Episode 607: Free Treatment: And I Have to Pay My Employees?

For this week’s episode, we are doing a re-release of one of our favorites (and one that is always highly requested!) Giving your employees in-house treatment as a benefit of employment is common, and a great way to increase employee retention! However, there are a lot of things to consider, especially when it comes to billing and how insurance carriers see things. Listen when Harley Hartliep and Paul Edwards sit down and talk about it in this week’s episode of What the Hell Just Happened?!

Transcript

Voice Over: You’re about to listen to an episode of What the Hell Just Happened. Join Paul Edwards and his guests as they discuss interesting HR topics and solve some of our listeners’ submitted questions. 

 

Paul: And occasionally I’ll go off HR topic and talk about whatever I want to talk about. Think barbecue. Space exploration. Technology. Money. Managing business. Things that interest all of us.

 

Voice Over: We get a lot of emails with questions. Stay tuned for details on how you can submit yours to the show. And now let’s get started. 

 

Paul: Okay, so everybody, Harley, introduce yourself and please tell all the listeners what you do for CEDR. Again, as you guys, everybody who is listening knows, what the hell just happened in HR, I’m often bringing folks over from CEDR HR solutions, another company I founded, and we kind of talk about things that are going on, and that’s, you know, what the hell just happened? Harley, what do you do for CEDR?

 

Harley: I am the solution center administrative manager. 

 

Paul: Ooo! So the solution center is that bank of experts that we have. Those are the people with tons of HR experience. They’re the ones who answer our members’ calls looking for a solution which is compliant with whatever state and local laws are and a human approach to, “And here’s the way you might address fixing this issue.”  So –

 

Harley: Yeah.

 

Paul: You’re bringing a very cool thing in here today. 

 

Harley: I am.

 

Paul: But, Harley, before we do that, I want to point out that we got you from dentistry. 

 

Harley: You did. I have worked in two facets of dentistry.

 

Paul: Which, two?

 

Harley: I started in orthodontia. I was an office manager, insurance biller.

 

Paul: Okay.

 

Harley: Treatment coordinator. And then I worked for oral surgery, also as a treatment coordinator. 

 

Paul: Oh, awesome. I didn’t know that you had worked for an oral surgery practice. 

 

Harley: Mm hmm. 

 

Paul: Okay, so that is something that we like to do here at…I gotta say here because I am sitting in the building. 

 

Harley: Yeah. [laughing]

 

Paul: That is something we love to do at CEDR, which is we’d like to find people who have actually worked in the industries that we’re working with and we work with all kinds of medical and we’ve got people from all over the place, but we’re always looking for that practical experience that gives every you know, that gives us, I think, a leg up when we’re trying to do the right thing, you know? 

 

Harley: Yeah.

 

Paul: And answer in a real way where we understand. I mean, I guess I get, you know, on a little bit of a soapbox. I think if you call your national international giant payroll company and you are asking them for HR support, the first thing you should ask them is to tell you what’s the difference between a hygienist and a dental assistant. And if they can’t answer that question, well, what’s the difference between an injection specialist and a, you know, whatever it looks like, they’re not going to be able to answer it. 

 

Harley: Yeah.

 

Paul: They’re not going to know. And if they don’t know, then how are they going to give you a good answer to your HR problem? To your human problem? Okay, now I’m off my soapbox, so I’m done. Harley, you’re bringing a really good problem in. I’m just going to paraphrase it. 

 

Harley: Okay.

 

Paul: Doctor. Doctor, is in this case, we’re in a dental practice, but as you pointed out, we see this in other types of medical practices. I think in med spas it shows up there quite a bit too.

 

Harley: Med spas, even in medical, urgent care. It happens in a lot of our other members, but most frequently in dental practices.

 

Paul: And “it”, what we’re talking about is some kind of program whereby the doctor will treat the employees as patients. 

 

Harley: Right.

 

Paul: So if an employee needs work done or needs something, there are often programs in place in these dental practices which either offer some kind of free treatment and also often extend it to family members.

 

Harley: Right. 

 

Paul: It’s kind of a perk?

 

Harley: I mean, a lot of times these practices, they’re small. They don’t have formal dental insurance to offer as a benefit. So this is where they try to supplement that. 

 

Paul: I have two brothers down in Louisiana who treat each other’s employees. 

 

Harley: Oh, that’s an interesting – 

 

Paul: It’s a very smart approach. 

 

Harley: Yeah. 

 

Paul: Yeah. It really – 

 

Harley: It keeps things separate.

