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  06.24.05 Issue #172


“What Do I Tell My Patients When the Insurance Company Says NO?”

Belle M. DuCharme
RDA, CDPMA. Director
The Center for
Dental Career Development

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“I diagnose treatment that I would like to have in my mouth. The patients seem interested in having it done but if the insurance company says “no” then the patient thinks it is not necessary. What should I say to that?”

This was a question sent to me via e-mail from a frustrated dentist.

Unfortunately many patients see their dental insurance as a “policing agent” to keep dentists from doing more than is necessary to treat them. Most of my career as a Dental Business Administrator has been spent educating patients about dental insurance in general. Never say that you know everything about any dental plan . If you say this ,then the patient thinks that you are responsible when treatment is not covered or coverage is less than expected.

Try saying, “ According to the information that you have provided , I was able to talk to a representative from your plan and this is what I found out. You are eligible for coverage as of 2-1-05. Your employer has purchased a package for you that includes the following benefits and coverage___________. Your insurance company has asked me to have you look at the booklet that was given to you at enrollment. The plan that you have has a small per calendar year balance of $1,000.00. Your employer has provided this benefit to help you get some of the dental care that you need but it does not cover all of the costs. I have seen better plans than this one but I have also seen worse. According to your plan representative, you must pay the deductible of $50.00 and a co-payment of 20% of the fillings and 50% of the crowns. They have allowed you to have two preventive cleanings a year to encourage you to seek preventive care . You will use the $1,000.00 up and then be responsible for payment of $550.00 out of pocket. You are ahead of most people by $1,000.00 and this is good.”

Remember that many people do not seek regular dental care unless they have dental insurance. They do the same with the medical insurance; only it has a larger maximum and generally a smaller co-payment for office visits. Most people seek out medical care when they are ill or in pain. Unfortunately, pain in dentistry often means more than a “quick fix” with an antibiotic and bed rest.

Say to the patient, “I want you to have the best dental care available whether you have dental insurance or not. I realize that you need these benefit dollars to be able to afford your treatment. We will use the proper codes in billing the insurance to help you maximize benefits that you have paid premiums to receive.”

Want to learn more about effective patient communication? Contact me at The Center for Dental Career Development 1-877-777-6151 and sign up for the Business Administrator Training.

Belle M. DuCharme, RDA, CDPMA

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