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Explaining Dental Insurance to Patients

Posted by Joe Gargiulo on Mon, Dec 11, 2017 @ 03:29 PM

dental insuranceIt’s important for dental offices to determine a simple method of explaining dental insurance to patients. There are many providers and plans for individuals paying their own insurance as well as those covered by employer-based policies, so it’s easy for patients to not fully grasp all of the moving parts. It helps to have a fluent office manager or front-of-house person who can review each patient’s plan and distill the detailed information down to terms that make sense.

Surprisingly, many dental offices assume patients understand the dynamics of dental insurance and don’t review coverage with new patients in advance of the first exam or treatment. That’s not the right way to start a new relationship.

A Suggested Approach

Dental offices can best serve their patients by reviewing a printed copy of their benefits matrix during a five-minute presentation. Focus on their out-of-pocket contributions, which are generally a top priority to most patients, and how factors such as deductibles, maximums, co-insurance, copayments and  re-imbursement levels affect the bottom line.

dental insuranceIt also helps to explain that these factors are a function of insurance company rules as opposed to being determined by dental offices. This is critical because patients sometimes blame dental offices for situations beyond their control such as benefit limits.

Without getting into the weeds too deeply, dental offices can explain basic dental insurance jargon such as “medically and dentally necessary” and “usual, customary and reasonable.” Regarding the first definition, patients should be informed that it defines what insurance providers deem as being necessary versus what actually is necessary to sustain good health.

Patients should also be told that costs and coverage vary by geographic region.

Sharing the Basics About Dental Insurance

If a patient has a group plan, an explanation of the common “100-80-50” coverage (aka “reimbursement levels”) is a huge game changer on the road to awareness. Frequently, basic familiarity with 100-80-50 coverage is all that patients need to appreciate how and why they are paying out-of-pocket expenses: 100 percent of diagnostic and preventative procedures, 80 percent of basic procedures and 50 percent of major procedures.

The reason is simple.

Most patients are already familiar with examinations, x-rays and cleanings (diagnostic and preventative); fillings, root canals and simple extractions (basic); and crowns, bridges and oral surgeries (major).

Dental office managers should also address frequently asked questions:

  • Why doesn’t my insurance plan cover the cost of all treatments?
  • Why is there a waiting period for certain procedures?
  • Why doesn’t my insurance pay for all preventive treatments if they prevent more expensive ones?
  • Why do I need to pay for a portion of treatments that are supposed to be covered 100 percent?
  • What options do I have if my insurance company doesn’t pay for procedures I am entitled to?

Dental Treatment Estimates

dental insuranceLast but not least, dental treatment estimates are a must, and should be thoroughly explained and reiterated if necessary. These estimates may include plan deductibles, maximums, co-payments and more. The goal is to provide full transparency enabling patients to make informed decisions.

For example, patients may be told that a crown will cost $1600 or more, and that prices vary according to the type of crown being inserted: all-ceramic ($840 – $1560), porcelain-fused-to-metal ($760 – $1590) or all-metal/gold ($670 – $1450). Note: this is the total cost of the crown before dental insurance plan and patient contributions are calculated.

As a sidebar, Delta Dental has a user-friendly tool, the “Dental Care Cost Estimator,” for patients to use while determining potential costs. They simply enter their postal code and select one of the procedures from a detailed drop-down menu.

For the sake of demonstration, we entered “94954” as a zip code (our office in Petaluma, Calif.) and selected “Bridge – 3 Units” in the dropdown. The cost is a whopping $3816 – $4599.

The tool is accompanied by fine print:

dental bridge drawing.jpg“Currently the Dental Care Cost Estimator only provides a range of costs that reflects what the dentists in the zip code provided charge for a procedure. Your benefits may pay a portion of that cost, and you may also be required to pay a portion of the cost yourself.”

Thus, patients can expect to pay half of that amount (50 percent since crowns are classified as a major procedure) or as much as $2300. But what happens if they don’t have $2300, don’t have credit cards and can’t qualify for a new credit line?

CrossCheck Payment Solutions

This is where CrossCheck’s Multiple Check service saves the day.

Multiple Check provides patients short on cash up to 30 days to pay their dental balance in full without credit. Here’s how it works.

Patients write 2 – 4 checks covering the full amount, all with the same purchase date. Next, they tell the staff which days to deposit each check over a 30-day window. It’s a win-win situation because they receive necessary treatment without delay and dental offices receive guaranteed funding by CrossCheck with each check deposit.

Download our free guide to learn how Multiple Check can help increase sales and mitigate risk at your dental office — your patients will be glad you did!

hold check, multiple check

Tags: Dentists