Have you ever wondered how to set up your Phase 1 and Phase 2 cases in billing?
Sometimes hearing what experienced colleagues do is the best guide. Here's a thread on SmileStream's Collaborate section that we thought would be helpful to many dentists. It even includes example scripts of an orthodontic patient consultation!
See POS graduates discussing how they set up mixed dentition set up and what works for them.
Dr. Nanavati
4/10/2019
Phase 1 Treatments
In recent past I have come across resistance from patients about doing 2 phase treatments. Many parents are not willing to pay for orthodontics 2 times.
I feel that many orthodontists do not do phase 1 treatments often and tell the patient to wait for all the permanent teeth to erupt. I have also faced that predicting the full eruption of permanent dentition based on lower 5's root formation is not always accurate. I have couple patients who were delayed in eruption by a whole year or so.
I am wondering if phase 1 treatment is worth the hassle for cases which are not towards more complex malocclusions. My asking price for phase 1 is USD 2500 and phase 2 is USD 5000. Kindly comment on this matter. Thank you for your time.
Dr. Yazar
4/10/2019
Hi- We do 2-Phase txs all the time. Majority of my patients are kids, and a lot of mixed dentition cases. Try to do whatever is necessary, single phase vs 2-phase.
We combine both phases and give a single fee. 2-Phase tx will get 24 month payment plan. Single phase will get 18 month payment plan. By the time they are done with 24 month payment, you might be starting Phase II; all paid. Patients like it. Comprehensive tx planning.
You do separate plans, most often they don’t understand, they think they are getting 2 separate ortho tx. Keep it simple. 1 fee and you start and finish the case. If it takes 4 years or 5 years or whatever. They know that no matter what you are going to take care of this kid's orthodontic issues. Then charge whatever you want to charge.
We always do Phase II records to confirm or change the tx decision; and put it in writing in details in advance and make sure communicate this to patient's parents. Hope this helps.
Dr. Nanavati
4/10/2019
Thank you very very much that is smart!
Dr. Her-Ellison
4/10/2019
I do a lot of 2 phases as well. I explain it like this: "When we were kids, orthodontist would just wait until all the permanent teeth were out and then deal with the problems at that point. The problem with that approach is that the bulk of GROWTH in the jaws may happen BEFORE all the permanent teeth are out. So by that time, if the patient has major issues like the jaw growing too little (overbite/crossbite/no room for all teeth), we then have to take out perfectly good teeth in order to accommodate or recommend surgery.
Think about it this way, growth happens during puberty. Kids are hitting puberty earlier and earlier these days so it’s important to address orthodontics earlier and earlier. Today, orthodontics is moving towards PREVENTION of major issues and not just "dealing with them". So, we routinely do a 2 phase approach.
One phase is done while the child is young and still growing and still has some baby teeth in there. We use the growth to our advantage and guide the patient's teeth and jaws to grow into what we want instead of dealing with problems after they have already happened... in which case, we may not be able to fix everything. Not everyone needs a 2 phase approach but I think in this child's case, due to his/her .......insert list of issues... a 2 phase approach would be beneficial."
POS had a handout about early intervention ortho that you can buy in the store. I'm not sure if they still have it.
Because most of our patients are also general patients, I usually start talking about the ortho issues long before it is time to start phase I so the parents are prepared. Then when they are ready, I simply say "hey mom, you know when I told you if this happens, we would have to start phase I ortho? Well it's time." Easy transition because they have already been educated and prepared.
I also have a single fee for my 2 phase cases. I tell them the fee includes both phases but there may be a break in between the two in which case, I will provide retention until all the permanent teeth are out. But if we meet all of our goals for phase I, phase II will be short and simple. We will "revisit" the plan once the patient is ready for phase II to see if we have met all of our phase I goals and what we will need to adjust in the plan if we don't.
Dr. Ranawake
4/12/2019
Good comments and advice by many. Thanks.
Dr. Nanavati
4/16/2019
Thank you for the script I appreciate it!
Dr. Nanavati
4/16/2019
It never occurred to me about a combined fee for phase 1 and phase 2. I also struggled with the dental insurance industry in USA having only one life time maximum with orthodontics insurance coverage. If I billed phase 1 treatment I cannot bill Phase 2 treatment to the insurance company etc....
I conclude that separating Phase 1 and Phase 2 is good for education and understanding but not good for case presentation and eventually making a sale.
Thank you all!
*Thank you to all doctors who shared their experience and tips, and allowed us to share it with others. Knowledge is invaluable. We appreciate your generosity and support of building a positive dental community.
*Note: Although the content came from a Collaborate thread, some formatting or spelling was adjusted to be easier to read in this blog format.
Have your own tips and set ups that you want to share? Please comment below.
