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Dental receipt template for Retail Trade

all right once these guidelines have been determined it is the responsibility of the business assistant to follow through with them basic practice financial policies should include statements on gathering financial information presenting the fee making financial arrangements with patients and collecting overdue accounts gathering financial information the registration form gathers all basic financial information needed to manage the account history and complete the patient identification portion of an insurance claim form information on the form includes the name address telephone numbers and a place of employment of the person responsible for the account information specifying the patient's coverage under a dental insurance if any and identification information for all individuals included in the account so usually that it's gonna be like a parent and then it's gonna they're gonna have their kids um under in their account if their kids are minors or if they're under um the parents insurance fee presentation before a case is presented to the patient an estimate is developed as part of the treatment plan this estimate is prepared in duplicate which one copy is provided to the patient and the other is retained with the office records after the dentist has completed the case presentation to the patient the business assistant may be asked to handle the discussion of the fees involved so actually most of the time the dentist does not explain the treatment plan to the patient unless the patient has specific questions to the doctor after their exam is finished most of the time the the presentation of the treatment plan is going to be your job as an assistant so credit report dentistry today is costly especially in the area of specialty procedures such as implants surgical procedures or orthodontics and orthodontists of course braces a credit report of the responsible party may be requested if this is in the if this is the dentist policy the responsible party should be informed before application of the credit report consumer accredited report agencies commonly referred to as credit bureaus or agencies provide a financial profile of the patient and usually what they'll do um when they pull when they need to pull the credit report is because the patient is doing either some type of payment plan or if they're applying for something called care credit and care credit is basically like a medical credit card you use it for anything to you apply for it it's like a credit card and then you use that card to pay for your services whether it's dental or medical and the amount of the [Music] credit line that you get with care credit it all depends on your credit um history if you have good credit obviously they're going to give you probably a few thousand dollars but if your credit is not that good then the amount might only be maybe like 300 500 it depends making financial arrangements financial arrangements are made with each patient when professional services are performed these arrangements should be made before treatment is initiated except in such instance as emergency treatment the arrangements should be reasonable to both parties and the arrangements should be made in a private setting which means nobody needs to hear what type of arrangements you're you're making um between the office and another patient accounting accounting is the means or process of recording classifying and summarizing financial transactions bookkeeping is recording the account process so okay so i have a question what two types of bookkeeping systems are used in the dental office does anybody know accounts what and accounts what anybody so the answer to that is accounts receivables and accounts payable those are the two types of bookkeeping systems okay so let's talk about accounts receivable the accounts receivable system manages all money owed to the practice involves maintaining financial records regarding all transactions related to collecting fees for professional services provided to a patient the dentist may choose to obtain bonding insurance on staff members who handle practice funds by receiving and banking patient payment or writing checks types of accounts receivable systems the most frequently used type of accounts receivable book bookkeeping system in a dental practice is the computerized system or a pegboard system increasingly offices are switching to electronic practice management systems because they are capable of integrating technology with accounting and more than likely um when you get into the office this is the type of system that you're going to see it's going to be everything is going to be computerized you're going to be able to do your treatment plan on the computer you're going to be able to print out any financial information from a ledger or transaction history for a patient computerized accounts receivable management data entered into computer program and used to maintain account histories and practice records essential that information be entered accurately because this is used to generate account totals in daily and monthly summaries important that the data stored in the hard drive of the computer is protected by being backed up daily because remember what i what i said what happens if your computer system crashes or what happens if god forbid the office catches on fire then you lose all all your stuff on your computer all your files an additional setup of backup files should be stored in a safe place outside of the office vital in the event of theft fire or other disaster that makes it necessary to reconstruct the loss the pegboard accounts receivable management pegboard accounting is a manual bookkeeping system also known as a one right system all records are completed with a single entry through positioning of the daily journal page ledger card and a carbonized receipt all financial records for each patient visits are completed by writing information just one time so basically manual accounts receivable management basics charge slips is used to transmit financial information between the treatment area and the business office daily journal page record of all transactions for the patients seen each day including the name of each patient charges payments and adjustments to the account receipts and walkout statements similar