Date: Fri, 12 Oct 2007 00:10:06 -0500
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 12 Oct 2007 to 11 Oct 2007 (#2007-75)

There are 5 messages totalling 746 lines in this issue.

Topics of the day:

  1. Handling patient insurance
  2. Handling patient insurance
  3. Invisalign
  4. New Office


Date: Friday, October 12, 2007 1:19 PM
From: Lively Orthodontics, P.A. <mdlively@BELLSOUTH.NET>
Subject: Re: handling patient insurance

Hi Rob: We are not a provider for any plans but do accept payment from the few companies that do not have a list of required providers.   We take the insurance off the top and the remaining balance is used to calculate the downpayment and monthly payment for the responsible party.  The insurance company will also provide a downpayment along with a monthly.  We do not tie it together.  We do not let the responsible party use the insurance money as part of their downpayment as it is different for all insurance companies.  We then have one contract with the insurance company and one with the RP.  $5000 fee - $1000 INS = $4000 balance for the RP.  It has worked well for us but be careful.  Our contract includes a clause that states should the insurance company fall more than 90 days behind, we will move that balance over to their account.  What we do from there is dependent upon the balance.  Also, make sure that anything remaining on insurance is settled when the braces are removed.  I do not have an problem with a balance remaining on the RP account if I finish early as I am still following them for 12-18 months with the retainers.  But, sometimes the policy is dropped or the RP changes employers and you are stuck with the bill if your staff is not on top of things.  This is rare but can be an issue.  

With warmest personal regards,



Date: Friday, October 12, 2007 11:09 AM
From: Diane Johnson <DHMJDDS@AOL.COM>
Subject: Re: handling patient insurance


My philosophy has always been to make getting and having orthodontic treatment as easy as possible for both the patient and their family.  Why put insurance roadblocks in their way?  We have always taken care of all the insurance for the patient. We research benefits before they even come to the office the first time, so we can let them know as exactly as possible what their insurance will cover and therefore what their out-of-pocket will be.  We file all their forms for them and accept assignment (actually, we expect assignment).  We follow up when the insurance company does not pay as expected.  We figure out coordination of benefits when there is more than one insurance covering a patient. Patients and parents don't understand insurance at all.  Make it easy for them.  We have a big two-doctor practice with one financial person who handles all the patient and insurance billing.  She does not do payables, we handle that ourselves (way too much opportunity for embezzlement, in my opinion).  She is extremely knowledgeable about all the various insurances and flex plans.  There is one exception--TMD patients.  We do have TMD patients pay in full for their splints, etc. and then file their claims with benefits going to the patient.  We have been burned way too many times on these patients. Isn't it amazing how once you get someone out of pain, they forget that they need to pay their bill?

Diane Johnson


Date: Friday, October 12, 2007 10:51 AM
From: Diane Johnson <DHMJDDS@AOL.COM>
Subject: Re: New Office


My advice would be to hire a firm that specializes in orthodontic office design.  Don't reinvent the wheel!  Experience in this area is the key to a design that you will love, rather than one you might regret.  We used a company that has since gotten out of the field (Dental Direction); they left the field of ortho office design so they wouldn't have to travel all over the country any more.  Their work was worth far more than it cost. Some things a specialty design firm will be able to help you with are lighting (which is absolutely critical), plumbing, computer cabling, phone cabling, room layout and extra touches like coffee bars, play areas, video games, etc. etc. that we really need in our offices these days. Use suspended ceiling.  It may not be the most elegant (although there are some really nice panel designs now), but it will give you the ability to run new cables, etc. through the plenum later.  You'll find that to be really important in a few years.  Run more cables or fiber than you think you could possibly ever use (cuz you'll add even more later).  Run conduit down solid walls.  Have several electrical circuits for each room, especially sterilization and in the lab.  Put sound proofing in the lab walls.  Be sure to have plenty of storage room, either a true attic (easily accessed), a basement, or a room that is intended for storage.  If you still have plaster models, be sure you have plenty of room for their storage, as well.  We have some special heavy duty rolling cabinets from DenStor that store an amazing amount of stuff in a relatively small space. After your plans are all finished, get at least three solid bids from well-respected construction companies.  Use Angie's List to vet the companies before you even contact them (if Angie's List is available in FL).  Don't use your brother-in-law or a patient for construction unless you really like pain and suffering. On your part. Make sure your plans are actually finished before you bid them out to avoid those expensive change orders. Good luck!  You'll love it when it's done.

Diane Johnson

Date: Friday, October 12, 2007 9:28 AM
Subject: Invisalign

After reading the article by Dr. Boyd in the September issue of the JCO, I have some concerns.  I hesitate to insult Dr. Boyd and I respect him for his contribution to the orthodontic profession, but where is our profession heading with Invisalign?  Invisalign reported recently that in the United States, 58% of cases treated with Invisalign were treated by GP's.  Orthodontists are supposed to set the standard of care, aren't we?  After seeing the cases treated in the JCO article, I am asking WHY ?  Are these the kind of results that we should aspire to?  What are these inferior results saying about our expectations and standards to general dentists?  What's going on here?

Dr. Greg Scott
Lakeland, FL  


Date: Friday, October 12, 2007 9:23 AM
From: Mary K. Barkley, D.D.S. <mkatbark@COMCAST.NET>
Subject: Failed Initial Consults

Dear Mark,
The best thing that I did in building my new office (one year
anniversary last week) was to work with an experienced design company. I
built my first office with an architect that had minimal experience in
dental offices, and there were many design glitches that were not easily
corrected. This last time, the quality of the result is much better, and
my stress level was much, much lower.
Mary Barkley
Chelsea, MI