Dental Insurance - What to Tell Your Patients
I have always recommended you play down the fact that you are a dental insurance expert in your practice - that way your patients will not blame you if the coverage is less than they expected. This is still good advice, and even more so in the existing state of dental insurance coverage. Your patients should be educated about the product their employer has purchased for them or that they have purchased for themselves, but sadly few know much beyond “I get two free cleanings a year.”
When you present the treatment plan and the estimated costs, you can also provide a printout of their coverage with the qualifying remark, “This is the information that your insurance company provided to me. It is the same information they would give to you should you ask for it. If you do not agree with anything, please call them and speak to a representative.”
The system of verifying eligibility and benefits before the patient crosses the threshold into your practice is very important in building trusting relationships. If you are fee for service, you may be saying “Our practice is not about insurance.” Okay - but patients with coverage are all about insurance, because dental benefits are often the motivator for seeking care.
Coverage through an employer-sponsored plan is often more comprehensive and cost effective than buying an individual plan. Many retirees are finding this to be true as they try to find affordable dental insurance that gives them the benefit level that they are accustomed to getting. Take, for example, this patient who will be retiring this year. She sent me the following email:
“I asked my dentist if he recommended any dental insurance for when I retire, and he told me there is no insurance - they basically just sell you a maintenance policy. You don’t get more than what you pay for up front. He said you would be better off taking $50 a month or whatever you feel will pay for what you need and putting it aside in an account. If you need it, it’s there, if not it is still there and you can spend it on whatever you want.”
C. C. Retiree
This is good advice in that the patient may pay $600 or more for a policy with a $1000 per calendar year maximum. Most people get their cleanings and exams covered but balk at paying the co-payment for other services such as a crown even though the plan would pay 50% of the covered charge. The benefits do not rollover to the next year and the patient has essentially paid for what they got and the insurance has not paid anything.
There are plans being sold to the unsuspecting that tell the patient they are getting 100% coverage on the full tier of services, preventive to major. Of course, there is the per calendar maximum of $1,000 that is not mentioned, or the fact that it is 100% of the “fee schedule” owned by the insurance company. This “fee schedule” has nothing to do with usual and customary fees for the area or the doctor’s fees on file. The 100% payout for porcelain fused to high noble crown was $258 dollars, about the same as the lab bill would be. So if the dentist is charging $1200 for a crown the patients out of pocket would be $942. What a surprise if you were expecting no out of pocket costs for a crown.
Scheduling a new patient? Wait to the end of the conversation before asking the patient if they have dental insurance benefits. The focus should be on “how did you hear about our practice” and building rapport with the caller. At the end of the conversation you may ask, “Mrs. Brown, will you be using a dental insurance plan to help with the costs of your care?” If you are “not about insurance” then that shouldn’t be the first question asked of a patient that calls to schedule an appointment. Often patients who will be paying cash feel slighted if asked about insurance before you get their name.
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