to a receipt but shows the current account balance so a walkout statement is what you will give out what you will give to a patient well the front desk usually gives them after you've checked them out for the day let's say they have some type of procedure done like a root canal or something like that if the patient uh chose to do some type of payment plan the accounts the walkout statements it'll it'll give them um kind of like a history of what was done that day how much they paid for that procedure and what their balance is um for that procedure if they didn't pay it in full recording payments all payments must be entered promptly into the bookkeeping system so they are recorded in the account history and on the daily journal page payments received by mail are entered in the same manner as those made in person as a safeguard checks should be stamped immediately with a restrictive endorsement which prevents anyone from cashing a check if stolen so basically um the offices are going to have a stamp and when the patient pays with that check on the back of the check what the you'll do is you'll stamp it and the stamp says for deposit only so nobody can cash it if um the check happens to be lost patient account records organized on the basis of information regarding the responsible party so the person who agrees to be responsible for payment of the account is known as the guarantor this is not always the patient it can be um you're gonna see that sometimes adults um actually come with a parent to the to the appointment and the parent is actually the one that's supporting this other adult so they'll be the uh basically the person that's going to pay it's not going to be the patient so the patient account record is used to track all account transactions a current account balance is maintained at all times this information is used to generate statements insurance claims and other collection efforts payment accounts can be handled in several ways including payment at the time of treatment cash check credit cards digital wallet professional courtesy and discounts daily proof of posting so end of each day listings on the daily journal page are compared with the appointment book to be certain that all patient visits have been entered the total for receipts must match the amount of money received so this is your basically your end of day receipts and if you guys use a lot of credit cards at the office that credit card is going to give you a report at the end of the day so when you do the report in the computer whatever amounts that it says of money that was entered for that date needs to match the receipts of those credit card machines bank deposits sorry bank deposits deposit slip an itemized listing of the cash and checks taken to the bank to be credited to the practice account the slip must bear the practice name address and account number the slip must be eligible cash is listed together and checks are all listed together a monthly statement a request for payment of the balance due on the accounts receivable under this plan the patient is expected to pay the balance in full on receipt of the statement so cycle billing statements for patients with last names in each part of the alphabet are mailed as specified times during the month divided payment plans the patient pays a fixed amount on a regular basis so this is what i was talking about earlier the patient does a payment plan so what happens is um it's the it's the office's um choice or policy of how many payments they can do how many months they can uh divide a payment for a patient um and it also depends on the amount so let's say a patient they're getting treatment done and the treatment is a thousand dollars they'll say well you have to give 500 down today and then we can um divide the other 500 in two payments so the patient will pay 500 today and then the next month to 50 and then the next month 250. what methods of payment can a patient use to pay on an account does anybody know anybody a check uh-huh what else um what forms of payment do you guys use anywhere else when you go shopping what other cash maintains you use cash correct what else debit credit card yep cash check credit card what else there's one more thing that it's not um you wouldn't use it like if you're out at the store but you would use it if you're at a dental office or at a medical office a personal check no anymore something that will actually pay the office on your behalf insurance insurance correct insurance all right so collections accounts receivable report this report shows the total balance due on each account plus an analysis on the age of the account management of collection efforts all collection efforts must be handled tactfully collection telephone calls when placing a collection call have all necessary information ready before making the call so you need to have the exact amount that is owed the payment due date and previous conversation notes so anytime that you call somebody for collections um you have to make a note in their ledger on the computer that you spoke to this person on so and so dates what they told you what you told them et cetera et cetera so that every time that that person is called you can go back and look on the note of what happened um on the pre during the previous conversation even if it wasn't you that were called them specifically collection letters should be firm positive and like make every effort to persuade the patient to pay the debt allow patient to avoid embarrassment final collection options the final decision on regarding turning accounts over for collection must be made by the dentist an account is never turned over without the dentist's specific approval so if let's say your office is going to have a policy that maybe an account that's passed through 60 days will be turned over to collection so that's just the policy you don't have to have it approved by the dentist you just know that after 60 days if the account is still has a balance on it it's sent over to collections collection agency a collection agency makes additional efforts to collect the balance on an overdue account the agency the agency's charge is a percentage of the amount collected and this is deducted before the balance is remitted to the dental office some attorneys also attempt to collect overdue accounts in exchange for a percentage of the amounts collected small claims of