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How one dental office manager is handling patient questions about the Affordable Care Act


When the calendar turned to 2014 and the Affordable Care Act began to affect dental practices around the country, I started asking some of my friends how it was making an impact on their daily professional lives.

One of my friends, Nomi Waters, gave me a little insight into the impact it’s having on the dental practice she manages in St. Paul, Minn. She also administers a Facebook group called “The Dental Marketing Project” and I am glad to be a member of that group.


Kevin Henry: What questions or comments are you getting?

Nomi Waters: At my office, we have received more comments than questions. Most of the comments seemed to be intended to inform us that they (the patients) “will have this really great coverage.” When we start discussing the changes, we find that most of the patients really don’t have any facts.

They just have an impression that ACA plans offer 100% coverage and all they have to do is hand our office an insurance card. The most common comment that we have received came this past December, “I’ll have Obamacare soon. I’ll have to get you the information for next time!” Other comments that we have heard include, “I’m going on Obamacare. It’s a pretty good deal for me,” and “My kids will be covered under our medical insurance when they come in next time. I’ll probably drop our dental coverage.”


Since January, we have noticed that we have had an increase in callers asking if we participate in the Minnesota healthcare program or MinnesotaCare (our state version of medical assistance) but, so far, we have only had one patient present her medical insurance card for an appointment … and she did so while making the comment, “It’s all 100% covered under medical now” (for her children’s appointments).


Henry: What was your response?

Waters: My response is to advise our patients not to drop their dental policy until we can figure out what kind of benefits the ACA policies will provide. I explain that since we are not involved in the contract that they and their employer have with the dental benefit company, we can only verify their benefits and repeat information that is provided to us by the insurance company’s representative.

We cannot guarantee any benefit coverage. We can only file claims on their behalf, so I suggest before they come to their next appointment, they send me their ACA dental benefit information so I can find out how those benefits will pay for services at our office.


When a patient has made a comment such as, “Everything’s covered,” I simply explain that while that would be fabulous, I am hearing conflicting information from insurance companies, dental experts, and consultants, so I suggest they be prepared to find out that everything may not be covered.

I tell our patients about the rumors that I’ve been hearing about high deductibles and long waiting periods. This usually brings a scowl to their face so I reassure them that we’re here to help, and let them know that I’m researching the plans. I let them know that I’m out there on the forums looking for all the information that I can find.


Henry: How much confusion are you seeing out there?

Waters: Our patients don’t seem to be as confused as they seem to be misinformed (or not informed at all). The most common misconception seems to be that many parents think that they can bring their child to any provider and receive 100% coverage for their children’s dental care under their medical plan because of ACA.


As for the one patient who handed me a medical card for her kids, she was in disbelief when I informed her about her plan after I verified it. I had to tell her that, since we are a non-restricted provider for her benefit company, they will pay some benefits under ACA but not 100%!


Henry: What’s the one piece of advice you’d give to your colleagues out there to help with questions they’re hearing?

Waters: Remember, they don’t know what they don’t know and they don’t know. It’s our job to help them know so we have to be in the know.


I would advise my colleagues to be proactive and verify all ACA benefits prior to the patient appointment and be prepared to explain and collect the out-of-pocket fees that will be owed to them due to high deductibles (the average ACA deductible that I have found so far is $100 per child).

Also, I would say to train the administrative team to present dental benefit information with an “it’s great you have benefits that will help you pay for your dental care” attitude, teaching them to avoid saying words like “insurance” and to avoid phrases like, “you can’t have bitewings this month because they won’t pay.” I advise them to step up their customer service and be likeable so parents with ACA plans that are out of network will be more likely to stay with the office in spite of the reduced benefits that will be paid (due to out of network status).

Editor's Note: For more information on the Affordable Care Act and how it is affecting dental practices and the dental industry, be sure to check out our Ultimate Guide to the Affordable Care Act for Dental Practices.

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