Limoli & Associates | P.O. Box 420505 | Atlanta, GA 30342 1-800-344-2633

Where are the answers?

Part 2 of 3

Dental Insurance Today — September 2021

Limoli blog

Where are the answers?

As concerns the other hard numbers, look closely and scrutinize the following specifics in your office.

Utilization Reports

  • By frequency – how many total patients have the plan directly reimburse you? 
  • By total dollar – of those patients/plans that pay you, how much are they paying? 
  • For what are they paying? 

This series of reports will tell you where your money is currently coming from. Look at the procedures as well as the dollar amounts. Do not start the analysis process with your largest plans. You will want to tackle the analysis of the little guys first. Once you master the skills and process with the smaller plans that are in your office you will be better prepared for the bigger plans with the higher dollars.

New Patient Data

By employer as well as by specific plan – are these patients coming to you because of the benefit plan and your willingness to accept authorization for payment and wait on the check from the plan? This is a tough question to ask yourself. Patient loyalty is one thing, but the family financial budget is another. 

By frequency – how many new patients are plan-dependent? Is the patient most loyal to the plan, employer or the level of care they receive in your office? How easy is it for your office team to talk money with the patient?

By encounter – why and how are new patients coming to your practice? For overall longevity and practice depth existing patients need to be your largest referral source.

New patient flow is the lifeblood of your practice. Qualify the new patient parameter not with just a comprehensive evaluation and diagnostics. A new patient is not quantified until the first phase of the treatment plan is initiated. The same goes for emergency treatments. They do not count as new patients until the treatment sequencing begins. Make sure your new patient number is accurate.

Since most all participatory plans will not directly pay an out-of-network provider office, new patients may be hesitant to pay the total cost out of their pocket.


Tom Limoli
Tom Limoli
“The Nation’s Leading Reimbursement Expert”
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