court another option is to take the adapter to small claims courts sometimes arrangements are made so the so that the business assistant not the dentist appears for the hearing one drawback to the option of seeking a small claims court judgment is that even if the court rules that the debtor must pay it is still up to the practice to collect the amount of the judgment so basically it's just like a waste of time collection letter follow-through the timetable 30 days a statement including financial arrangements is sent 60 days a second statement is sent accompanied by a kind printed collection message or a telephone call 75 days past due another telephone call is made and an amicable collection letter is sent so after 90 days a third statement is sent with a stronger collection letter noting that the account will be turned over to a collection agency for action 105 days a telephone call is made stating unless account is paid by a specific date account will be turned over to a collection agency for action 120 days overdue the account is turned over to a collection agency so like um sometimes that is the amount of time 120 days but it's up to the the office to say when it's going to be hand handed over to a collections agency okay so what is the time frame for an office to begin collections efforts anybody know after how many days should they start trying to collect their money if the patient hasn't been paying on their own 30 days 30 days good accounts payable management all the money that is owed by the practice expenses and disbursements determine the cost of doing business in the dental practice so expenses are called overhead as these expenses are incurred they become accounts payable disbursements are the payments made for these accounts payable dental office overhead so there's two two things there's a fixed overhead and then there's a variable overhead so fixed overhead means that it's going to be the same month after month it's not going to be a surprise so business expenses that continue at all times including rent or mortgage utilities insurance and salaries most of those always remain the same variable overhead expenses such as dental and business supplies independent contractor fees laboratory fees and equipment repair fees and those are variable because they change all the time what you order this month if you had a very busy month maybe next month you have to order double so that changes um if you had to have somebody come in and look at uh let's say the roof of where your office is that's an independent contractor so that's a variable overhead because you didn't know that you were going to have to do that laboratory fees it all depends on how many crowns bridges etc you sent over to the lab for that month gross versus net income so gross income is the total of all professional income received the net income is the gross income minus all practice related expenses so basically gross income is all the money that you receive in in total and then the net income is the money that you're going to have left over after you pay all your debt or expenses that you had for that month disbursements effective management of a dental practice requires organized handling and prompt payments of all bills for practice related expenses a certified public accountant so cpa is often employed on a retainer basis it will be the cpa's responsibility to handle the major financial records such as annual profit and loss statements tax returns and other government reports packing slip it's an itemized listing of the goods stripped and the recipient of the shipment so a packing slip is basically inside anything that you order there's a slip it has a receipt it has the name of what you ordered in the quantity that you order and the price of it an invoice is the detailed list of goods shipped and services rendered is an itemized bill so an invoice is basically going to tell you okay so i'm charging you uh twenty dollars to fix this uh high speed uh thirty five dollars to change your light bulbs forty dollars for me to just come all the way out here that's a detailed list of uh that's an item an itemized bill okay so statement is a summary of all charges payments credits and debits for the month organized expedienture records statements and invoices that have not yet been paid are placed in the accounts payable folder as part of the organization of exponential records expenses are classified into categories these usually include groups such as professional supplies laboratory fees salaries rent and maintenance utilities and business office supplies at the end of the year this expense documentation is removed and filed in the same categories with other business records for that year payment of accounts monthly payments check all invoices from suppliers to make sure they match the statements cash on delivery also known as cod the payment is due at the time of delivery there is a handling fee and petty cash this is for small expenses or supplying patients with change and petty cash is usually kept inside the office inside the business office it's like a little box and it has changed let's say like change for a hundred dollars or whatever it is because sometimes the first patient of the morning comes in and pays in cash with a hundred dollar bill and their their um whatever they had done that day is only 15 let's say so now you have to give that person cash back their change so you would get that from the petty cash also let's say the office for whatever reason they ran out of toilet paper now you gotta run to the dollar stores uh to buy toilet paper for the whole office so you'll use money from the petty cash so that being said what does cod mean cash on delivery correct cash on delivery is required good job so check endorsement before the payee can receive cash for the check he or she must endorse it which means they must sign it with a restrictive endorsement the check can be deposited only to the account of the named individual a rubber stamp with the appropriate restrictive phrase and the payee's name may be used in place of the payee's signature as a safeguard such a restrictive endorsement should be placed on all checks as soon as they are received stop payment order if the maker of the check for various reasons does not want the bank to pay a check he or she has written the maker may request that the bank issue a stop payment order