How to Get HMO Patients to Use Their Dental Benefits Before They Expire
At 9:40 on a Thursday night in late February, the Smile & Skin Clinic Facebook page gets a message:
Hi po! Pwede pa po ba HMO cleaning this week? Mag-e-expire na daw po sa March 1.
Jen sees it at eight the next morning. The week is full, and so is Saturday. By the time a slot opens, Ms Reyes's plan has renewed and the cleaning her employer paid for this year is gone.
Two more messages like it arrive before lunch, from two other people at the same company.
Nobody did anything wrong here. Patients always remember late. What the clinic didn't know was that her plan renewed in March, because nobody had ever asked her. That part you can fix, and the rest of this is how.
The short version
- An HMO dental benefit doesn't run on the calendar year. It resets when the plan renews, and for a company plan that's the employer's contract date. That can be any month.
- Ask every HMO patient two things and write them down: which HMO, and the month their plan renews. Note the employer too, because one answer usually covers everyone from that company.
- Send the first reminder about eight weeks before renewal and one more about three weeks out. Then stop.
- Write "covered by your HMO", and never "free".
- Give the renewal date and a booking link. Don't ask anyone to reply to an SMS.
- Confirm coverage at the desk on the day, before treatment, and never promise it in the chat.
- Before the patient leaves, write down next year's renewal date. That's next year's reminder done.
How HMO dental cover works in the Philippines
Most of what you'll find online about this is American. "You have $1,200 in unused benefits. Use them before December 31." Two parts of that don't survive the trip.
First, there's no balance. Philippine HMO dental cover is usually a list of procedures, not pesos. Maxicare's published benefits page lists dental care as an optional add-on made up of items like an annual oral exam and consultation, annual oral prophylaxis, simple tooth extractions, permanent fillings, temporary fillings as needed, and desensitisation twice a year. So there's no "you have ₱X left" to send. What your patient has is a cleaning and a check-up they haven't used yet.
Second, the date. The benefit resets when the plan renews. For an employee, that's when their company's contract with the HMO comes up, and companies don't all renew in January. One employer near you might renew in March, another in July. A December blast only fits the people whose plans renew in January. For everyone else it's months early, and they'll have forgotten it by the time it matters.
And an unused cleaning doesn't wait for them. HMO fees buy coverage for a period, not a stock of services. A Respicio & Co. commentary on unused HMO contributions puts it plainly: "unused HMO coverage is not refundable merely because no claims were made." If a patient tells you their plan carries a cleaning over, check the plan. Don't build your reminders around it.
What's on the list, and what usually isn't
Here's Maxicare's published list, next to work a check-up often turns up that the list doesn't mention:
| On Maxicare's published dental list | Not on that list |
|---|---|
| Annual oral exam and consultation | Root canal treatment |
| Annual oral prophylaxis (cleaning) | The crown, bridge or denture itself. The list covers treatment planning for these |
| Simple tooth extractions | Removal that isn't simple, like an impacted wisdom tooth |
| Permanent fillings, and temporary fillings as needed | Braces |
| Desensitisation, twice a year | Whitening |
| Simple denture adjustment, recementing a loose crown |
That's one HMO's published list. Employers buy the plans and the plans differ, so what counts is the patient's own. Keep the right-hand column in mind anyway. That's the work a check-up finds, and the patient should hear its price before you start, not at the counter.
How patients use the benefit
Each HMO has its own steps. Intellicare's published dental steps are short: pick a dentist from the dental list and book before the visit, present the Intellicare card at the clinic for validation, then sign the Dental RCS after the procedure. Maxicare members can request a Letter of Authorization (LOA) through its member portal.
Your front desk already knows which of your HMOs needs what. The reminder should say it, so the patient doesn't arrive without it.
Why it's worth an afternoon
The patient loses the cleaning, and you lose the visit. The check-up is when the dentist spots the small cavity before it becomes a bigger job.
Covered follow-up work needs time too. If the check-up finds a filling, and fillings are on the patient's plan, that second visit also has to happen before renewal. A reminder sent ten days out leaves no room for it.
The rush lands on you all at once. People from the same company remember at the same time. All it takes is one person mentioning it at work, and suddenly twelve people want a cleaning in the same fortnight, on top of your regular patients.
