Issue #43-4.14.08

Sally McKenzie, CEO McKenzie Management Printer Friendly Version

Crossing the Great Divide: Insurance

How often have you found yourself stymied by one seemingly easy question, a simple sentence that completely turns the tables on you? Consider this scenario. You present the necessary treatment plan to the patient. She clearly understands the need and is eager to proceed.

Then the Financial Coordinator steps in and unveils the price tag. The patient swallows hard and asks the question that she intuitively knows the answer to. “Will my insurance pay for that?” And there you are, standing at the great divide between the care the patient truly needs and the bare minimum that she too often settles for. Those six little words suddenly present a seemingly insurmountable barrier between treatment diagnosed and treatment accepted. For a split second you’re thinking, “Oh no, do we have to go there?” Yes, you do, and you should have gone there a long time ago.

Rather than trying to dance around the insurance issue, tackle it head on. Educate your patients about insurance limitations and other financial options just as you educate them about proper oral healthcare. Specifically, patients must fully understand that although standards of dental care have improved dramatically in the last 25 years, dental insurance coverage remains virtually unchanged. Most policies have a per calendar year cap that has not been increased in more than two decades—an important detail that patients often aren’t aware of.

I recommend that your Financial Coordinator sit down with the patient and review what’s covered in the dental plan. Discuss the calendar year cap, deductibles, co-pays, coverage for preventive care, etc. For example: “According to the information you provided and additional information I gathered from the insurance company, your employer has purchased a package for you that includes the following benefits and coverage.” Explain those to the patient.

“The plan your employer provides offers a small per calendar year balance of $1,000. This will help cover some of the care you need. In addition, your plan includes a deductible and co-payments.” Explain those to the patient.

Though it’s essential that patients understand the limitations of their insurance plans, it is equally critical that they recognize that those limitations cannot dictate treatment recommendations. A dental team cannot ignore gum disease or other infections of the mouth that may not be covered by insurance any more than a medical team could ignore infection or disease in the heart or lungs. As a health professional, you have an obligation to diagnose and prescribe the best care for your patients, regardless of what the insurance company says it will cover.

The six-month prophy versus necessary periodontal treatment is a good example of the common disconnect between insurance benefits routinely offered and treatment often needed by patients, and it causes significant frustration for practices and patients alike. The insurance plan emphasizes the benefit of two cleanings a year and the patient believes this is all they need unless the doctor and dental team regularly reinforce to the patient that neither the practice nor the patient can ignore bacterial infection because of insurance limitations.

Each time your patients raise questions regarding whether a procedure will be covered or why coverage was denied it is an opportunity to further educate them on the doctor’s commitment to diagnosing and recommending a level of care appropriate for the patient—not the insurance company.

However, managing the patients’ expectations regarding their insurance is only the first step. Help patients bridge the financial gap between dental care covered and dental treatment needed. Provide financial options, such as

• treatment financing through CareCredit
• a slight reduction in the total fee for procedures over $500 paid in full
• building account credit in advance
• paying for multi-appointment procedures in specific installments at the time of the appointment

The objective is to emphasize to the patient that dental care need not be limited by insurance constraints. And it’s essential that the patient feel that the Financial Coordinator is an ally and is trying to be genuinely helpful. To convey that message, the Coordinator must fully understand the benefits of the various financing options. Only then can you all lead Mrs. Patient to a financial solution that allows her to logically justify proceeding with treatment in spite of insurance limitations.

Sally McKenzie is CEO of McKenzie Management, a nationwide dental management, practice development and educational consulting firm. Working on-site with dentists since 1980, McKenzie Management provides knowledge, guidance and personalized systems that have propelled thousands of general and specialty practices to realize their potential. Sally can be reached directly at 1.877.777.6151.

Interested in speaking to Sally McKenzie about your management concerns? Email her at Sally@thedentistsnetwork.net.