for the check the written stock payment order must reach the bank bookkeeper before the check is presented for payment so basically before they have to request the stock payment order before the office deposits the check or before they even uh you know they post that money onto the account the bank charges for the service non-sufficient funds a check will be returned to the payee marked nsf if there is not enough money in an account to cover the check when a check from a patient is returned the amount of the check must be charged back against the patient's account often the telephone call to the maker will resolve the problem and then the check may be redeposited also remember um the bank charges i think it's like 25 for any check that bounces business summaries all checks must be accounted for in a specific expense category with a computerized system posting to the appropriate category is part of the check writing process totals from monthly summaries are carried forward to an annual summary through the keeping of these records the dentist in the account at any time can quickly tell what the practice expenses have been to date okay so what term is used to indicate that the account does not have enough money in it to cover a check anybody we just spoke about this non-sufficient funds what is it nsf non-sufficient funds that's the term that is used to indicate that the account does not have enough money in it to cover a check okay so payroll complete and accurate employee records must be kept at all times a separate payroll sheet should be maintained for each employee this sheet must have the employee's full name social security number address and number of exemptions claimed payroll deductions income tax withholding so state and federal that obviously has to come out of your check federal insurance contributions act commonly known as social security that also has to come out of your check automatically and any other deductions like if you have to pay child support or i think if you owe the irs i don't know if they would hold you your whole check or just portions of it and that's the government um part so dental insurance now we're going to get into dental insurance a plan that assists a patient financially with the cost of dental care a person can obtain dental insurance a traditional dental care insurance plan a managed care dental insurance plan or government programs such as like medicaid and medicare and medicaid and medicare are two different things medicaid are medicaid is usually for children and pregnant women under a certain age and then medicare is usually for retired um [Music] people that are retired already that are living off social security or people that have uh been they [Music] deemed like disabled that they can't work that's usually what medicare is for managed care dental insurance plan capitation plans preferred provider organizations those are called the ppos and those are the ones that the doctors really like because ppos um the patient basically pays a percentage of it and then the insurance will pay the rest and the patient has the choice that they can go anywhere they want they don't have to be specifically assigned to an office to a certain office so exclusive provider organizations direct reimbursement plan individual practice associations patient protection and affordable care act and government programs okay so the parties involved in dental insurance the patient or the subscriber and this is the person who carries the plan dependent there's a subscriber's spouse or a child group the union or employment organization that has negotiated dental insurance as part of his benefits package carrier the insurance company that pays the claims and collects the premiums and provider the dentist who renders the treatment to the patient and uh once you get into the office you learn a lot more about insurances it's really not that complicated it's just a certain type of insurances require different things but you'll start doing it so much over and over again and then you start dealing with almost always the same insurances that you that'll be like you'll know like the back of your hand eventually how benefits are calculated the usual customary and reasonable fees so a usual fee is the fee that the dentist charges for a given service the customary fee is a fee within the range of the fees charged for the same service by dentists with similar training and experience within the same geographic area so let's say um i'm a dentist here in kissimmee um and i charge 15 for a cleaning so there's a dentist across the street from me and they charge 15 as well so that's a customary fee it's uh the fee is basically kind of the same for the area now if i go to let's say windermere or winter park then that fee over there their customary fee might be sixty dollars for a cleaning because it all depends on the area so a reasonable fee is a fee justified by special circum circumstances necessitating extensive or complex treatment the schedule of benefits this is a list of fixed specified amounts that the carrier will pay toward the cost of covered services the patient is responsible for the difference between what the carrier will pay and what the dentist actually charges um so this is also yeah it's pretty self-explanatory so let's say um the the patient is getting a cleaning and the cleaning is 50 but the insurance is only going to pay uh 15 out of those 50 so the patient is responsible for the other 35 okay fixed fee schedule this is an established fixed fee for any treatment received by the patient the dentist must accept the amount paid by the carrier as payment in full so let's say again you go to get a cleaning done but the dentist your insurance only pays 50 for the insurance but the dentist charges 65 for the cleaning the dentist has to accept that the insurance is only going to pay 50 for that cleaning and they won't charge you anything else um they won't charge you the difference basically determining eligibility when a subscriber starts a new job a 30 to 60 day waiting period is commonly required before coverage becomes effective so if a subscriber changes jobs is laid off or retires his or her coverage is customarily terminated within 30 days of the change so they still give you those extra 30 days after you've been laid off or fired or switched jobs etc the subscriber has the option to continue coverage