Troubleshooter 4 4

Case acceptance in an insurance-driven world

Jan. 22, 2014
Patients trust dental assistants to provide them with the right information

“Do you take my insurance?” “Does my insurance cover this?” How many times have we heard this question from patients? As dental assistants, we play a vital support role in our practices. We’re the ones who answer the tough questions when the dentist and financial coordinator are helping other patients. The patients relate to us, and they trust us. Case acceptance can become a challenge when the dental benefits are limited or restrictive, and patients do not understand the benefits of completing the recommended treatment.

One of the main things that confuses patients is understanding the details and nuances of their dental insurance. This is because the dental benefit package is filled with unexplained stipulations, the insurance card reads “Premier,” or patients have come to expect that their insurance should cover most dental care. In fact, most dental benefit plans cover preventive and basic care, and most adults require “major” care, including crowns, bridges, and dental implants. For example, it is common for an adult to need two to three crowns. If the crown fee is $1,000 per tooth and the dental plan has an annual maximum between $1,000 and $2,000, then a patient will likely exceed his or her annual maximum.

Let’s look at a brief history of dental insurance. Dental insurance became popular in the 1960s, and the annual maximums were around $1,000. In today’s dollars, that equates to $6,000 to $7,000 annually. Let’s further consider the application process for dental benefits when compared to medical insurance. When someone applies for medical insurance, there is a lengthy and involved screening process. This is to ensure that the insurance company will not take on a “high risk” patient without making the person pay a higher premium. For example, if a patient has a disease that requires ongoing treatment, surgeries, or hospital visits, the person will likely have a higher premium.

On the other hand, when a patient has periodontal disease, fractured teeth, or needs orthodontics, the person may have the EXACT same coverage as a 10-year-old with no dental disease. Realistically, for dental benefits to have expanded coverage, there would need to be process similar to medical insurance screening. Since there are no required doctor exams, the insurance company does not know anything about the patient’s oral condition before coverage is activated, and it simply relies on the laws of averages.

With all of the thousands of dental plans available, it makes our job as dental assistants more difficult. Patients are more likely to back out of treatment when they don’t fully understand the benefits, so we need to be armed with the facts. We know how important dentistry is to our overall health, and it is our job to share those benefits with our patients.

ALSO BY BROWN AND RICHARDSON:What every dental assistant needs to know about new patients

Recent studies have shown that each tooth has an “entrance” to the bloodstream and is part of the oral-systemic connection. This is why physicians require their patients to premedicate before dental visits if they have had joint replacements or have heart defects. A premedication is an antibiotic that a patient takes before an appointment to help reduce the bacteria released into the bloodstream, and the risk of complications with the artificial joints and heart valves.

There are many ways to show patients the importance of dentistry. From a patient’s first experience with your office, you must be clear about dental benefits. Explain what their benefits cover, and that it is only a partial reimbursement for basic services.1 This becomes even more important if your office is nonparticipating and considered “out-of-network.”

Another key point is to refer to their coverage as “dental benefits” rather than “dental insurance.” The term insurance implies that if you pay your premium, your insurance company will cover the financial responsibility. The more you educate patients about their dental conditions and plan benefits, the more they will trust you and understand that you have their best interest in mind.

When you’re reviewing or reinforcing the treatment plan with patients, this can be overwhelming for them. Before you dive in, say, “I know this may seem like a lot of information. One of our priorities is to make sure that you are aware, so you can make the best decisions for your health. While it may seem overwhelming today, please understand that the decisions for your health are yours and we are here to be a partner in your overall health and wellness. We want you to have enough information because you may make different decisions if you have more information.”

This will help put patients at ease, because it puts them in the driver’s seat and shows them that you have their best interests at heart. When you are reviewing treatment recommendations, wait until the end, after all the questions have been answered, to discuss financial options. When you get to the financial portion of the appointment, explain all of the financing options that are available, and don’t be afraid to “talk money.” If they sense that you’re uncomfortable with it, this may make them feel uncertain as to whether the treatment is actually needed.

Case acceptance in an insurance driven world is a challenge facing dental assistants across the country. However, with strong verbal skills and confidence, you will successfully find ways to help patients fit dentistry into their budgets, and comfortably into their lives.

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Brianna Richardson is a Certified Dental Assistant (CDA). She is the executive assistant at The Tanya Brown Group, and founded for dental assistants and aspiring dental assistants who are preparing for dental assisting exams. She can be reached at [email protected].

Dr. Tanya Brown founded and actively practices at The Center for Cosmetic & Restorative Dentistry in Chesapeake, VA. She works with dentists and dental teams who “Connect the Dots” to be more productive and have more fun. Contact Dr. Brown for a complimentary copy of the New Patient Call Form at [email protected], 757-819-7000, or 855-700-TEAM (8326).

1: Credited to Linda Miles