EP 98: Tips for Getting Insurance Claims Paid with Dr. Travis Campbell

In this episode of The Double Your Production Podcast, Dr. John Meis and Wendy Briggs sit down with Dr. Travis Campbell, a dental insurance expert and dentist who teaches teams how to navigate the complexities of insurance. Known as “the dental insurance guy”, Dr. Campbell understands the nuances of insurance and helps practices get fewer denials and make more money in insurance reimbursements.

In this episode, you’ll learn:

  • Common insurance myths and what the insurance laws and contracts actually say
  • How to navigate underhanded insurance tactics and get your claims paid
  • How to anticipate incorrect EOBs (and what to do about it)
  • Where to find up-to-date laws in your area regarding insurance
  • Simple ways to improve your documentation (how detailed notes, charts, and photos can help you get better reimbursement)

Listen now:

Bio:

Dr. Travis Campbell has been a practicing dentist since 2009 after graduating from Baylor College of Dentistry in Dallas, Texas. He loves the clinical side of treating patients, yet early on he developed a similar passion for the business side of running a practice.

In addition to seeing patients, Dr. Campbell is an author, trainer, speaker, consultant, and contributor to various online dental communities. Having gained a reputation as a resource for other dentists in the complex area of dental insurance, Dr. Campbell’s new moniker is “The Dental Insurance Guy!” From understanding insurance to developing strategies to accelerating practice growth, Dr. Campbell delivers practical, actionable content that dentists and team members can use immediately. He dispels many of the myths and misinformation around today’s dental insurance policies and explains how to navigate the complexities of being an exceptional dentist, business owner, and leader while still having a life outside of work.