under the consul consolidated omnibus budget reconciliation act which is also known as cobra determining the benefits information that explains the coverage under a specific plan is found in the benefits booklet and benefits booklet um they said they send this to everybody that has insurance it tells you what they cover what they don't cover where you can go for these um treatments what where the doctors are etc do the patients ever look at that not really and then that becomes a problem for the office and for the assistant and for the patient limitations the least expensive alternative treatment dual coverage determining primary and secondary coverage the birthday rule coordinating of benefits and non-duplication of benefits dental procedure codes so the code of dental procedures and nomin nomenclature was developed by the american dental association which is also known as the ada and you will hear that a lot to speed and simplify the reporting of dental procedures those codes are provided in current dental terminology which is cdt which is published periodically by the ada and that means that they have to keep switching it because codes are either changed or are added the codes are very specific each procedure has a designated code number and like i said once you get into the office and you start doing certain procedures if you start doing them over and over again you will learn these codes like like with your eyes closed you won't even have to think about it twice to remember a code for a specific procedure i remember when i used to work at the dental office um my manager even even when i wasn't at work my manager would call me just to ask me what is the code for partial trying what is the code for this what is the code for that and she was the manager of the office and i i could always tell her off the top of my head what the code was because i used to do it so much we memorized them claim forms claim form preparation claims for dental treatment are filed in one of two ways by submission on the claim form that is mailed to the carrier by electronic transmission in which information is submitted electronically to the carrier when you get into the office you might learn how to do both if you start working front desk both types require the same three primary areas of information patient and subscriber identification dentist identification and details concerning the treatment provided so a paper claim a dental insurance claim form is used to submit a pre-determination of benefits for plans treatment to request payment of claims for services that have been rendered the ada provides a standardized claim form that is accepted by most carriers so this is pretty much like a universal uh form the completed claim form is generated in duplicate which means one one copy is submitted to the carrier and the other copy is retained with the practice records the claim form includes toolboxes for patient signatures these related these relate to release of information in the assignment of benefits the release of information is permission to reveal to the insurance carrier information regarding the patient's dental treatment because if you want your insurance to pay for your dental treatment you need to let the insurance know what exactly it is that you need done or that you had done assignment of benefits it's an authorization to make payments of allowable benefits directly to the dentist an electronic claim software data are downloaded to generate and submit claims from the practice computer to the carrier's computer advantages the speed of claim submission and payment reduction in paperwork fewer errors and this is this is true because i used to do electronic claim forms so you just it's basically just like a form that you fill out on the computer it tells you what information you need most of the time you just enter it by drop down menu et cetera you upload the patient's x-rays and then you click submit and it submits it electronically to the uh insurance company and usually you'll get payment much faster than if you're sending it through mail because what happens when you send stuff through mail what what can happen if you're sending a letter or a check or anything through the mail it gets lost it gets lost correct so a lot of the times when you send paper claim forms um the insurance after maybe like 15 days you're like oh well the insurance hasn't answered me the patients will be calling you what happened with my claim did they approve this did they pay for this et cetera et cetera you look it up or you call the insurance company and they say well we never received the claim form and then what happens you already lost 15 days now you got to start over again and now that's more time wasted hipaa and electronic transactions so transaction standards to protect the integrity and promote the standardization of electronic claims submission the goal of this program is to allow one standardized format for each specific transaction along with a standard set of procedure codes by doing this electronic data transmissions are more efficient which results in a cost savings for healthcare providers one thing that i will let you know with [Music] um paper claim forms you have to be so so careful filling those things out because any little thing that uh any little mistake that you do and it could be the most ridiculous smallest thing the insurance company when they receive it they'll be they'll turn back and they'll say well this t wasn't crossed so we can't pay for this you need to resubmit it so it'll be like the pettiest things but you have to be so careful when you when you fill those out try claim form processing so it may be necessary to file a pre-determination for planned treatment so what does predetermination mean anybody know anybody want to take a guess if you have to send something out to the insurance company for pre-determination before you have anything done on your treatment plan what does that mean what are you asking what are you asking for to see if you qualify for the procedure or treatment correct not if you qualify but if the insurance is willing to pay for that treatment so that's a predetermination most of sometimes um especially with uh ppo insurances you know preferred provider organization of insurances even though they pay more they want you to submit the treatment plan that they're supposed to be paying for