimate the amalgam paymentfor your composite filling and
then you will have a betterestimate unless you're
absolutely certain there's nodowngrade.
You know porcelain crowns tendto get paid at worst case
(28:21):
scenario as base metal crowns.
Always estimate that Implantsand bridges a lot of times will
get downgraded to partials Ifyou're not absolutely certain
they're going to pay for theimplant, assume they're only
paying for the partial.
You do that.
You solve a huge number ofissues right there Now at a
network.
On the network, the number oneis try to create a blue book.
You know you've got, you're outof network, right it sounds
(28:43):
like?
Do you have a blue book?
Paul Etchison (28:45):
We didn't at first and, oh man, did we need
it.
It's different.
Yes, it changed everything.
Yeah.
Yeah, we figured it out, butyeah, we didn't have it for a
good five, six months going intoit, and it was.
We learned a lot.
Travis Campbell (28:56):
For those who don't know, a blue book is just
a fee schedule of what insuranceis going to pay as their UCR,
which is not the office fee.
That's their magic hidden fee.
What are they going to pay toan out-of-network office?
So you've got to look throughevery claim and start keeping
track of those fees and once youhave them which is sad that
insurance won't give it to youbecause the only people that are
really suffering are thepatients Once you have it, then
(29:19):
you can estimate pretty closely,very similar to what you could
in network.
But you have to have that feeschedule.
Paul Etchison (29:24):
Yeah, it is really sad too, Because it does.
It screws them over, butthey're never going to look bad.
The insurance companies don'tlook bad, we look bad?
Oh no, of course not.
We had.
I'll just share and I know a lotof listeners have heard this
story before but when we wentinitially out of network with
Delta, we had some patients thatpreventative was covered 100%.
We said, great, here's our UCR.
We've never used UCR for thesecoats because our cash patients
(29:46):
would pay our cash price ormembership plan and nothing else
mattered in the PPOs.
So we were getting on a hygienevisit, billing out $500,
telling it was covered 100%.
They cover 100% of theirallowable amount and they get
reimbursed.
So they paid us $500 and thenthey get a check from their
insurance carrier for like $130,$150.
(30:06):
And that would tend to piss meoff very much if I was in the
patient's shoes and I completelyunderstand that.
And what was crazy about thatis I didn't catch wind that this
was even happening until aboutfour months into it.
So what was I doing, Right?
Yeah, I take a lot of blame forthat, but we figured it out.
And then we built the blue bookand figured out that game.
(30:27):
But that was a first for us.
Travis Campbell (30:28):
Yeah, absolutely.
And again it comes down tocorrect verification, correct
fees and correct breakdown ofbenefits.
If you have that, you solve somany issues right there and then
, which is why collections againshould be 99% as a minimum.
Yeah, it'll ebb and flow everycouple months, which is why the
best way to do it is at least doquarterly tracking of it,
(30:50):
because if you go less thanthree months you have too much
ebb and flow and the number cango up and down a little too much
.
You do at least a quarter andthere usually is very stable for
offices across the country.
And the last thing is what'syour denial rate?
And denials meaning not thelike expected first-line SRP
denials.
I'm talking about denials thatyou have to deal with more than
once, or you know, like crownsthe first time denials are then.
(31:13):
Or denials on your basicservices where a lot of times it
was just you didn't know therewas a limitation.
I had somebody this week sendme already that they got denied
on fillings because they didn'trealize there was a waiting
period and that fillings wereconsidered basic and that the
waiting period was for basic butnot for diagnostic, and so the
insurance paid literally nothingon a $1,500 claim and they were
(31:37):
like what do we do and I'm likeyou're probably not going to
collect all that $1,500, becauseI don't know how you describe
that to a patient to get them topay for something that would
have been 100% covered otherwise?
Paul Etchison (31:46):
Right.
So pretty much, just look andsee what's happening, get the
pulse on your practice and takea little deeper dive into what's
going on and why, and you'llprobably figure something out.
Just ask enough questions.
