Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Saturday, August 20, 2011

When Your Doctor Sells Credit Cards

This was the title of a WSJ mid-July article and it caught my attention, more because I didn’t think the general public cared about the topic than that I would learn anything new.

There seems to be a resurgence of dental subjects in the media lately. This is partly due to greater dissemination of information regarding links between oral health and general health, but also, as the WSJ article states, there has been an increased desire for people to want medical and dental services that are not covered by insurance, and that are expensive: teeth implants and cosmetic procedures in dentistry, but also plastic surgery, corrective eye surgery and even expensive veterinary services.

I recently returned from Chicago where I was an observer on coding of dental procedures and was interested in cross-over codes between medical and dental. For example, there is a procedure where blood is centrifuged, decanted, and the enriched plasma is placed in a surgical site to enhance healing. Dentistry is beginning to find interest in codes that tell WHY a procedure is being done. For instance, high risk medical patients, like diabetics and patients with coronary heart disease may benefit (as will insurance carriers and employers who pay for health care) from frequent teeth cleanings. So we could use a code to identify high-risk patients.

Because there is increased need for financing to pay for services not covered by insurance, there are at least three financial institutions who have credit cards designed to pay doctors for the care they render: J.P. Morgan Chase & Company has ChaseHealthAdvance, Citigroup, Inc. has the Citi Health Card, and the first and still biggest is called CareCredit offered by General Electric’s GE Money unit. I am most familiar with CareCredit, but am sure the others present similar problems.

I first ran into problems with CareCredit almost from the time it was offered, more than ten years ago. As a member of the ADA I was approached to accept CareCredit, as payment for large cases. Like all credit cards, the appeal was on several fronts: I would have greater acceptance of my treatment, I could separate case acceptance from finances, I had no accounts receivable problems (Because CareCredit would buy the debt, albeit at a reduced cost), no default worries, and the credit check was out of my hands. Many dentists signed up. But almost immediately issues that began to crop up.

If the dentist got the patient’s permission, the total treatment plan would be paid at an early, sometimes even first, appointment. The patient didn’t necessarily realize that as there was a grace period before any payments began, sometimes as long as a year. But if the patient failed to proceed with the entire treatment, they would have overpaid and since I had sold the entire debt to CareCredit for something like eighty cents on the dollar, I could not easily refund for the overpayment. This is awkward and if the patient did not complete treatment because they were dissatisfied, extremely awkward.

In California, if the patient was a member through a managed care plan, prepayment was essentially illegal, since only copayments for services rendered could be collected and then, only at time of service. These refunds became such a problem that the California Association of Dental Plans invited top management of GE Money unit to a meeting to discuss our problem and hear suggested solutions. Although sincere promises were made by GE to better train the dentists using CareCredit and to establish a dedicated liaison CareCredit staff person to assist patients, five years have passed and the problem still exists, even on the Medicare, Medi-Cal side.

So, for those of you who are considering a healthcare credit plan, I will echo the advice of the WSJ:
• Be sure you want to complete the entire treatment plan and have confidence that the end result will be satisfactory
• Alternatively parse out the care and ask for credit unit by unit (this will NOT be the doctor’s choice as the doctor receives more of a higher dollar contract)
• Be sure you know the terms of the promotional grace period to avoid an unexpected balloon payment
• If your primary healthcare is through a managed care plan, separate covered services from non-covered services and pay for covered services without including them in the credit contract
Next Blog I’ll tell you about my wife’s birthday and see if I can hit some responsive chords.

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