The myth that patients should know their benefits

Dental Products ReportDental Products Report-2015-05-01
Issue 5

Dental office websites often have financial sections that state, “You are responsible for knowing your insurance benefits, but we will help you file claims” or, “We’re happy to help you with your claims, but you are responsible for knowing your plan details.”

Dental office websites often have financial sections that state, “You are responsible for knowing your insurance benefits, but we will help you file claims” or, “We’re happy to help you with your claims, but you are responsible for knowing your plan details.”

When these were written, they were no doubt intended in a friendly but firm way, but in our insurance-dominated landscape, it could easily be perceived as a red flag to the patient. What the patient really needs to read is “we’re here to help you with your benefits.”

How did we get from insisting that patients know their plans to becoming mini-insurance databases? Simple: The market has pushed us in that direction. The National Association of Dental Plans and Delta Dental of Pennsylvania report 78 percent* of the plans sold are PPO plans. Let’s put it another way-individual and group purchasers of plans select plans that offer a preferred provider network in an effort to reduce expenses. These networks are swelling with providers now-a very different scenario from 10 or even five years ago.

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This has created an opportunity for offices that are willing to take on the burden of discovering and tracking patient benefits. Is your insurance administrator collecting new patient benefit information on the new patient call? I hope so-if you wait to collect the information, you and the patient may be surprised at how the plan works in your office. Patients have already been primed by medical offices to hand over their insurance information rather robotically. Dental offices should also be collecting it but with much more of a customer service bent.

The patient relies on us to help decipher his or her benefits. Is that fair to the dental office? Definitely not. But is it the new business reality? Absolutely. Let’s look at it from a different perspective. Let’s say you are scheduled to have an inpatient surgery on your foot. Your surgeon’s office will likely preauthorize the procedure for you. But what would you do if the office asked you to find out what the surgery would cost and if there are any plan exclusions? Is there a limit to how much anesthesia you can have? What hospital can they use? What material can they use during the surgery? Is there a missing toe clause? You get the idea!

Related reading: Why insurance coordinators need to be flexible in today's dental world

*Source: 2014 NADP/DDPA Joint Dental Benefits Report on Enrollment  

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Most of us wouldn’t know the first question to ask or even what department of the insurance company to call. We look to the surgeon’s administrator to know his or her way around the insurance maze. It’s a stretch to expect our patients to know enough to ask about alternate benefits such as amalgam-priced payments for composite fillings or partial denture payments for implant placements. For laughs, you could ask your neighbor to read that sentence and explain it back to you. It’s a rare patient that could do this. Frequency limitations for bitewings and crown placements regularly confuse providers, so it’s an easy assumption that patients wouldn’t even think to ask about it. The only time a patient is aware of a frequency limitation is because they have run into it at another office and ended up with unexpected out-of-pocket expense.

Related reading: Top 5 things you need to know about dental fees

This absolutely adds work to your already-stressed administrative team, but here’s what I tell my audiences: If you’re not helping them with their insurance, they’ll find an office that will. That’s hard to hear for a healthcare provider. We’re supposed to be blessed with the sanctity of the patient-doctor relationship. Ask your medical colleagues how well that relationship is working for them. American physicians’ private practice is highly influenced by the benefits market. I’m not suggesting we let insurance drive our decisions regarding patient care but that we realize how important it is to the patient that his or her benefits are understood.

I want your office to be the one that tells patients they’ll help with the language. Think of your team as translators of a foreign language for your patients. In essence, their dental benefits read like Latin to them. Your administrators are similar to a dental Rosetta Stone-provide your patients with the translation and a smile along with an offer to help rather than an admonishment that they should know their benefits.   

About the author

Teresa Duncan, MS, FADIA, FAADOM, is an international speaker who focuses on revenue, dental insurance and management issues. She is a fellow of the American Association of Dental Office Managers. Her memberships include the American Academy of Dental Consultants, National Speakers Association and the Academy of Dental Management Consultants. She was recently named by DPR as one of the Top 25 Women in Dentistry. Teresa received her master’s degree in health care management.


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