Step 1: Find out when each patient's plan renews
Ask when they hand over the card. It takes ten seconds:
Kailan po nagre-renew ang HMO ninyo? Kahit month lang po.
A lot of patients won't know. Ask them to check with HR or the HMO's member app, and mark it "unknown" until they do. Don't guess. Ask again next visit.
Write down the employer as well. A company's group plan normally renews on one date for everyone on it. So when the first patient from a BPO in IT Park tells you March, you probably have March for the other eleven. Confirm it with the next one who comes in, then use it.
Keep this with the patient record, not on a sticky note at the desk. A simple tracking sheet is enough:
| Patient | HMO | Employer | Plan renews | Last covered cleaning | First reminder | Second reminder |
|---|---|---|---|---|---|---|
| Ms Reyes | Maxicare | BPO, IT Park | 1 March | March last year | 4 January | 8 February |
| Mr Lim | Intellicare | Bank, Mandaue | 1 July | August last year | 6 May | 10 June |
| Mr Cruz | Maxicare | BPO, IT Park | 1 March | Unknown | 4 January | 8 February |
Collect what you'll use and nothing more. You need the HMO, the employer and a month. You don't need a photo of the card sent over Messenger for a reminder. Patient records count as health information under the Data Privacy Act, and our guide to winning back old patients explains what that means for what you text.
Step 2: Time the reminders
These dates are what we'd use. The reason for each is in the last column, so move them if your clinic works differently.
| When | What to send | Why then |
|---|---|---|
| About 8 weeks before renewal | First reminder, to every HMO patient on that renewal date | Room for the cleaning and a second visit if the check-up finds a covered filling or extraction |
| About 3 weeks before | Second reminder, only to those who haven't booked | The last point where they still have a real choice of times |
| The final 2 weeks | Nothing outbound. Answer whoever messages you | Those weeks fill on their own. A new message now creates demand you can't serve |
Spread the first send. If thirty of your patients share a 1 March renewal, don't text all thirty on 4 January. Send ten a week over three weeks, so the bookings arrive at a pace your chairs can take. How to automate dental patient recalls covers metering a queue against real capacity. For the hour of the day, see the best time to send recall messages.
Step 3: Write the reminder
Every reminder needs four things: who it's from, the renewal date, what's covered, and a way to book.
Say "covered by your HMO", never "free". It isn't free. The employer paid for it. "Free cleaning" also reads like a promo, and the Code of Ethics the Board of Dentistry adopted under PRC Board Resolution No. 14, s. 2008 says offering "Promotional Rates" isn't allowed. Our old-patients guide quotes the section in full. A reminder about cover the patient already has isn't a discount, but "covered" keeps you well away from that line. It also saves you the awkward moment at the counter when the patient finds out the filling isn't free after all.
Write "if you haven't used it yet". You know she didn't use this year's cleaning with you. You don't know she didn't use it somewhere else.
Use a full link, and don't ask for a reply. Nobody can reply to an SMS from a sender name like SMILESKIN, and Philippine networks block shortened links. Our SMS template guide covers why, and what a link costs in characters.
The first reminder, eight weeks out, at 159 characters:
Smile & Skin Clinic: Hi Ms Reyes, your HMO renews on 1 Mar. If you haven't used this year's cleaning, it's covered until then. Book: https://yourclinic.ph/book
That's one SMS segment, with a single character to spare. A longer clinic name or link pushes it to two. A peso sign does worse. The ₱ isn't in the standard SMS character set, so one ₱ switches the whole message to an encoding that fits 70 characters per segment instead of 160, and this reminder becomes three.
The same reminder in Taglish, at 157 characters:
Smile & Skin Clinic: Hi po Ms Reyes! Sa March 1 na po magre-renew HMO ninyo. Kung di pa nagamit ang cleaning ninyo, covered pa po. https://yourclinic.ph/book
The second reminder, three weeks out, at 156 characters:
Smile & Skin Clinic: Hi Ms Reyes, your HMO renews on 1 Mar, three weeks from now. If you still want this year's covered cleaning: https://yourclinic.ph/book
There's no third. Two is enough to reach someone who meant to come, and anyone who still wants a slot in the last week will message you.
