The Debate Rages: Fee For Service vs. Medical Billing

by Mona Patel, DMD

Accept medical insurance. Contract with a medical billing company. This is the dictum proclaimed from most dental sleep medicine courses. Lecturers claim significant money can be made if you buy their software or use their medical billing services. It sounds very appealing, but if you’re like most dentists, including myself, then your experience with medical insurance is quite the opposite.

Getting started in sleep was challenging enough! We had to learn which home sleep test to use, what to charge, which appliances to use for which patients, how to treatment plan sleep appliances, and how to build systems for our team. The last thing I wanted to do was add medical billing to the seemingly overwhelming and ever-growing to-do list. So, I didn’t. Instead, I started my sleep program with a fee-for-service (FFS) model.

Now, several years later, I can confidently say that I wouldn’t have done it any other way. Other colleagues of mine do successfully use medical insurance reimbursement in dental sleep, but for our team – simplicity was key to optimal results. In my experience, here are some of the benefits of using the FFS model:

• Simplifies collections
• Reduces confusion for patients
• Creates value-focused treatment plan
• Allows for 3rd-party financing options

In our practice, patients can feel confident in exactly what they are getting, what they are paying, and the options for payment. We focus on building tremendous value and making it very easy for our patients. This has resulted in a very favorable case acceptance rate. I am not boasting, but some of my insurance-accepting colleagues have shared that our acceptance rates are significantly higher than theirs. Without the hassles and headaches.

Medical Insurance Isn’t All Negative Though.

Here are some pros:

• Potentially reduced cost for the patient
• Potentially increased case acceptance
• Potentially appealing to referring physicians
• Adds value to your office offering alternative financial options

What About the Negatives of the FFS Model?

Long ago, our general dentistry office adopted the FFS model, so there were no implicit switching costs. Having said that, if you accept dental insurance, patients may ask why you don’t bill medical insurance. When this happens, we explain that we are not contracted with insurances and offer to provide any documentation they need to pursue reimbursement independently. This could potentially be perceived as a negative, but we view it as an opportunity to build more value.

What About Negative Aspects of Medical Insurance?

When we initially attempted to bill medical insurance, we had some undesirable experiences and uncovered these negatives:

• High patient expectations
• High deductibles that patients couldn’t afford
• Low coverage limitations
• Complicated workflow
• Confusing timeline

For our practice, medical billing added cost, complexity, and confusion. Patients would get upset when we had to send them a bill for the remainder of their treatment plan 30 days after we provided the appliance. This was because they wrongly thought medical insurance would cover 100% of their treatment plan and because medical insurance doesn’t have to respond to a claim until the 30th day of submission (after you deliver an appliance).

As anyone that has had to endure lengthy hospital stays can attest, medical insurance isn’t bad. It can be beneficial for practices and can contribute to building physician relationships, building value, and contributing to long term referral potential, but it isn’t required to succeed in DSM.

“…some of my insurance-accepting colleagues have shared that our acceptance rates are significantly higher than theirs.”

For our practice, it made sense to use a fee-for-service model; to keep it simple, increase production, and build value.

Medical billing isn’t the only way to do sleep in your practice. Consider the options and decide what is suitable for your patients and your practice.