How to Explain Dental Insurance to Patients

One of the most common topics I am asked to talk about is how to explain dental insurance to patients.  It’s a valid request because so many consumers are becoming more insurance driven.  This has caused an increase of in-network providers and, due to the added layer of competition, many fee for service practices have had to tweak their initial patient conversations.  The good news is that if you follow the specific protocol outlined below, your conversion rate should always hover around 94% regardless of your patient demographic.

When a potential new patient calls your office, he/she knows two things:  they need to make an appointment and they have dental insurance.  The one thing you know is that you have 3 minutes to create a connection with this person and let them know we appreciate them choosing your practice.  As the front desk team member who answers the phone, it is your responsibility to take control of the conversation so that your entire connection isn’t left to schedule and insurance.  To learn more about the new patient phone call, check out our Training Your Dental Front Desk on the Telephone article.

Inevitably, regardless of how hard you try to ask “How did you hear about us?” or “Where did you move from?”, you will always have that one caller who insists on asking the insurance question immediately.  So, you are left with a potential new patient asking “Do you take my insurance?” as your only opportunity to make a first impression.  Yikes!  Now what? 

Step 1:  Proper mindset

As the “first impression specialist” at your office, your goal should be to show the patient that their needs are our top priority.  If the caller asks the question, we must assume insurance is a top priority for them and answer the dreaded question….  “Do you take my insurance?”.    The key now is your mindset.  You must have the attitude that while insurance is a great benefit for patients, we don’t ever allow insurance to dictate patient care.  It’s funny…  when I am doing small group trainings someone always mentions that talking about insurance puts a lump in their throat because they are always afraid they will loose the potential patient if not handled properly.  This couldn’t be further from the truth!  Remember earlier, I said that a caller only knows two things and one of them is insurance.  They could be asking this question because their spouse asked them to, maybe because as a new resident they just made doctor appointments and had insurance on their mind, or so many more reasons.  However, in our minds we cringe and go straight to, “They aren’t going to schedule with us because we aren’t in-network.”  This defeated mindset will come across the telephone and change the entire tone of the conversation.  This change is what causes potential new patients not to schedule.  Rarely is the true reason ever really insurance. 

Step 2:  Don’t provide too much information

Because front desk team members have so many tasks that revolve around insurance, we have a tendency to want to give the caller so much information that they are an insurance expert by the end of the call.  This is okay, IF they ask for the information, but make this the exception to the rule.  Most of the time, a potential new patient wants to know if they can hand you their card and use it to pay for a portion of their visit.  I was training a small office of 2 front desk folks last week.  A new patient call came in and I was shocked as I observed the conversation.  The team member spent approx.. 15 minutes talking about insurance and never asked how they heard about us, if any family members are due for a dental visit, and never mentioned scheduling the actual appointment.  I’m sure at some point the caller’s mindset shifted from “I need to make an appointment” to “How do I end this conversation”.    My point is answer the caller’s questions but do not offer more than they ask.  Their insurance policy is a contract between them and the carrier.  At this point, you aren’t privy to the specific contract language and are only able to answer general questions. 

Step 3:  Always be honest

How many times have you seen a negative review that references the quality of dental care?  How many times have you seen a negative review that references that “They can never get my insurance right.” Or “I always have billing issues.”.  The later statement is much more prevalent in the land of Google than the first.  You have to make sure to listen to the caller’s specific questions and answer them completely and honestly.  Nothing ruins a great new patient visit than when the EOB comes back and it discredits the information we provided over the phone. 

If a potential new patient asks, “Do you take my insurance?”,  here is the guideline I use to answer:

“I’d love to look into that for you. Who is your carrier?”

“Delta Dental.”

“Great.  Do you know if it is a PPO or an HMO plan?”

“I’m not sure, how would I know that?”

“PPO means that you are able to use your insurance at almost any office.  HMO means that your insurance can only be used at a specific dental office location.  Usually with HMO, the name of the doctor for you to visit is on the back of the insurance card.”

“I don’t see an office or dentist’s name anywhere.”

“Perfect.  Let’s proceed as if it is PPO and at the end of the call if you’d like to give me your insurance information I’d be glad to verify your benefits.  If anything differs from our conversation, I’ll let you know.”

OUT OF NETWORK:  “As a PPO plan, we will be able to assist you with your benefits and file all claims on your behalf as an out of network provider.  But in the dental world that doesn’t mean too much.  Dental insurance is opposite of medical insurance.  Dental insurance acts like a gift certificate of money up to the amount of your annual maximum.  As I mentioned, I will verify your benefits but 99% of the time insurance will still pay the same percentages for your treatment.” 

If the caller asks what the difference is between an out of network provider and in network, you can say “Delta Dental will calculate their payment to us based on their fees, not ours.  Sometimes it’s a bit

more, sometimes a bit less, and a lot of the time it’s almost the exact same.”

IN NETWORK:  “We are an in-network provider for your plan and will be able to assist you with your benefits.”

If the potential new patient asks any other questions, let them know that you are going to research their specific policy and will call them back to let them know exactly how your office will work with their insurance. 

Most important thing to remember when discussing insurance with a patient:  Never take responsibility for the patient’s insurance plan.  It is a contract between them and the carrier.  You are the nice person who will do your best to verify their benefits and estimate out of pocket costs. 

Role play the scenario above until you feel confident how to explain dental insurance to patients. 

To learn more about training your dental front desk on the telephone, contact me today at FrontOfficeCoach@gmail.com or 214-755-0955.  For more information about our front office training solutions, visit www.FrontOfficeCoach.com.


About the Author…

Tracy Civick is a nationally recognized speaker, coach, and author who focuses on motivating dental front office teams to grow practice revenue and get a better handle on the daily dental practice front office tasks.  Her memberships include The Academy of Dental Management Consultants and AADOM, Academy of Dental Office Managers.

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