6.4.10 Issue #430 Forward This Newsletter To A Colleague

Insurance Plans Putting You on the Defensive?
by Sally McKenzie CEO
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I recently had a conversation with a dental office business employee who told me she feels like she’s spending a lot of time being defensive and having to justify the doctor’s services. The practice recommends what the patient needs, not just what the patient’s dental insurance plan covers. And this employee, who is relatively new to the practice, is struggling when patients question the necessity of treatment not paid for by insurance. The employee is frustrated because she can’t understand how a patient could have insurance and not know what it covers. Welcome to the world of dental insurance!

Circumstances such as this can put employees in an uncomfortable position. And, not surprisingly, many dental teams believe that it is the patient’s responsibility to understand their dental insurance plans. The problem with this philosophy is that it creates too many situations like the one above where the staff and even the doctor have to defend or justify treatment recommendations. Although patient expectations and demands for dental services have increased, dental services covered by insurance plans are significantly limited. Understandably, the lack of coverage is very frustrating for both patients and practices. And with the recent economic struggles, more and more patients that didn’t give much thought in the past to what their insurance did or did not cover are questioning the need for certain procedures or delaying treatment.

What’s more, many patients can’t understand how it is that medical insurance pays out large sums of money over extended periods of time to cover treatments for illness, but dental insurance typically provides a mere $1,000 to help offset the cost of basic services. And that amount has not changed in decades, which further fuels the misperception that dental care can be delayed or even ignored. Worse yet, some patients look to the insurance company as the “dental expert.” If the insurance only covers two cleanings a year, that must be all that they would need. If the insurance plan will cover fillings but crowns are the best treatment plan for the patient, many opt for the insurance company’s “recommendations” rather than the doctor’s.

Frustrating as it is, the sooner practices take on the responsibility of educating their patients about the limitations of dental insurance, just as they educate them about proper oral health care, the stronger the practice/patient relationship will be. Moreover, this is the perfect opportunity for the practice to reclaim its role as the dental care experts.

Your financial coordinator should sit down with the patient and review what’s covered in their dental plan according to a prepared script in which the situation and options are clearly articulated and the coordinator is ready with the answers to those frequently asked patient questions and concerns. Discuss the calendar year cap, deductibles, co-pays, coverage for preventive care, etc. The greatest benefit of a script is that you know precisely how to respond and you are well prepared. Doctor and team can better manage the messages to ensure they are clear and professional.

Additionally, it’s important to consider not only “what” you say but also when you say it. Patients need to understand that they have a limited dental benefit – a specific amount of money that they can put toward their dental care each year. It is nothing like medical insurance; however, that doesn’t mean that you, the dentist, can ignore gum disease or other infections of the mouth. After all, if a patient had an infection or disease in their heart or lungs or any other part of their body, they would not expect their physician to ignore it because insurance wasn’t expected to cover the treatment.

As a health professional you have an obligation to diagnose and prescribe necessary and desired care for your patients, regardless of what the insurance company says it will cover.

Next week, turn the insurance barrier into a building block.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com. Interested in having Sally speak to your dental society or study club?Click here.

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