You can learn more about Dr. Campbell at: https://dentalinsuranceguy.com/

Speaker 1:
Welcome to the Double Your Production Podcast with the Team Training Institute, the one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it, who are in the trenches, who know exactly what you are going through. And now, your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs.
Dr. John Meis:
Hey, everybody. Welcome to this episode of the Double Your Dental Production Podcast. I'm Dr. John Meis here with Wendy Briggs, and our great guest, Dr. Travis Campbell. How you all doing today?
Dr. Travis Campbell:
Doing well, John. How are you?
Dr. John Meis:
I'm doing absolutely great. Wendy, how are things there?
Wendy Briggs:
Hey, can't complain. We're here, we're happy, we're about to have a great conversation. I'm excited. I've been looking forward to this one for quite some time, so all good on this end.
Dr. John Meis:
I am too. This is the first time that Dr. Campbell and I have had a chance to meet, so it's nice to meet you. I've heard a lot about you. Why don't you let our audience know what it is that you do and what you're known for?
Dr. Travis Campbell:
Well, I am a dentist. I still run clinical practice. I've got two offices, but the main thing I'm known for is, I'm the dental insurance guy. I teach people how to get less denials, how to make more money dealing with the insurance companies, and just how to navigate all the nuances of how to deal with insurance. It's always fun because there is several things that I see on a very regular basis on just myths that most of us think one thing and yet, the source material and the laws and the contracts actually say something completely different.
Dr. John Meis:
Oh, that's a great topic. What are some of those? What are some of the myths?
Dr. Travis Campbell:
One fun one is that, and Wendy will probably love this one, EOBs are always correct. My team will probably tell you just like most team members will probably tell you, we find at least one incorrect EOB every day. Something that says just the absolute wrong numbers, tells you to write off something that contractually you are not obligated to write off, tells you that they paid something that they didn't. It's amazing how many times just a straight computer chart can be off.
But the main one I talk about is EOB softwares were generated typically 20, 30, 40 years ago, and state laws on non-covered services were created typically somewhere between 2000 and 2010, and so the EOBs have no idea what to do with that. You get this little asterisk at the bottom that says in certain states, your dentist can charge you full fee. Yet, as we all know, most team members have no idea what that means, and I haven't ever found a patient who knows what that means. You get these EOBs that tell you one thing, and yet state law is telling you the exact opposite. That's one of the major ones I talk to people about.
Dr. John Meis:
Sure. Yeah. How do you manage that in an office? How do you spot it? How do you communicate with patients about it? Because the insurance company might be communicating with them differently than what the state law would suggest is the right way. Yeah?
Dr. Travis Campbell:
Well, it comes down to this discussion I usually start most speeches with, if I give one, is in order to understand the insurance company, you realize you've got two perspectives looking at the same thing. In order to come together, somebody has to change. I still have yet to find a way to change the insurance company, what they do on a regular basis. Once I find it, I'll let you know.
Dr. John Meis:
That'd be good.
Dr. Travis Campbell:
But the answer to this-
Dr. John Meis:
I've got some ideas for changes.
Dr. Travis Campbell:
Yeah. Yeah. Yeah. Well, I've got some ideas, too. Now, whether or not they're going to like them or not, that's a whole different story. But the number one thing is to change what we are doing, and one way to change what we're doing is especially if state law says a certain service should be full fee and we know it's not going to be covered. Don't even involve the insurance company in the first place to send you an incorrect EOB. Click it, do not send insurance, and then you're good. And then you don't even have to have the discussion where, well, the EOB says one thing and you're telling me something else. Well, don't have the EOB and then you fix the problem.
Dr. John Meis:
Yeah.
Wendy Briggs:
Yeah. I think that's such sage advice, but we see team members in a straight up panic because they don't know how to do that, or they've been taught that's not correct or not right. You're the dentist, right? Dr. Campbell?
Dr. Travis Campbell:
Mm-hmm.
Wendy Briggs:
I don't know if you ever run up against, a lot of times, we see where I sit in the hygienist chair specifically right now, especially right now, I see a little bit of a divide between what the doctor wants and what the team wants. How do you deal with that in regards to insurance? Because I see this divide in more than one way, as I'm sure you do too, regarding insurance. Team members are like, "Why do we have to deal with insurance?" Doctors are like, "We can't survive in this area without it." How do you manage that disconnect.
Dr. Travis Campbell:
This is where it's fun to put things together for people, but I just got from a conference I spoke at for two days this weekend. I had more team members in the audience nodding along and agreeing with me than the doctors, and it was because they're the ones who deal with insurance every day. We don't, typically, but this is what my team deals with. I tell them, "Look, would you rather have to argue with a patient that has an EOB in hand and that is telling you something different than what you notice to be true, or would you rather deal with them on the front end and go, 'By the way, if you want this service, we cannot send an EOB because insurance is going to tell you cannot have it'? Pick your poison." Of course, patients and most humans hate people telling them what they can and cannot do, so it's a great way to go.
