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Love & Orthodontics
Love & Orthodontics
Dr Chris Baker is a pediatric dentist, faculty member of three dental schools, longtime AAPD member and American Orthodontic Society Past President. She practices in Texas. Dr Chris writes about orthodontics, pediatric dentistry and life.
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drchrisbaker
drchrisbaker

Doctor, 'Insurance-Company-Speak' is not your Mother Tongue

Doctor, 'Insurance-Company-Speak' is not your Mother Tongue

4/13/2018 5:30:26 AM   |   Comments: 0   |   Views: 68
The languages dentists have to learn! 

Do you-speak 'insurance company-speak'?  
Do you speak 'parent-speak'?  
Do you-speak 'child-speak'? 

Today I am looking at insurance company-speak. 

And btw (by the way - that's 'text-speak') - “corporations” here refer to insurance companies, big box and other corporate dental practice owners, and government entities including Medicaid and Medicare, all of whom skim your money off the top, so you do not get paid what you have earned.

What on earth are you paying them for?

The privilege of keeping some of your money after you spend more money paying staff to file claims for the patient, to wait on hold on the phone for hours, literally, waiting to talk to the “corporations” to evaluate how much of your money they will send to you, file appeals, and then find out the appeal reached the corporation after the “deadline”.  Why is there a deadline on getting your money?  

I am a dentist, not a provider.
Provider sounds like a waiter.
Provider, they say, as if somebody has to help you do your job.
Provider means anybody can do it – it does not imply many years of school, experience, professionalism, licensing, board examination and wisdom.

“Provider” is insurance-company-speak, just like;

“Usual and customary” - whose usual?  whose customary?  Not yours, for sure!

“Acceptable” - to whom?

“Estimate of benefits” (EOB) - that is the patient’s benefits - it should have NOTHING to do with you.  they are not be YOUR benefits.  Because they are not benefits at all, but rather the “spoils” left after the corporations took a lot of your money.

“The network” - a list of doctors whom the corporations have convinced should share their income with the corporations.

“Participants” - see “the network” above

“Network providers”  - see “the network” and “participants” above.  Amazing how many names you are being called.

“participation” - the act of becoming a “network provider” or “participant” and reaping the losses as you pay the corporations.

“Healthcare” - insurance-speak for disease care; the acts and services of restoring diseased organs in the body, of addressing adverse growth and development, and at disease care’s best, of working to help the patient PREVENT disease and adversities of growth and development.  
“Healthcare” is also the name the corporations use for themselves, and not for the practice of medicine that you provide.

As Dr.  Paul Henny reminds us, we don’t make health; that is something that cannot be bought by the rich nor given to the poor.  It is something the patient maintains and works on and with.

Interestingly, the corporations have successfully made the education of patients and parents as to how they can take responsibility for their health, a “non-reimbursed” “service.”  In insurance-speak, this means it looks completely worthless to the corporation and relatively worthless to the patient. This leaves the impression that the doctor who is dedicated to helping the patient learn prevention can just do it for free.  

And now, the corporations are taking on the diagnosis of your patient.  They are defining what periodontal disease is, for example.  (Insurance-speak parameters for periodontal diseases may not even include the presence of calculus, or pockets of a certain depth.)

It’s amazing that an administrator/clerk/bureaucrat working for an insurance company/corporation in another state purports to know your patients’ conditions more than you, even though you’ve been treating the patient for many years. 

Think about it - do you really want to continue contributing to the corporation executives’ seven-figure incomes out of your pocket?  Do you want to continue working for that?

The story of the frog comes to mind, who finds himself in cool water and doesn’t understand there is a burner under his pot of cool water.  As the water gets warmer and warmer, the poor frog doesn’t realize he is being cooked and will soon be dead.  

Are you serving yourself and your patients? Or are you serving the corporations? ...and their executives and stockholders? (And some of their CEOs with seven-figure incomes?)

"Choose this day whom you will serve."    ~ Joshua 24:15


© 2018 Dr Chris Baker

Blog, Courses and Seminars:
www.loveandorthodontics.com
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