Has your dental office been speaking and marketing to physicians about oral appliances but receive fewer referrals than expected? One reason may be that you are not contracted as a participating provider with medical insurance. Most insurance companies have taken steps to minimize the use of out-of-network providers, including significantly higher deductibles, higher coinsurance percentages, and even Out-of-Network Consent Policies and patient notification forms.
Physicians recognize a discord is created when their patients receive large bills because of using an out of network facility. Having marketing sleep testing services (Millennium Sleep Lab) to physician offices for several years, one of most common questions I get asked is, “How much will this cost my patient?”, and saying it’s covered by insurance is sufficient. Physicians understand that patients are experience rising healthcare costs and want to find a balance of quality patient care and affordability. If they know that your services will be out-of-network, they will naturally restrict referrals to only patients that have tried every other option or that they know can afford the service. As a result, you are missing out on many patient that could benefit from dental sleep therapy.
Additionally, many insurance companies have an Out-of-Network Consent Policy that requires the referring physician to advise the member that he or she will be paying out-of-network cost sharing amounts and will pay much higher amount than if they were to go to an in network provider. For some plans, an Out-of-Network Consent form must be signed by the patient that emphasizes the patient will have far greater financial liability when using a non-participating (non-par) provider. This process is time consuming for the physician staff, because of the added documentation and the time explaining and discussing options with the patient. Some insurer’s administrative policies state that “whenever possible” a participating (par) provider must refer to other par providers (both professionals and facilities), and in recent years, have even started sending letters threatening that if the physician does not discontinue referring patients to out-of-network providers and start referring their patients to in-network providers, they would be terminated from the insurers’ network.
This creates a dilemma for the physician knowing many of his or her patients do not have out-of-network benefits, and a high percentage of those that do will have a high deductible or will not sign the consent form.
Sleep Impressions has a solution. As an in-network provider with most major insurance plans, we can alleviate the roadblocks you are facing when marketing your services to physician offices. Not only will you receive more referrals, you will also see an increase of patients going through with oral appliance therapy by minimizing out of pocket costs.
From CEO Jeff Scholtes