Now, I want what I want. Don't send the claim. Awesome. We're good. Now, from the team members' point of view, and dentists, the thing I point out to them all the time when talking about the next myth is, should you send every claim or are you required to send every claim? Just look at your contracts. Your contracts do not require you to send every claim, but nobody ever reads them. There's only one contract in the country and I'm sure people probably can pick out the company it is, but I'm not going to just harp on people. But there's one company that says in certain ways, that you should send every claim for everything. I've got two responses to that. For one is, the way you read that contract language, it is open for interpretation. That's one thought.
The second thing though is, here's what I talk to people about. You've got state laws and you've got insurance contracts. I don't know about you, but the government has more authority than random insurance company A or D, and so you have to follow who is actually correct. And the state will always trump insurance. If state says one thing, it does not matter what your insurance says, because by the way, again, if you read your contract, somewhere at the end of the contract will say, all the clauses within this contract are valid, unless otherwise invalidated by state law. I'm like, "Oh, well there's your out."
Dr. John Meis:
Yeah.
Dr. Travis Campbell:
Yeah.
Dr. John Meis:
What's the best-
Dr. Travis Campbell:
It's just understanding legality.
Dr. John Meis:
Yeah. What's the best way for our listeners to really identify what the state laws are and how that applies to them?
Dr. Travis Campbell:
Well, they can go online and look for them themselves. The AAPDs had a link to the state laws for a long time. Now, sadly or unfortunately, nobody's actually gone in and updated those, but I did. On my website is a list of all the updated state laws, and it's constantly updated. By the way, there are three new ones in the last three years. One came out this year, one came out last year, one came out the following year. Now, there are 42 different states that have non-covered service legislation laws.
The other thing to do is, on that same website, as a free course is most of the myths. It's less than an hour and it goes through most of the major myths about insurance, and part of that is actually, I pull out the clauses of several major insurance companies on their insurance contracts and show people. This is exactly what's in your contract, read it for yourself and interpret it yourself. But the interpretations aren't that difficult. The fun part about it is, or the interesting part about it is, I get the question all the time of, well, why don't I just call the insurance company and ask?
I'm like, well, okay, for one, understand who you're talking to at the insurance company. When you pick up the phone, you're not calling their lawyer. You're calling their high school graduate who knew nothing about dental insurance a week ago, who was trained on, just like everybody else in every other corporate facility, a list of questions and a list like a little training manual, probably a few pages long, because that's the only way they could do it. You can never train every employee on everything that a corporation does. It's impossible. They're trained on a short list.
When you ask them a question outside their training list, they are not going to have an answer. Now, ideally they should tell you, "Well, I'm not sure." But as human nature is, like pretty much everybody in dentistry, where we do what we do to help people. We like to be helpful. If we think we have a correct answer, we will give you that answer. The problem is we guessed at it. When it comes to legality, how often can we guess about laws and be accurate?
Wendy Briggs:
Yeah, I would also add that-
Dr. Travis Campbell:
I'll leave that one up for interpretation.
Wendy Briggs:
I think too, in today's world, you can be on hold. I see posts all the time, on hold for more than two hours to actually talk to a live person. That's another part of the frustration. I wanted to ask this one, because this one comes up all the time not only with our members, but just professionally. It seems to be that now, insurance companies are being even more bold in some of the denials that they're doing.
We've long told people, "Hey, insurance companies themselves have admitted to blanket denials or certain percentage of the claims that they get." But now, it seems super ticky-tacky, and of course, I'm bringing my bias to the table, especially in regards to perio. It seems to me that insurance companies have decided that they can really make people miserable in this and deny perio that in literally anyone's standard, should be treated.
Then I saw one the other day that they denied it because it wasn't treated soon enough. It's really getting quite ridiculous. What are your thoughts on that and how can our listeners improve their acceptance of claims and claims being paid? I know you teach. There are some specific things that they can do to improve that. That's a two-part question.
Dr. Travis Campbell:
Okay. Well, Wendy I'm with you, because perio is one of my pet peeves. I'll say in dental school, our education on restorative was really good. Our education on perio was to be nice, almost non-existent. Most of what I've learned from perio, I actually learned from my hygienists, and then hygiene CE courses. It's amazing the things we don't know as dentists, because most of us don't like being gum gardeners. Most of us do not like picking up a perio probe. I don't know many of us who actually go read AAP regulations and recommendations. Perio is a big one for me.
