Episode #353: How to Become a ‘Whistleblower’ on Dental Insurance Companies?

Naren Arulrajah: This is the Less Insurance Dependence podcast show with my good friend Gary Takacs and myself, Naren Arulrajah.

Gary Takacs: We appreciate your listenership, your time, and most of all, we appreciate your intention to reduce insurance dependence in your practice. Our goal is to provide information that will help you successfully reduce insurance dependence and convert your practice into a thriving and profitable dental practice that provides you with personal, professional, and financial satisfaction.

Naren Arulrajah: Hello everyone. Welcome to the Less Insurance Dependence podcast, the official podcast of the Reducing Insurance Dependence Academy, www.rid.academy.  Membership to the academy is a gift from Gary and me in appreciation for your listenership. Visit www.rid.academy, and do not forget to register. By registering, you will have access to all of our resources and a free pass to all of our events, including our annual summit.

I am Naren, your co-host. Today’s podcast is titled How to Become a Whistleblower on Dental Insurance Companies. I know it’s a controversial topic, so I’m really excited to find out what are the pearls of wisdom that Gary has to share.

But before I jump into that, I have a quick announcement to make. We have an event coming up: Re-Imagining Dental Practice Success: New Models for Growth and Ownership. So this is gonna be an interesting panel. You’re gonna bring in some awesome experts, 7:00 to 8:00 PM on the 28th of July. You’ll also get one hour of CE. Just go to thrivingdentist.com/events  and sign up.

And I’m looking forward to, uh, you know, having you there, and hopefully you’ll be able to take a lot of notes from all the experts we’re gonna have.

Gary, let’s jump into today’s episode: How to Become a Whistleblower on Dental Insurance Companies.

Gary Takacs: Well, I hope we have our listeners’ attention. I’m sure we do. Yeah. Let’s start—let’s start by defining the term "whistleblower." Yes. Now, uh, let’s not assume that everybody listening knows what that term means. How would—how would you define "whistleblower"? And then I’ll give my definition, then we’ll proceed. How would you define "whistleblower"?

Naren Arulrajah: I just remember all the TV coverage of one or two people. You know, uh, would you consider Snowden a whistleblower? I don’t know what he did, but he was all over the news. I can’t remember now.

Gary Takacs: Well, I think "whistleblower," I think the term, uh, uh, means that someone has found something wrong, right? And they brought it to attention. You know, they brought it—something was wrong. Could be, you know, related to a government agency, for example, that, uh, this agency wasn’t doing something right. And, someone discovered it. And, uh, it just was a principled kind of thing that "this isn’t right," and they blew the whistle. You know, they—they blew the whistle to get attention. Right. You know, and to bring out the—bring out the unfairness around whatever was done. And let’s get—so let’s, let’s use that kind of as the definition of a whistleblower: they discovered something that wasn’t right, and, uh, they said, "No, we’ve gotta make this right," and they blew the whistle.

And so there’s a lot of people that think that the dental insurance companies have all the control.

Gary Takacs: And—and so they go to the, "How am I supposed to do this? How am I supposed to do this? And what am I supposed to do?" And they—they lean on the insurance company for the source of this information, right?

Yes.

But in fact, there’s a higher power. It’s not the dental insurance company. The dental insurance company—they don’t have the ultimate authority. They have to answer to someone, right? Or something. Uh, "someone" isn’t the right term. They have to answer to something.

Who does the—all dental insurance companies have to answer to? The state Insurance Commission.

Exactly. The state. And remember that—that insurance is state regulated. It’s not federally regulated—it’s state regulated, right? So if they are selling insurance policies in your state, they have to answer to the Insurance Commission.

However, this is where it gets tricky, Naren. The Insurance Commission is not, uh, an agency that looks over and—and takes care of—of—of dental offices, of dentists, or of the employers that buy these policies. They’re a consumer watchdog agency.

Right.

Consumer—the—the people that have the policies, the patients that have the policy that’s who the Insurance Commission is ultimately beholden to. Does that make sense?

Naren Arulrajah: It does make sense, Gary.

Gary Takacs: And then this is where it comes into play. Any of our listeners will know that insurance companies will pull the wool over your eyes when you’re following up on claims.

Yes.

Hey, well, you’ve had this claim for two months. How come you haven’t paid? Honest to gosh, I have this in my own experience. The clerk at the insurance company will say—back in the day when they used to have printers, and they would print checks, you know, remember? You can imagine that—not electronic deposit to send out payment—they’re printing checks, right? Can you imagine that, Naren?

Naren Arulrajah: Uh, I can still imagine. I think, uh, one of my friends, uh, built a billion-dollar company. They just replaced checks with, uh, electronic stuff. 

Gary Takacs: It’s huge—electronic. And that’s where all the insurance companies are going. But back when the insurance companies used to print checks, one—“Well, our printers are down.”

Naren Arulrajah: Right? Right.