 

Paul: It keeps things separate. So that’s kind of interesting. Anyway, I just threw that out there. 

 

Harley: No, that’s awesome. 

 

Paul: Okay, so first thing and Harley, you used the word noble to describe this. It’s a noble cause to want to take care of your people. 

 

Harley: Yes.

 

Paul: So this doctor is, I think, relatively new, has a team. Team comes to the doctor and says, look, other practices do this. “This” being provide some kind of treatment program and we should do it, too. So the doctor feels a little pressure, but I think the doctor also agrees it’s a good idea. 

 

Harley: Yeah they agree that it’s a good idea. They struggle with the concept of doing something for free and paying someone to do that for them. 

 

Paul: Right. So they’re looking for some kind of a fix to that. So in comes logic, right?

 

Harley: Right. 

 

Paul: And they come up with what I think is a really it makes sense that they come to this – 

 

Harley: One hundred percent. Yeah. 

 

Paul: So what do they do in there? Let’s give, well now, with no further ado, what do they, what in this case that we’re talking about and we see this often.

 

Harley: Yeah. This isn’t any one member. This happens all the time.

 

Paul: What’s the idea? 

 

Harley: The idea is, well, I’ll give the treatment to you and your families for free. In exchange, you will clock out and treat each other and each other’s families for free. 

 

Paul: Right. Which makes, I think, in a tit for tat sort of thing, this makes sense.

 

Harley: It makes sense.

 

Paul:  I’m going to do something for free. You’re going to do something for free. But, Harley, since working here, you’ve learned that that’s the problem, haven’t you? 

 

Harley:It is a problem. It’s a problem for several reasons. 

 

Paul: Mm hmm.

 

Harley: Obviously, wage and hour compliance is not there at all. If you have employees clocking out and doing productive work inside your practice. But also there’s other issues with that as well. Let’s say that the employee got hurt while this was happening. Now there’s a worker’s comp claim that’s complicated by the fact that they weren’t on the clock. 

 

Paul: Mm hmm.

 

Harley: What if the patient got hurt and the person who was providing treatment to them wasn’t on the clock? Is your malpractice insurance carrier going to cover that? 

 

Paul: Yeah.

 

Harley: You know, that’s just a small factor to think about.

 

Paul: What would a lawyer do with you treated patients while you were not on the clock? Does that mean you’re, what does that mean? That would not be, that would not fall in your favor. So I want to go back to the thing that Harley was just like, “Well, there’s a wage and hour issue.” Harley, there’s a huge wage and hour issue here.

 

Harley: Oh yeah. Yes, that’s the biggest one.

 

Paul: They’re doing…They can’t volunteer. No one can volunteer their work to you. And so in order for your practice to be fully because, by the way, your practice is fully accountable, so free or not, something happens in your practice, you need your malpractice insurance in place, you need your worker’s comp insurance in place, you need all these things in place.

 

Harley: Right.

 

Paul: So you complicate that when you try to get people to go off the clock. But still, it’s a wage and hour violation because they are working for you and you can’t have people clock out under those conditions. It just, you can’t do it right. 

 

Harley: Correct.

 

Paul: It’s not legal. It can get you in quite a bit of trouble.

 

Harley: 100%. 

 

Paul: Okay. So – 

 

Harley: You can’t pay people in chicken. 

 

Paul: You can’t pay people in chicken either. You can’t trade them – 

 

Harley: A little call back to the early to the early days.

 

Paul:  A little call back to the early podcast. 

 

Harley: [laughing]

 

Paul: So now that we’ve put that out there, we have to come up with a plan, right? We need a policy that we communicate. So I just thought we would touch on a few things here.

 

Harley:Yes, please do.

 

Paul: Just a few things, Harley. Like, well, first I want you to talk about the insurance concerns. 

 

Harley: Okay.

 

Paul: You talk about that because you’ve run insurance. And by the way, everybody’s listening. I’m hashtagged disclaiming. I don’t think we’re supposed to say hashtag anymore.

 

Harley: [laughing]

 

Paul: I am disclaiming that we nor Harley are experts in insurance. But we know something and we’re about to tell you that it’s a problem with the insurance. What’s the problem? 

 

Harley: The problem is, is you cannot bill insurance if you aren’t going to bill the patient. 

 

Paul: So a lot of times people bill into this stuff. It’s free unless someone who’s coming has insurance. And then if they have insurance, we’re going to bill them. 

 

Harley: Right.

 

Paul: Is that a problem? 