The number one problem I see in perio is lack of correct documentation. I preface this by, I don't mean documentation from the insurance company's point of view. I mean, documentation of what a periodontist would do. Because again, there is this idea that as general dentists, if we do anything that's within a specialty realm, we are held to the standard of the specialists. Right or wrong, that's what it is. If we're dealing with SRPs, we're dealing with perio, we should deal with the documentation necessary that a periodontist would be held to.
Almost every claim I've seen, I get them almost daily, on pero denials, documentation was the number one problem. An incomplete perio chart was the top issue within documentation. It's amazing how many times we think we can just throw pocket depths at them and get approval. I'm like, "Perio is not diagnosed by pocket depths." Perio is diagnosed by clinical attachment loss, and you can't have that without the additional information. That's part of it is getting paid for what we're doing anyway. I don't know if that answered both of your parts, or was there a part I missed? Because your question was-
Wendy Briggs:
But that was really good. I'm going to ask you for a little bit more. You said complete perio charts. Is there ... Sorry, I'm losing it. Hold on, just one sec. It's coming back. It's coming back. That's what happens to me. Dr. John and I had a course this weekend as well. Sometimes coming back from the courses, we have to baby our voices a little bit. So I apologize for that.
Yeah. That was it. Just any other documentation you found that can improve claims being accepted? That was one. The second part was just games that insurance companies are playing. Are there any red flags to them for getting claims denied? Is there any consistent things that can lead to denials as well?
Dr. Travis Campbell:
Well, obviously putting in correct information in the claim is one big one. Most of these claims are run by computers first. If all the claims detail is not in there and it's one letter could be wrong, like a patient's name, it gets rejected before it even sees a person. That's one big issue is make sure your system has everything in there correct. I assume most people by now are doing electronic claims. If you're not, then you need to have somebody who has zero chance of having dyslexia, because you've got to get every little thing right.
The other thing is just making sure that you're documenting everything thoroughly to send out with that claim. Now, do we get denials even when we send everything out correctly? Yeah. Like you said, insurance companies have admitted in the past to just red-stamping a claim, not even looking at it and sending it on. Well, here's the challenge, and I tell teams, sometimes we are at fault for some of these problems and this is one of them. On average, a claim that is denied across the dental insurance industry, 50% chance that claim will never be appealed.
But what have we just trained the insurance company to do? If they red-stamp claims, half of them will never come back. One answer is appeal every claim, if you don't think it's right, and in many cases they're not. Half the times, we can appeal it just by sending back the same information that gets approved. It's like, hmm. Yeah. That was just a delay tactic. It is what it is. Now, are delay tactics good or ethical? No. Are delay tactics things that should not happen? Yes. Is there anything we directly as a dentist can do? No.
Again, it's changing ourselves. Appeal everything, and magically, a lot of these claims just come back. But it's also knowing what's in there. Yes, we talked about perio chart. Perio chart's huge. I also ask the question, what's worth more than 1000 words?
Dr. John Meis:
Picture.
Dr. Travis Campbell:
A Picture. Yeah. Take photos of probes in the mouth, with blood. It's amazing how these work. Again, you go back to the claim reviewer, who's probably a high school graduate and has never seen in-the-mouth in the first place, and they see a bunch of bloody photos. What are they going to do? Ugh. Approve. I don't want to see this again, and move on. You laugh, but it's fun. But it's true. Then you've got to look at, okay, we've got some clinical notation needs.
Some insurance companies now are asking for, which tooth or which teeth are infected when we're dealing with perio. Now, of course we can ask this. The normal, obvious question is, well, the teeth are on the perio chart. Yes, they should look at that. In reality, a lot of times they don't. In our clinical notes, we just mark which teeth have four plus millimeter pockets with bleeding and clinical attachment loss. That's it. Just, it's in the chart. We cut and paste it. Simple. Takes five seconds to click all the teeth and hit go on most softwares.
Then you look at a lot of times insurance companies now are asking for how much time we spent, so we actually insert that into the clinical notes. Again, just something to cut and paste for the front. It should be on average somewhere, at least minimally, 43, 41 is 30 minutes, 43, 42 is 15 minutes per quadrant. You add that up, you put it in the chart and you go. Then the last part is just knowing that there are other minor details that should be in there. We should naturally be healthcare providers.
Unfortunately, in the dental realm, a lot of us, our clinical charts are a little suspect compared to what a physician would write, and so we've just got to up our game a little bit. If you see red, bleeding, swollen tissue, write that in the note. If you smell the perio, write that in the note. All those details that hygienists, they just think about, they sleep, they probably dream about these things, those go in the clinical charts. Then when you get a denial or a delay tactic, you send all this other stuff with it and it's just more information that supports what you did.