That's what it's like doingone-on-ones with your team.
If you feel like your practicehas no problems, you're not
talking to your team.
There's things going on.
(32:06):
So talk about dental insurance.
Guy man, I love what you'redoing because there's so many
people now we're struggling tohire with dental experience.
And it was hygienic, and thenit was, and now it's every
position, it seems, and it'sjust the labor force thing.
And there's so many of us thatwould love to go outside of
dental, but we just don't have agood resources for learning the
(32:29):
dental insurance side.
So we want to find people withexperience.
What does Dental InsuranceGuide provide to dentists and
what have you put together?
So we want to find people withexperience.
What does Dental InsuranceGuide provide to dentists and
what have you?
Travis Campbell (32:40):
put together Because I've looked at your
program and I love it so good.
Well, thank you.
So it's an online trainingprogram that has courses
everything from basic toadvanced that can take anyone
from where they are now to beinga quote expert in filing and
managing insurance claims.
So it doesn't matter wheresomebody starts with.
And the fun part is we evenadded this year, you know,
filters to say what is the levelof experience that this course
(33:04):
kind of deals with, and sosomeone who's new can deal with
all the basic courses first andkind of get that low level
understanding before they moveup, versus someone who's coming
with experience can go in thereand start at maybe the
intermediate or the advancedlevels.
And the great part is it's amembership, it's not a paper
video.
It makes things easy for people.
And there's almost 50 coursesnow and a new one that comes out
(33:28):
every month, and then I'm onthere answering questions almost
every day.
So there's a Q&A feature, andthe funny thing on the Q&A
feature is I think I get moreteam members to actually ask me
questions because their doctorsgive them access to the portal.
Then I get doctors askingquestions.
Well, to your point, you don'tknow what these things are
dealing with because the teamwants to try to insulate you,
(33:49):
because they know you're busy,and so they're trying to deal
with the insurance stuff.
Well, giving them access tosomeone who can answer their
questions has been huge for alot of offices as well.
Paul Etchison (34:00):
Yeah, I could see that the mini insurance buildup
or the mini buildup that's beenout since 2014.
Is there like people talkingabout this or am I like the last
to come to the party, Like whydid I just hear about this?
Travis Campbell (34:19):
Well, I will say you know more than most
because you even knew there wasa second code.
Most of the time when I evenask people, when we're talking
about buildup denials, who knowsthere's actually two codes for
buildup?
It's maybe 5% of the room thatusually raises their hand and
most of them I see my book ontheir desk.
So there's a reason they knewit.
So yeah, I mean it's a verycommon question because most
people don't read through acoding book.
I mean I will say you probablyhave to take a couple of
(34:40):
caffeine pills or something todo this.
But years ago I picked up acoding book and I read it cover
to cover.
Now it was boring, but youlearn a ton and you realize
there's so many codes that weshould be billing out that we're
not, or codes that we should bebilling different than what we
are to get better results.
Paul Etchison (35:00):
Where is Dental Insurance Guy?
Where do they find moreinformation?
Check out your courses andeverything that you offer.
Travis Ca (35:05):
Dentalinsuranceguycom .
That's great.
I like complexity, you know.
Paul Etchison (35:09):
Yeah, yeah, great , great domain.
Well, man Travis, thanks somuch, man.
It was a really great episodeand I know, gosh, sometimes I
have guests on and I'm justasking questions for the
listeners, but this was a lotfor me.
I mean, I learned a ton and Iknow if I learned a ton,
everyone listening learned a tonas well.
So, man, I love what you'redoing in the industry.
That's someone who really gotdeep into the insurance and just
(35:30):
a very not the most fun subjectto become well-versed in, but
something that is such a largepart of our practices.
It's amazing we don't know moreabout it and I just love that
you put something together, anice program for dentists.
So thanks for taking some timeout of your day and coming on
the program and, man, I hope Ican have you back sometime in
the future.
Travis Campbell (35:49):
Awesome, it was a pleasure to be with you here,
paul, again.
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