 

Harley: It is a problem.

 

Paul: Yeah. 

 

Harley: So, I mean, just because the office doesn’t provide dental insurance doesn’t mean that the employee or their families might not have it through another person in their family who’s working, right?

 

Paul: Right. 

 

Harley: And so what the doctor see is money on the table that they’re not claiming. So they’re like, well, “We’ll do this for free, but we’re going to go ahead and submit the claim and we’ll write off the difference.” 

 

Paul: Right. 

 

Harley: The problem with that is the insurance company needs to get the same discount that the patient gets.

Paul: Right. And the patient’s getting –

 

Harley: A 100% discount.

 

Paul: A 100% discount. 

 

Harley: So, you know, people who work in this industry, they know about fee schedules and percentages and co-insurance and all of that. And that comes into play still here. And they…and it’s kind of standard in these offices to do stuff like that. 

 

Paul: Mm hmm.

 

Harley: But insurance companies do audit, occasionally, and you don’t want to be found in noncompliance.

 

Paul: Yeah.

 

Harley: Especially with an insurance company you’re contracted with.

 

Paul: Yeah. So if you dig down in your agreement and talk to your insurance provider, you’ll find what Harley’s telling you and you’ll be able to kind of, you know, learn about it and educate yourself – 

 

Harley: Yeah, verify all this with the insurance company themselves. 

 

Paul: Yeah.

 

Harley: They’ll tell you exactly what their expectations are. 

 

Paul: Yeah. So the next thing I want to go back to is how you would build a policy or something that would kind of explain how you do this. I’m just going to give everybody a few ideas. There’s more that we build into these policies when we’re working with a medical practice. So some ideas: it doesn’t always have to be free. It can be at cost. And a lot of times if it’s a little bit of a stretch for you, you’re still paying everybody because you have to. You could put in that we’ll do this for costs. You got to pay for labs and you’ve got to pay for materials. So if the practice has an outlay of money for any reason whatsoever. So, I mean, you’ve got to make it clear, if we’ve got to put a crowd on that the practice is going to practice is not going to pay for it.

 

Harley: Mm hmm.

 

Paul: The patient has to pay for it. The employee or their family member has to pay for stuff like that. That’s the first thing.

 

Harley: Right.

 

Paul: You want to make sure you cover your rear end there. The other part of it is, is that you could also, we often address, and I guess I’m going to give away some secret sauce here, we’ll often put into a policy that these opportunities for this quote unquote “free treatment” or whatever it looks like are to be inserted into calendars, into slots that cancel. So we’re not going to stay open extra hours. We’re not going to all come in and on a special day or anything. We’re going to…When a patient cancels, we’re going to say, “We have a patient cancellation today at 4. We figured this out at 10:00.” You know why we didn’t figure it out at 9:30, Harley?

 

Harley: Why? 

 

Paul: Because Cindy’s late again.

 

Harley: [laughing]

 

Paul: And Cindy is the one who’s supposed to be checking the answering machine and letting us know when people have canceled. And we didn’t find out until 10:00 because Cindy rolled in at 9:20 with a cup of coffee from Starbucks in her hand. 

 

Harley: Got to get that corrective action going for Cindy. 

 

Paul: Okay. All right. So I blame Cindy. These are…So in the policy, it’s that when we have open slots and look, we know that not everybody can just leave work or come running over here to get something done, but eventually they’ve got to fit into the practice’s calendar to get the work done, unless it’s an emergency. 

 

Harley: As simply as not giving away your high production timeslots.

 

Paul: Yup.

 

Harley: You know, if you are busiest after 12:00 – 

 

Paul: Yup.

 

Harley: On a weekday? Say employees have to do their appointments in the morning, you know?

 

Paul: Oh!

 

Harley: Every office is going to be different. 

 

Paul: Yeah.

 

Harley: Every specialty is going to be different. And, you know, that’s the nature of the Solution Center’s relationship is we can help you puzzle through those factors. 

 

Paul: Awesome. Okay…For those of you who have…No, I almost went off on a tangent there. We’re probably going to edit that part out. 

 

Harley: [laughing]

 

Paul: Harley, I almost went down another tangent. 

 

Harley: Oh no.

 

Paul: You need to in your policy to find when they become eligible.

 

Harley: Right.

 

Paul: You know, is it in their first 30 days? You have to wait 90 days. They have to get through their getting acquainted period before they become eligible for these benefits. Reflecting back to the noble thing and the fact that we might be making someone wait, again, you may make exceptions to your rule because someone’s got an abscess and they need you to work on their tooth.