We get the question all the time. Well, insurances are saying that it's because X-rays don't show the damage. I'm like, "How much bone loss do you need for an X-ray to even start showing damage?" We all know this for interproximal cavities. It's like 60%. But we forget the fact that bone and perio is no different. You can have 60% of bone loss and you don't even see it on the x-ray. You've got to realize the majority of what that is, is the insurance company, it's the only option they give the reviewer is for pero denial is there's not enough bone loss on an X-ray.
But in reality, what they're saying is, your documentation for everything else is not good enough to support reimbursement. Improve documentation and they'll stop getting that note.
Wendy Briggs:
That's really great insight.
Dr. John Meis:
Yeah, it really is. I appreciate the, if we hold ourselves to a higher standard on our documentation, we're going to get better reimbursement. Not that that forgives the insurance companies for all their misdeeds, but start at home and fix what you can fix, and that can make a lot of progress that way.
Dr. Travis Campbell:
Yep.
Dr. John Meis:
Yeah.
Dr. Travis Campbell:
I think the number one, and I'm sure Wendy will agree with me on this one, the number one untreated, undiagnosed disease in the world is perio.
Dr. John Meis:
Yeah.
Wendy Briggs:
Absolutely.
Dr. Travis Campbell:
I think one of the major reasons is because we fear that we can't get reimbursed. Well, we don't have that fear because we get 99% reimbursement on SRPs. The 1% are the cases that they're teenagers, there's all sorts of other things, but they don't fit the normal demographic for what you would expect for a pero patient, and so we collect upfront from the patient for that. We're still going to fight it, but we know those are the cases that might get denied and so we've already got our money.
The 1% denials aren't denials on us getting paid, they're just denials on reimbursement, because the insurance company may say several different things that says the policy doesn't cover reimbursement. That's one of those big things that we all have to understand as team members and dentists, that a lack of reimbursement may not be, or definitely isn't them saying you shouldn't have done the treatment, because they can't say that.
There's no legal way an insurance company or a dentist that has never clinically seen the patient can say you did incorrect treatment. What they can say is your documentation doesn't reach the level for reimbursement of the treatment per the policy, and that's a whole different story.
Dr. John Meis:
Yeah. That's awesome. Dr. Campbell, you mentioned your website and some resources on there. Can we share with our listeners what the URL is for that? We'll put it in the show notes, but can you share with us what that is?
Dr. Travis Campbell:
Sure. Dentalinsuranceguy.com.
Dr. John Meis:
Awesome.
Wendy Briggs:
Awesome. Yeah. Very good. Very good insights. As I said before, I think one of the biggest disadvantages we have is sometimes when people ... You started out talking about myths, and whenever somebody goes online, on social media, or asks a question of how can I get this covered, you have all the armchair quarterbacks saying, "Just drop plans. Why are you still participating? Get rid of insurance and your life will be so much easier."
We absolutely think, to each their own, but we know as well with our work, the most successful practices that we work with accept all kinds of insurance, and so there is a way to do it well. There is a way to do it right. There is a way to absolutely not reduce the quality of your care when you participate with insurance, but wouldn't it be great if you could have the best of both worlds, which means be able to accept the insurance and minimize the headaches?
I think that's why we wanted to have you on the podcast is to help our listeners understand there are some things we can do to make accepting insurance and dealing with insurance so much better for everybody. I think you have taken a lot of time to figure out the right way to do that, and so we certainly appreciate your insights today.
Dr. Travis Campbell:
Well, the other fun thing, because I see it all the time too, I think the movement to drop insurance companies across the board has gotten exponentially larger since COVID. It used to be a very small voice. Now, it's a huge voice. But the funny thing is, if you're dropping it because you're not getting approvals, to realize you're not going to get approvals out of network either.
Reviewers have no idea when they see a claim on who's in or out of network. They're purely doing it on, is there policy coverage for this service, and is their documentation match the checklist? Neither one of those is going to be affected by whether you're in or out of the network. That's why I tell people, "If you want to drop network, great, go drop it."
But if your challenge is getting approvals, getting reimbursement, then you should fix that problem because your network status has nothing to do with that. That's what's always interesting to hear when I hear people say that as the reason for dropping. I'm like, "That's not going to fix your problem."
Dr. John Meis:
Yeah. That's a really good insight. Yeah. For sure. All right. With that, we'll call it a day. Dr. Campbell, thank you so much for being on. Thanks, everybody, for being with us, and we'll see you on the next episode of the Double Your Dental Production Podcast. Good day, everybody.
Wendy Briggs:
Thanks, everybody.
Dr. Travis Campbell:
Thank you.

Resources:

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