Gary Takacs: “Our printers are down.” Right. Um, what’s another famous one? “We never received your claim.”

Naren Arulrajah: And yeah. How do you—how do you argue with that, right? Like, “We never received your claim.”

Gary Takacs: Let me tell you how. Okay. Uh, now your claim doesn’t go from your office to the insurance company. It goes from your office to a clearinghouse to the insurance company.

Naren Arulrajah: Right.

Gary Takacs: The clearinghouse takes your claim form that was put on Dentrix, Eaglesoft, Open Dental—claim form goes to the clearinghouse. Immediately, the clearinghouse converts it to a UCF—Universal Claim Form.

Naren Arulrajah: Okay?

Gary Takacs: They then send that to the insurance company, and you can get a transmission report from your clearinghouse on when that claim was sent, right? And so you could say that—so when you’re calling to follow up on a claim, and the clerk says, “We—we—we never received your claim,” you say, “Well, that’s very interesting, because I have a transmission report from our clearinghouse indicating that you received that on the morning of June 6th at 10:42 AM.” Hold, please. And—and then they go running down the hall, uh, and they come back and they say, “We found it.”

Gary Takacs: “We found it.” Right? Or they ask for an attachment: “We need a perio chart, we need a radiograph, we need a photo.” “Well, I have a report from the clearinghouse indicating that those attachments arrived on the morning of June 6th at 10:42.” Hold, please. They come back and—“Oh, we found ’em. We found—”

But a lot of people that don’t know this will just fall victim to whatever the clerk on the insurance company tells you. “Okay, I’ll resend it.”

Now, if you hit resend, they now have another 30 days to respond.

Naren Arulrajah: Okay?

Gary Takacs: The—the—the federal law that’s converted to state law says insurance companies have 30 days to pay or respond to a claim.

Naren Arulrajah: Right.

Gary Takacs: What’s the part of that clause that really causes us to wrinkle our forehead? What’s the part of that clause?

Naren Arulrajah: 30-day what?

Gary Takacs: You have 30 days to pay or respond.

Naren Arulrajah: Right? Isn’t that—the 30 days itself is the part of the wrinkle?

Gary Takacs: No.

Naren Arulrajah: Or respond.

Gary Takacs: ‘Cause now they can ask for something, and now you—you could—you could fall victim to it.

Naren Arulrajah: Technically, it could be 10 years before you get done.

Gary Takacs: They keep going. They can keep doing it—technically.

Naren Arulrajah: Wow.

Gary Takacs: But here’s what you do, and here’s how you become the whistleblower. And I want you to listen—I want all of our listeners to listen to this. And by the way, the fact that that clause says pay or respond indicates how strong the insurance company lobby is.

Naren Arulrajah: Hmm.

Gary Takacs: That’s how they got that in the regulations.

Naren Arulrajah: I see.

Gary Takacs: Because they’re paying billions of dollars for lobbyists to get that kinda language in there.

Naren Arulrajah: I just—you know, this is—this is—this is BS. It’s why you need to be off. This is, like—makes you mad.

Gary Takacs: It’s why you need to be out of network. Okay?

Naren Arulrajah: Yeah.

Gary Takacs: Yeah. But for those of you that aren’t quite ready to do that, then—then let’s become a whistleblower.

Naren Arulrajah: Yeah.

Gary Takacs: And the reason—so whistleblowing is good. Um, ’cause they—they’re taking advantage of you. I mean, when they said their printers are down, do you think that was really true?

Naren Arulrajah: No.

Gary Takacs: No. It’s just an excuse. It’s just an excuse. And they’ll give you excuses. But when you respond back with support—and here’s the support: “The transmission report indicated that you received this on the morning of June 6th at 10:42, and I have that report in hand. And if I don’t have a check within seven days, please know I’ll be advising our patient to file a formal complaint with the State Insurance Commission.”

Right?

And—and that check will arrive in your hands in less—you know, first of all, it’s often done electronically—but it will arrive very quickly. But notice the language that I used: If I don’t receive payment within seven days—seven days—and just give ’em seven days—If I don’t receive payment within seven days, we will be advising our patient to file a formal complaint with our State Insurance Commission.

Right?

And that strikes the fear of God in the company. Seriously. Because if I say, “We will be filing a complaint,” they put it on mute and start laughing.

Naren Arulrajah: Because insurance—

Gary Takacs: Don’t—

Naren Arulrajah: Don’t know. Yeah. Because they—they don’t care about dental complaints. They only care about patient complaints.

Gary Takacs: Insurance Commission pays zero—and it’s not that they—they don’t care. It’s just that’s not their charter.

Naren Arulrajah: Yeah. Yeah. The charter is only listen to—

Gary Takacs: Patients. The charter is—we’re a consumer watchdog agency. We—the doctor, the office—isn’t part of our, you know, part of our jurisdiction.

Naren Arulrajah: Mm-hmm. Mm-hmm.