before you do any treatment just to make sure that they're going to pay what they say they're going to pay because there's going to be there's going to be a lot of times that if you don't uh if you don't submit the predetermination what's going to happen is that on let's say in the system when you enter the the patient's insurance or in their benefits uh booklet it's going to say well the insurance will pay 800 for a thousand dollar roof canal but when you go ahead and do the root canal and then you submit it to the insurance the insurance says no we're not going to pay 800 we're only going to pay 500 so what's going to happen with the remaining five hundred dollars that that wasn't paid for what do you think happens with that comes out of the pocket right exactly the patient is gonna have to pay for that so if in the beginning with the treatment plan you told the patient well the root canal is a thousand dollars the insurance is gonna pay a hundred and you're only going to be responsible for 200 and then you come back and say oh the insurance only paid 500 now you have to pay 500 out of your pocket how do you think the patient is going to act if you're upset about that exactly they're going to be upset so that's why it's important to sometimes um send out for those pre-determinations because you want to make sure that the insurance is going to pay what they say they're going to pay so all charges are entered into the patient's account history or ledger a claim for payment is submitted to the insurance company financial arrangements are made with the patient for payment of his or her portion of the fee so this is one like a payment plan comes in like i spoke about earlier um let's say that a patient has a treatment plan that's going to be a thousand dollars they will probably be asked to pay half of that up front so the day that they have the treatment done they'll pay 500 and then the office will finance the other 500 however they feel like they should finance it they can finance it a hundred dollars a month for five months or 250 dollars a month for two months etc it all depends tracking claims and process claims that have been submitted for pre-determination but have not yet been returned claims that have been submitted for payment but have not yet been paid charges for claims that have been generated but have not yet been submitted and claims that have been returned for any reason and have not yet been resubmitted so remember what i said claims sometimes claims will um come back for this the pettiest thing they'll say oh this information was missing uh this x-ray um didn't show the correct tooth etc so it's very important that when you send out those claims you have every you have every single thing that you need because they will come back and won't want to pay for it if there's the slightest thing uh the slightest mistake i mean so payments for insurance for insurance carriers um checks received from insurance carriers should be accompanied by an explanation of benefits that tells which benefits have been paid and which have been denied the explanation of benefits break breaks down how payment was determined so if after the after making this payment the patient owes the balance he or she should be notified what the insurance carrier has paid his portion and that the patient is now responsible for the unpaid balance so that will happen often okay handling overpayments credit the check from the carrier to the patient's account so anytime you get a check in the mail or check from an insurance as soon as you receive it um you have to enter that in the information under the correct patient write a check from the practice to the patient to refund the amount of overpayment um so that can happen too uh indeed like if you overcharged the the patient or the insurance paid too much and the patient had already paid their portion um you'll write a check from the office to the uh to the patient of repaying them and make an entry on the account ledger if there's a credit or any order if money was given back to the patient so insurance fraud some examples of dental insurance fraud are billing for services not providing changing fees on a claim form to obtain a higher payment disregarding a co-payment or deductible only the insurance payment and writing off the deductible so let me tell you that um this happens a lot in medical and dental offices i'm not saying that you know it's whatever office you go to that's going to happen but you have to be very careful with that um where i used to work there was a a specialist doctor that he was claiming to do these deep cleanings on the patient's mouth and charging about hundred dollars per quadrant for these claims billing it to the insurance and the cleanings were never done so when the other dentist he because they would see the patients after the the general dentist is the one that refers a patient to a specialist so a patient let's say a dentist says well you have um a lot of uh builds up under your gums your gums are very inflamed you're starting to lose bone et cetera i need you to go see a periodontist and a periodontist is the specialist of the gums and the bones so usually what they do is they once they see the pair dances the periodontists will do a tree a treatment plant for them and they'll say well you need deep cleanings um usually what they do is they divide the mouth in four quadrants because they have to go very deep under the gums so most of the time the patients will have to either get numb or they just want to do it slowly by quadrant because [Music] the general dances evaluates your gums and i'm going to do the looks at your gums and wreaths ends again and they see that so oh literally these deep clean because they see on the patient's tree plant as completed and they see it on the patient's ledger they see that the patient paid for it but inside the patient's mouth and when they see the x-rays none of that stuff happened it's actually the same as when they sent the patient over to see the specialist so that's why i already started this one that was committing that give me one second i thought i thought it was my computer but yeah you're breaking up and then it had went blank and then it came back oh my goodness what is this my computer is is probably my computer because it's not responding at all to anything let me just stop this from here all right let's see