5 Things Never to Say to Patients about Insurance

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 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.

  1. 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. Always remember, when describing to the patient the expected reimbursement, use words like, “estimate, estimated, potential reimbursement, our experience has been.”

    Should you strive to maintain accurate information in Dentrix? Absolutely! This will help the business team estimate the potential benefit and collect the patient’s portion. The patient should be made aware of your intention to help them maximize their legitimate reimbursement, but the carrier is ultimately in control of the reimbursement made on their behalf.

  2. We are going to send a Pre-treatment Estimate. Only send a pre-treatment estimate when the plan requires it. 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?

  3. 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.

  4. 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. 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.

  5. 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.

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.

Adapted from an article originally published in the Summer 2017 issue of Dentrix Magazine. Visit www.dentrix.com/magazine to read the full article.


Author Bio:

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.”



Author: Roy Shelburne, DDS
Published: 10/18/2017
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