When a dental practice based in Washington reached out to Elevate to discuss dental billing and insurance verification services, it was not the first time this practice had opened a dialogue. The practice had considered using Elevate but ultimately opted for another company with a slightly lower collection percentage. However, the practice discovered that some of the promises made by that company were not being fulfilled, which required the doctor to engage in constant oversight of the dental billing partner. Typically, utilizing a dental billing partner saves both time and money, but in this case, the doctor’s attention was being split between her patients and managing the dental billing company.

Several factors further complicated the doctor’s situation. First, she had decided to move out-of-network from all dental insurances, but she still had outstanding claims tied to carriers. By moving out-of-network, she needed to understand what she should be collecting from her patients at time of service. She also wanted to help her patients get reimbursed through any benefits for which they might qualify. And lastly, she would need a patient portion dental billing solution to accommodate her new business model. Her existing dental billing company offered a version of these services, but in a more “one size fits all” format; she was in search of a modified set of solutions that could adapt as her practice evolved.

Elevate engaged a team comprised of sales, operations and business support leaders to evaluate this dental practice’s situation and collaborate on a sustainable and economically efficient solution. For example, the dentist thought she would require a complete breakdown to verify each existing patient based on that patient’s insurance, but her volume of patients was enormous. A project of that magnitude would likely be cost-prohibitive, given that complete breakdowns are typically reserved for new patients or patients with new insurance. Elevate recommended taking a different approach and conducting an insurance consolidation project for the dentist. This project would involve assessing up to 20 insurances that were most used by patients and determining fee schedules from that angle. This option fell within the dentist’s budget and would ultimately accomplish the same goal. Following the insurance consolidation, only new patients would require complete breakdowns and all existing patients would be tied to their respective carriers.

The dentist and the Elevate team also joined forces to develop an out-of-network dental billing solution to help the practice reimburse patients who paid upfront due to the practice’s new out-of-network status. In this situation, the practice would collect the fee for service from the patient, and Elevate would submit a claim on behalf of the patient for a flat monthly fee based on volume. If the patient was eligible for any reimbursement, the insurance would send the payment directly to the patient. This allowed the practice to provide a valuable service to its insured patients while also freeing the practice from the time-consuming task of managing any incoming insurance payments and distributing them to patients. Further, Elevate proposed a special project to work the aging that had accrued while the dentist was in-network, so she could get what she was owed from the insurance companies. Elevate would assess a percentage of the collections as its fee for this solution.

Finally, the dentist and the Elevate team worked together to develop a patient portion RCM solution that would both leverage the efficiencies of today’s technology and automation while maintaining a personal touch with patients, a high priority for the dentist.

The Elevate team is often asked why it does not publish pricing for its services, and this case is an ideal illustration of why. Only the individual practice owner can fully understand his or her financial needs and goals, which is why a customized approach is so critical to fulfilling those objectives. Through extensive collaboration and creativity, Elevate and this dentist were able to design the ideal suite of solutions for this practice, developed with the foresight that continued evaluation, growth and adaptability would be key aspects to the partnership.