Gary Takacs: Uh, but when you say, “We’ll be advising our patient,” it literally strikes the fear of God. And I’ve been told—and by the way, this—this came up on our 700th episode of the Thriving Dentist Show.

Naren Arulrajah: Yes.

Gary Takacs: So, little cross—little cross-promotion here. Uh, those of you that may also listen to our Thriving Dentist Show, we just hit episode 701. One of our guests on—we—we invited multiple friends of the podcast to share a quick tip. And the quick tip was: What’s the one thing that you know now that you wish you would’ve learned earlier in your career? And one of our—our guests talked about some things like this, that we—we—we’re talking about now—we’re sharing with you.

Gary Takacs: Um, so, uh, she made the point of saying the one thing she wished she had known earlier in her career that she now knows is the insurance company’s not in control—the Insurance Commission’s in control.

Naren Arulrajah: Right.

Gary Takacs: That was her tip. It was Tessina—I don’t know if you remember her contributing there—but it was Tessina. And, uh, she said, "That’s what I wish I would’ve known earlier, ’cause I’d start doing this stuff earlier in my career."

Uh, so it—it kind of triggered my thinking about doing this podcast episode for LID—for Less Insurance Dependence. So just write down that language: If we don’t receive payment within a week, we will be advising our patient to file a formal complaint with the State Insurance Commission.

Because in every state, if they get a complaint from a consumer, the Insurance Commission is obligated to research it.

Gary Takacs: And if they research it and—and it has merit, then they—it starts to, you know—the insurance companies do not want to get on the bad side of the Insurance Commission. They—they don’t want to—they want to be invisible to the Insurance Commission. They don’t want to be brought in for these complaints.

‘Cause if they get enough complaints, the State Insurance Commission could—could eliminate their ability to write insurance policies in your state. And that has happened.

That has happened. And this is with very misbehaving insurance companies. And they have eliminated the ability for them to write insurance policies in that state.

Uh, and so that’s the language. And remember—write it down so you know—it’s not we will be filing a complaint, ’cause they just laugh at you on that. ‘Cause they know it will go nowhere.

But, We will be advising our patient to file a formal complaint with the State Insurance Commission.

Now let me—let me add on a—let me bring this back on a positive note. Be a whistleblower when you’re being taken advantage of by the insurance company.

Naren Arulrajah: Right. Let me ask you this, Gary, if you wait—

Gary Takacs: One minute, let me finish this. Be a whistleblower, yes. But I also want to play the other side of the coin, to be fair. I’m asking this rhetorically to our audience: have you ever worked with an insurance clerk who’s been very helpful?

I’ll bet many office managers are nodding their heads yes. Remember, good people can work for insurance companies. Would you accept that on face value, Naren?

Naren Arulrajah: Yes.

Gary Takacs: Not at the executive level, but at the clerk level—is it possible that a good person could work for an insurance company and be helpful?

Naren Arulrajah: Yes.

Gary Takacs: Sure. If the person is helpful to you, mirror and match that helpfulness.

Say something like, “Susan, thank you so much. One of my goals is to really help our office with claims processing and insurance, and you’ve been very helpful. Thank you.”

How many times do you think they get thanked on the phone during the day?

Naren Arulrajah: Very little. Probably zero. Especially today, when people are all about me, me, me. They don’t thank others.

Gary Takacs: They don’t get thanked. And when you thank them, they start to feel better. You can say—let’s say her name is Susan—“Susan, can I ask a request? Can I get your direct number and call you directly in the future? Because I love working with you.”

And many times, they have a direct number.

Naren Arulrajah: It cuts through the nonsense. Makes it easy for everyone. 

Gary Takacs: Yeah.

Naren Arulrajah: And like you said, they want to help you because you are kind. Simple as that.

Gary Takacs: Be kind, be helpful, be appreciative. Mirror it back to them. But when you’re getting the runaround—like “printers are down” back in the day—or just getting garbage answers, then pull out the stick.

And the stick is: If we do not receive payment within a week—and I’m documenting this phone call—we will be advising our patient to file a formal complaint with the State Insurance Commission.

That’s how you become a whistleblower. They do pay attention. If they’re acting up, they’re not trying to be kind, but they realize it’s better to pay you than deal with the consequences of the Insurance Commission, which might result in their loss of the ability to write policies in the future.

Naren Arulrajah: Right. So I think the lesson for me is, they will take it as close to the line as possible.

Gary Takacs: And get away with it if they can.

Naren Arulrajah: If they can. And your role is to not let them do that.

Gary Takacs: Or find helpful people within the company that’ll help you. Exactly.

Anyway, I hope you’ve enjoyed this episode: How to Become a Whistleblower on Dental Insurance Companies. On that note, I want to take a minute and say thanks. We appreciate each and every one of our listeners at the Less Insurance Dependence Podcast. Stay tuned—we’ll continue with more useful information.

Until next time, thanks for the privilege of your time today.