When the patient messages you first
Patients also message you first, at all hours: "accredited po ba kayo sa Maxicare?" If nobody answers, there's another accredited clinic down the road. On Messenger, where a reply does reach you, answer with something like this:
Yes po, accredited po kami sa Maxicare at Intellicare. Iche-check po namin sa HMO kung covered ang cleaning sa plan ninyo pagdating ninyo. Dalhin lang po ang HMO card ninyo. Ito po yung link para pumili ng oras: https://yourclinic.ph/book
Swap in your own HMO list. Notice it doesn't promise the cleaning is covered. It says the clinic will check.
Step 4: On the day
Verify before treatment. Use the HMO's own process, whether that's card validation or an LOA. Do it at the desk, before the patient is in the chair.
When the check-up finds something, sort it into two piles. Work the patient's plan covers gets booked before the renewal date, while it's still covered. Work it doesn't cover gets a price, in pesos, before anyone picks up an instrument.
Before they leave, look ahead a year. Confirm the renewal month and update your sheet. If they've changed jobs since last time, they're on a new plan, maybe with an HMO you aren't accredited with. Better to find that out now than in eleven months.
Common mistakes
One December blast to every HMO patient. It assumes every plan resets in January. Time each reminder to the patient's own renewal date.
Calling it free. See Step 3. "Covered by your HMO" is accurate and it doesn't read like a promo.
Promising coverage in the chat. "Covered po yan!" at 10 PM turns into an argument at the counter when the plan says otherwise. Say you'll check, then check.
Reminding patients about an HMO you've dropped. Accreditation changes. Check your current list before you send, because a reminder that ends in "sorry po, hindi na kami accredited diyan" costs you the patient and the goodwill.
Asking for an SMS reply. It goes nowhere, and the patient thinks you ignored them.
Leaving reminders running after the patient books. Once Ms Reyes has a time, stop the second reminder. A "three weeks left!" text the day after her cleaning makes the clinic look like it isn't paying attention.
Where OtterFlow fits
Most of this is a list and a calendar, and a spreadsheet can run it. It fails the way every recall list fails. In a busy week, nobody opens it.
For the reminders going out, OtterFlow's recurring SMS reminders work on one person, one start date and one rhythm. Make a draft called "HMO renewal" that repeats every year and links to your cleaning service, then give each HMO patient a reminder starting eight weeks before their renewal date. The message can say "your HMO plan renews in about eight weeks", so one wording works for every patient. Add a one-off reminder three weeks out for the second nudge.
The reminders page doesn't know your appointment book, though. When Ms Reyes books, pause her three-week reminder yourself.
For messages coming in, put your accredited HMO list, what patients should bring, and how you handle verification into your FAQ. Then when someone asks "accredited po ba kayo sa Intellicare?" at 10 PM, Flo answers from what you wrote, in English, Taglish or Bisaya, whichever the patient uses. If they ask something you haven't covered, like whether their root canal is included, Flo says it doesn't know, takes their details, and flags the chat for your staff instead of guessing. It won't diagnose, either. Then it offers times that are genuinely open, books the one they pick, and sends the SMS confirmation and the reminder before the visit.
OtterFlow doesn't check eligibility, file the claim, or know what a patient's plan covers. That stays with the HMO's process and your clinic software. If you want to see how the late-night answer sounds, you can try Flo on the demo clinic from the OtterFlow home page.
Setup: ₱0. Then 4,975 a month.
Questions clinics ask
What if the patient doesn't know when their plan renews?
Mark it unknown and ask them to check with HR or the HMO's app. If someone else from the same company has already told you, use their date and confirm it at the next visit.
Should we remind patients whose HMO we're no longer accredited with?
No. Tell them at their next visit, or when they message, that you've stopped accepting that HMO, and give them your cash price for a cleaning if they ask.
What if most of our HMO patients renew in January?
Then November and December are your crunch, and they overlap with the holidays. Start the first reminders in early November, spread them across three weeks, and decide before you send how many HMO cleanings a day you can take.
Start with one company
Look at last month's HMO patients and find the employer that shows up most often. Ask the next patient from there when their plan renews. That one answer gives you a renewal date for the whole company, and a reminder date eight weeks before it. Do that one company properly, see what comes back, then add the next.
If you'd rather the reminders and the "covered po ba?" messages were handled for you, the 15-minute call below is where to start.