Dental insurance is a modern day reality that has become one of dentistry’s most commonly expressed challenges, frustrations, irritant, confusion and limiting obstacle to practice operations and growth. Our experience of coaching practices is when the dental team feels this way, they tend to let policy benefits dictate their diagnosis, treatment plans and case presentation which inevitably influences the standard of care and sends a message to the patient that if insurance doesn’t cover it then they don’t need it.

Dental insurance is a necessary evil and can’t be ignored as two out of five USA dentists say they are not busy enough while forty-eight percent (48%) of American workforce has some form of dental insurance that drives them to attend dental visits. Dental insurance funded by employers contributed to forty-nine percent (49%) of the national dental spending of 114 billion dollars in 2013.

Although we may know it is necessary , it is easy to get caught up in the Evil part due to the current economics, decline of full fee indemnity plans, increase in PPO’s and minimal fee increases for network providers.

As well as eroding annual allowances, increased patient deductibles, deleted coverage of ideal treatment procedures and the intense paperwork and energy needed from the dental practice business office.

So, what do we do about the things we can’t control? Nothing. We focus on what we can control which is a transformation of evil to opportunity through our attitude, management system play book and patient education.

With dental team understanding, assessment of current insurance situation and simple steps to maximize plans while educating the patient about their policy insurance success can happen.

Team Understanding

This is a common knowledge of basic information about dental insurance, benefits, who is involved, types of insurance and how to explain to the patient.

What is Dental Insurance?

It is a policy provided privately or by an employer for financial assistance for reimbursement of select basic and preventive dental services. Dental plans have an annual maximum dollar amount and often involve a required patient deductible or possible co-payment for procedures covered at lower percentages.

The policy is negotiated between the employer focusing on the lowest cost per employee with the insurance company who is in business for profit. The patient is the policy holder who is responsible for deductibles and co-payments and the dental practice is a third party provider delivering health procedures while supporting the patient to maximize their allowances and benefits and still offering the best dental solution.

Types of Dental Insurance

Plans can generally be divided into two types: managed-care and fee-for-service.

• Managed-care dental plans are cost-containment systems that restrict the type, level and frequency of treatment, limit the access to care and control the level of reimbursement for services.

  Preferred Provider Plans (PPP)—network of credentialed and accepted providers who all agree to accept a REDUCTED fee guide based on contract legalities. If patients on a PPO choose an “out of network” dentist they will be paying more out of pocket. Adults aged 24-64 are more likely to have a PPO and the number of patients on PPO plans has decreased from 55% to 47%.

• Fee-for-service dental plans (FFS) – Indemnity or private plans where dentists are paid for each service performed according to the fees created by their UCR full fee guide. Indemnity plans have decreased by 4% and over 65 seniors are more likely to have indemnity, discount dental and direct reimbursement plans.

How to explain to the patients

“Mr. Patient: You are fortunate to have dental benefits as less than half of working Americans are provided this luxury. Your unique dental policy is designed to provide you with financial assistance for preventive and basic dental procedures. It was decided upon by your employer based on cost savings with an insurance company who is in business for profit.”

“Our role as your dental professional is to inform you about the conditions inside your mouth and the best dentistry has to offer to treat them. We will also help you as best as we can as a third party to maximize your annual allowance if needed and offer alternative payment options for the balance.”

ASSESSMENT of current insurance situation

Look at your current database and collect information about how many insurance companies you work with now, what type of plans are they, how many patients are attached to each company and the impact of reduced fees via adjustments. You can use your practice management software if you know how to run advanced reports OR you can reach out to us for quick, efficient and economical online automation tool called the GPS navigator. It will collect and interpret your dental insurance landscape of unused maximums and remaining benefits for all subscribers.

***For more information call 1-800-345-5157 or email [email protected].

Tips to MAXIMIZE insurance

• Make sure the computer has all active patients with insurance company attached
• Attach all family members to the family dependent policy
• Input each known patients policy benefits of annual maximum, deductible and category percentages into the practice management software system
• Input the full UCR fee guide for the practice
• Post and bill ALL procedures at your full UCR fee and adjust off the fee difference by the name of insurance company.
• Collect co-pay and or deductible at time of service over the counter
• Electronically file all claims for patient and know the turnaround
• Don’t ask a new patient if they have insurance until the END of call
• Post ALL incoming bulk insurance payments to the specific patient and procedure
• For assignment practices who accept reimbursement from the insurance company, manage the unpaid insurance claims every 2 weeks.
• ONLY send pre-determinations or estimates for patients who have accepted and want financial confirmation
• The clinical team NEVER OFFERS estimates in the operatory and defers to the business team

Patient Education

• Be positive if they have benefits as it is a luxury and bonus
• Encourage patients to learn, read and familiarize themselves with their individual benefits booklet or online version
• Explain that the dentist is an important member of their health care team
• Educate them about the oral health being the gateway to overall body health and a significant part of your overall wellness.
• Create a DENTAL INSURANCE facts sheet and give out , email or post in practice

If you would like a complimentary fact sheet please email [email protected] or call 1-800-345-5157 and mention this column