There is a rule in private practice as there is a rule in life and that is, 10% of the patients will take up 90% of your time. That time may be to clarify treatment recommendations or insurance benefits etc. Interacting with the public is a real learning experience, don’t let yourself be scammed by someone who is dishonest or malicious. Know how to protect yourself.
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| THE LATE FRIDAY AFTERNOON EMERGENCY |
THE LATE FRIDAY AFTERNOON EMERGENCY
The patient presented in the late morning in such distress that she was inconsolable pre-operatively and needed relief but she was not npo (non-per os) for treatment with intravenous sedation, therefore treatment was scheduled for later that afternoon to address her acute problem. As she writhed in the chair she requested “oxycodone, that’s the only thing that works” for her. The patient said she was going to return after picking up her prescriptions. She returned later that afternoon for treatment, I performed an extraction under intravenous sedation/anesthesia. Immediately post-op she was comfortable and out of pain, and upon discharge from the office. Upon discharge she presented with multiple credit cards that were all denied for payment, her balance was $675. The patient was discharged with post-op instructions and prescriptions and a post-op appointment. The next morning, I called the patient to see how she was feeling, I had to leave a voice message “Hi patient, this is Dr Pollick, I’m calling to see how you are feeling since your treatment yesterday…………?” to let her know I called. Sunday, the following day, the patient called complaining of pain and that she went through all her oxycodone and needed more. I explained that she may have a dry socket because she smokes and that she should come into the office for placement of a medicated dressing into the socket as that is the recommended treatment for an alveolar osteitis. I reiterated the medication regimen to follow. She refused to make another appointment as her she said her schedule didn’t permit it. The next year at tax season I sent her a 1099 tax form. She received the benefit without the responsibility of payment.
There isn’t technology available that would change this scenario, unless facial recognition technology exists for practice management software?
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| SHARING DENTAL INSURANCE BENEFITS WITH A FRIEND |
SHARING DENTAL INSURANCE BENEFITS WITH A FRIEND
Before the age of electronic records this happened more times than one would expect. Susie Smiles presents for an extraction requesting intravenous sedation for an infected wisdom tooth. We verified with her dental insurance carrier that she had insurance coverage and the office staff discussed this with her in advance. The receptionist called her to review our financial policy and the copay information that she would be responsible for at her first appointment, including the pre-anesthesia instructions she must follow. She is to bring an adult escort to accompany her to the appointment and then home to care for her. When the patient presented we obtained a copy of her insurance card and New York State license and she had with her a female escort who was approximately the same height with the same hair color. The patient completed her medical history and signed it as required. A panoramic radiograph was obtained and she was completely examined and then prepped for surgery including signing a surgical consent. It was determined that she had an acute pericoronitis that required extraction of her wisdom tooth with intravenous sedation. Upon discharge from the operatory, her escort was given post-operative instructions and was asked to sign acknowledgment of receipt. Additionally, the patient signed the paper credit card receipt. She returned for post-op suture removal and did well. About a week later her husband called upset that we put through a charge for her copay on her charge card. We explained that he needed to discuss this with the patient, he was the insurance guarantor for the patient. We were then contacted by the credit card company to verify the transaction and that we followed the protocol to process the charges. About a week later the “patient” called saying her license and credit card were taken by her friend who used them without permission, then she admitted to allowing her friend to use them.
I determined that the license signature was the same as that on the medical history form and the same as the signature on the discharge forms. Proving the patient was there and signed the forms. The bank didn't press charges or continue with their inquiry as it was determined that the patient signed all paperwork they required. In retrospect the signature on the consent form was studied and it appeared different to the one on the license offering some doubt as to the identity of the patient. Ultimately, her husband called saying he was going through with a divorce and she was paying him back.
How technology would change this situation:
1. Take high resolution head-shot of the patient for their record upon presentation.
2. Obtain an accurate and clear reproduction of their identification.
3. Always be vigilant
The Girldoc😉
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