Discover the phrases you should never use when talking to patients about insurance and why.
Like it or not, dental insurance has had a profound influence on dentistry. The insurance industry will continue to help mold the reimbursement landscape and patient perceptions of dental care and its affordability. It’s challenging to do and say the right thing when having the insurance dialogue with our patients.
It’s very important to train the dental team appropriately so that they can communicate with patients in a way that helps the patient understand what they can expect from the insurance without accepting responsibility for what the insurance carrier does. Here are five statements that should never be made to patients about their insurance coverage.
- Your insurance will… It is foolhardy to believe we can always predict what the plan will cover, how much the plan will pay, and explain the ever-expanding limitations that could affect the expected reimbursement. Suggesting to the patient that the practice can always accurately predict the expected payments and what their copayment will be is dangerous and detrimental to the reputation and credibility of the practice. Should the practice strive to maintain accurate information in the dental software? Absolutely! This will aid the business team in estimating the potential benefit and collecting the patient’s portion. Always remember, when describing to the patient the expected reimbursement, use words like, “estimate, estimated, potential reimbursement, our experience has been.” The patient must understand that reimbursement is subject to many variables outside the practice’s control. The patient should be made aware of your intention to help them maximize their legitimate reimbursement; however, the carrier is ultimately in control of the reimbursement made on their behalf.
- We are going to send a Pre-treatment Estimate. Only send a pre-treatment estimate when the plan requires it; otherwise, it is poor use of the business team’s time and expertise. Pre-treatment estimates only delay necessary treatment, and obtaining an estimate is no guarantee of payment. This disclaimer appears on every pre-treatment estimate: “The services are still subject to the plans restrictions and limitations.” That being the case, why even obtain a pre-treatment estimate at all?
- We will accept the insurance payment as payment in full. This statement should only be made if the plan covered the service at 100%. It is considered illegal in every state and unethical by the American Dental Association to waive any portion of the patient’s copayment and/or deductible. Waiving the patient’s portion is a material misrepresentation to the carrier of the actual fee charged for the service, a potentially fraudulent act. The practice should make every attempt to collect the patient’s portion of their treatment cost and document those attempts. Failure to attempt to collect the patient’s portion could be problematic.
- We will bill your insurance and send you a statement after we receive the insurance reimbursement. Every attempt should be made to collect the patient’s portion on or before the day the service is provided. Collecting on or before the date of service will serve to reduce the practice’s accounts receivables and reduce the number of statements that are sent. Chasing the money is never easy for team members and is one of the least enjoyable parts their duties. If the practice carries balances and/or charge interest on open balances, most states consider the practice a lender and may hold the practice to the same standard and subject to the regulations as the banks in your state.
- No, we do not take your insurance (unless you neither file claims nor accept assignment of benefits). When the practice is not in-network with the potential patient’s insurance plan, never mislead the patient or provide inaccurate information. However, it’s better not to just blurt out the answer “no,” ending the conversation without taking the opportunity to establish a relationship with that shopper. When this occurs, you have lost the opportunity to educate that patient and perhaps encourage them to become your patient. While it is important to always be honest with the potential patient, other responses can be provided that reduce the likelihood of the patient immediately moving on to the next practice on their Google search. (See below for more information.)
When talking with our patients, it’s important to help them understand their benefits. The patient should be aware that the coverage they have is a benefit that can help defer the cost of treatment, but that dental insurance seldom covers everything the patient needs to become and remain healthy. The dental team can help the patient understand the benefits and limitations of the coverage they have, and it could be helpful to eliminate the phrases identified here.
What to say to potential patients when you’re not in-network with their insurance plan
Consider using these responses when you are not in-network with a potential patient’s insurance plan.
If you file the insurance claim for the patient and accept assignment of benefits, the response could be:
“We have many patients that are covered by your plan, and our staff member Mary is great at working with dental insurance plans. She does everything possible to obtain the maximum reimbursement available through your plan.
We are not in-network with your plan because that plan has some significant limitations and restrictions associated with participation. If we were in-network, the insurance provider could then dictate and limit the kind of care we can provide our patients. Our doctor is concerned about your health, the overall appearance of your smile, and the long-term success of all dental care provided. Our doctor does not feel comfortable providing anything less than the best care available. Our valuable patients deserve the best care available and should not be limited to the type of care any insurance company dictates.
While we are not in-network with your plan, we accept assignment of benefits from it. With an assignment of benefits in place, you will only need to pay what the plan does not cover. Can I make you an appointment to meet our doctor? I know you will be impressed!”
If you do not accept assignments but do file the claim on the patient’s behalf, your answer might vary. Again, always be honest. Consider this response:
“We have many patients that are covered by your plan, and our staff member Mary is great at working with dental insurance plans. She will work with your dental plan and file a claim for our services on your behalf. Following each visit, you will pay us for the services provided. After the claim is processed by your insurance provider, you will receive reimbursement directly from the insurance provider.
We are not in-network with your plan, nor do we accept assignment of benefits from it because that plan has some significant limitations and restrictions associated with participation. If we were in-network, the insurance provide could then dictate and limit the kind of care we can provide our patients.
Our doctor is concerned about your health, the overall appearance of your smile, and the long-term success of all dental care provided. Our doctor does not feel comfortable providing anything less than the best care available. Our valuable patients deserve the best care available and should not be limited to the type of care any insurance company dictates.
Furthermore, being out-of-network greatly reduces our administrative fees, and we pass those savings on to our patients by keeping our fees for service reasonable. Can I make you an appointment to meet our doctor? I know you will be impressed!”
Read the Insurance Information topic in Dentrix Help to learn more about entering and customizing insurance information in Dentrix.
By Roy Shelburne, DDS
Dr. Shelburne graduated from the University of Virginia with a double major in Biology and Religious Studies in 1977. He went on to graduate with honors from Virginia Commonwealth University’s Dental School and opened a private general practice in Pennington Gap, Virginia, in 1981. He has served as Secretary/ Treasurer and President for Southwest Virginia’s Component 6 of the Virginia Dental Association and as a delegate to the Virginia Dental Association’s Annual Meeting. He and his family have served as short-term volunteer missionaries with the Baptist Medical Dental Missions International and on various Mission of Mercy projects in Virginia. In March 2008, he surrendered his dental license after being convicted of healthcare fraud and spent 19 months in Federal Prison and 2 months in a halfway house. Dr. Shelburne is a nationally known speaker/writer/and consultant who openly shares his mistakes, what he learned as a result, and how to avoid those career ending errors. “It is a wise man who learns from his mistakes, but a wiser man still that learns from another’s.”
Originally published in Dentrix Magazine, Summer 2017