 

Harley: Mm hmm.

 

Paul: You know, only on the other…Another point to make is, you know, when you treat your patients, when you treat your employees, they can proselytize for you. Like, it’s like, “Hey, doctor did a great job, you know, didn’t hurt me,” or their smiles are better or their teeth are cleaner or whatever that looks like. 

 

Harley:Yeah, I mean, that was a firsthand experience. Goes a long way with a patient. You know, you’ve got someone in the chair who’s nervous about dental work and doesn’t know what to expect. And you can firsthand say, “Hey, you know, Dr. Reid has done my work personally. I know how he is. I wasn’t in any pain. I felt comfortable.” It’s just, you know, a small forward motion for the employee. 

 

Paul: Yeah. You’re like, “They had nitrous waiting for me in the waiting room.”

 

Harley: [laughing]

 

Paul: “I don’t remember going to the back. It was awesome.”

 

Harley: Oh I don’t know about that. [laughing]

 

Paul: “I got a complete facelift. I didn’t even know it until I got out.”

 

Harley: Yeah.

 

Paul: Okay. So the other thing that you need to have your policies, what happens if they leave? So –

 

Harley: Yes.

 

Paul: Oftentimes we’ll have doctors, they call in with this, and they’re stuck between a treatment and a treatment place.

 

Harley: Mm hmm.

 

Paul: They’re stuck between a rock and a treatment place because they’ve got ongoing treatment going on with an employee who’s either left or been released or a family member. And what you have to do is address that. And we have ways of addressing that. If it was free, it’s not free going forward and a way to sort of address that they are your patient.

 

Harley: Yeah.

 

Paul: So that’s the big complication. 

 

Harley: You need to know that up front that, you know, things might change financially for them or you make it, “Hey, you get this much of a discount,” and especially this, you know, I think about ortho, you know?

 

Paul: Uh hmm.

 

Harley: Where I came from. You put basically handcuffs in people’s mouth – 

 

Paul: Yeah.

 

Harley: That don’t come off. 

 

Paul: No. 

 

Harley: And that’s your employee. And either they leave and they resign or they’re terminated. Now they have –

 

Paul: Handcuffs!

 

Harley: A metal fixture in their mouth. 

 

Paul: Yeah. That needs ongoing care.

 

Harley: Correct.

 

Paul: Yeah. 

 

Harley: And so just having a plan in place for what’s going to happen when and if that occurs.

 

Paul: And complicate it more, and again, we over at CEDR, we help with this all the time. Make it an associate who has done that work, who either the associate leaves and you got to address it in their contract or employees last patient leaves.

 

Harley: Mm hmm.

 

Paul: So just remember and in medical, especially, when you make your employee your patient, you have added a whole nother level there – 

 

Harley: Yes.

 

Paul: And I think we covered everything Harley. Did I miss anything? 

 

Harley: The only thing is and it’s not something that we help with too much, but we always tell people, make sure, you know your patient abandonment laws in your state.

 

Paul: Yeah. So at the end we always in a term letter we always ask when we’re solving for the termination or someone resigning and just paperwork going out the door.

 

Harley: Right. 

 

Paul: Are they a patient? If they are a patient, there’s something that you have to do about that. 

 

Harley: Correct.

 

Paul: Some communication. Okay. So What The Hell Just Happened in HR was…A dentist wanted to provide some services to their employees, and they came up with a great idea, which is the dentist will give away their time as long as the dental assistants and the hygienist and everybody will give away their time. And that is not legal.

 

Harley: Not legal. 

 

Paul: That’s What The Hell Just Happened in HR. 

 

Harley: Thanks, Paul.

 

Paul: Thanks, Harley.

 

Voice Over: Thanks for joining us for this week’s episode of What the Hell Just Happened. If you have an HR issue, question, or just want to add a comment about something Paul said, record it on your phone and send it to podcast@wthjusthappened.com. We might even ask if we can play it on the show. Don’t forget to Like and Subscribe and join us again next week.

 

Feb 12, 2024

Friendly Disclaimer: This information is general in nature and is not intended to provide legal advice or replace individual guidance about a specific issue with an attorney or HR expert. The information on this page is general human resources guidance based on applicable local, state and/or federal U.S. employment law that is believed to be current as of the date of publication. Note that CEDR is not a law firm, and as the law is always changing, you should consult with a qualified attorney or HR expert who is familiar with all of the facts of your situation before making a decision about any human resources or employment law matter.