Dentaltown January 2017 - 43

orthodontics

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Powerprox 6-Month Braces
(Trouble Getting Started)

A Townie asks for advice about insurance predeterminations and procedures when it comes to orthodontic work
Dentaltown.com > Message Boards > Insurance > Claims Processing > Powerprox 6-Month Braces (Trouble Getting Started)

I took the course about a year ago. We are presenting to patients and they are wanting the
treatment. They ask how much and so I refer to my office manager. I noticed no one was moving forward, so I asked what the problem was-she is requiring a predetermination on all the
patients with insurance. She says that she cannot tell the patient what insurance is going to pay
without it, and that some PPOs reimburse or have a contract fee so low that I would lose money
on doing the treatment. Our practice is 95 percent PPOs. Those of you who have a patient base
like this, how do you do it? ■

drjconnell
Member Since: 06/21/07
Post: 1 of 115

3/4/2010

It's important to bring some procedures into your practice that are fee-for-service. Insurance
for ortho is generally minimal and I tell people that it will help them out a bit, but they can't
rely on it for full or a substantial part of the fee. I present patients with the treatment plan,
create a value to them-meaning I discuss how this will help them now and in the future both
cosmetically, periodontally etc.-and give them a fee that I feel is reasonable for me, and then
let them decide. The key is creating a value and they will come up with the money independent
of their insurance. Works sometimes, and other times people just don't commit. ■

jeffc418
Member Since: 04/19/05
Post: 2 of 115

3/4/2010

First of all, I would stop doing pre-determinations. All pre-d's do is prevent you from doing
more cases (whether they be orthodontic or otherwise). Also, with ortho you want to collect the
entire fee regardless of insurance coverage. You fill out the forms for the patient, but have the
money go directly to the patient. The insurance company tends to play fewer games that way.
(I do this only for ortho-if I happen to be doing a crown, I collect the copay and then submit
insurance.) This will save you a lot of aggravation and prevent the "cooling-off" period that
pre-d's were designed to create. You want to get the patient started when they are excited, not
after six weeks.
In regard to PPOs, some docs have had success with the 8999 Misc. Ortho; others submit
for everything records, braces, retainers, etc.
You may want to call Margie at Powerprox. She knows ortho insurance very well and she can
help you better than I can. ■

drrick
Member Since: 03/19/00
Post: 4 of 115

3/7/2010

Some PPOs require predetermination prior to treatment. That is part of my dilemma. The
other part is my office manager (who used to be a consultant for and own Fortune Management)
believes that PPOs reimburse so low that I would be losing money to see these patients. I don't
get that, because all the restorative I do is reimbursed low and I am still making a little money.
Also, I am not sure how to code things and hopefully Margie will help straighten that out for us
later this week. Once I get some answers, I will post them for you all.
What are some of you doing to get the word out about Powerprox? Right now my hygienist
is really selling it. I would like to put something in their hands, though. ■

drjconnell
Member Since: 06/21/07
Post: 12 of 115

3/9/2010

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