The three most annoying things patients say about dental insurance …and how to respond.


Dental insurance will play a factor in how you will pay for what you want. Dental insurance should never dictate what you want.

Recently, I took a pole among our clients and asked what were some of the most challenging and annoying things patients say about dental insurance.  I compiled the responses and among the answers I read a lot of frustration. I chose the top three and hope to provide some constructive ways to handle these statements in the future.

Let’s get something out of the way right up front. Most patients don’t know what their dental benefits cover. They don’t understand how dental insurance works. For the most part, patients aren’t informed and let’s face it, who wants to take time to read the benefits manual? Just thinking about it makes me want to stick forks in my eyes.  So what do they do? They look to us.  Why is it that they think we would know? We’ve taught them this behavior.

Because we allocate our precious manpower and resources to make calls on their behalf. Because we investigate their benefits. Because we communicate with the insurance provider for pre-authorization. Because WE read the terms of their policy, we have, in essence, assumed responsibility for their insurance so they don’t have to! We, and I’m talking dentists as a whole, have created our own nightmare.

On the other hand, the insurance companies work very hard to create the perception in the patients’ mind that they are a vigilant benefactor who stands beside them and protects them from you, the greedy dentist. Because patients don’t understand the nature of dental insurance and the fact that the goal of the insurance provider is to NOT pay, we become the casualty.  And as a result, when insurance benefits pay for only a small amount of the procedure or deny the claim, or refuse to cover any costs, the practice becomes the bad guy. The patient takes it out on the messenger. We must learn to remove ourselves from being the “middleman”.

So how do you reverse this destructive trend?
You sit down with your patients and you have a dutch uncle talk with them about insurance realities. You have an opinion, knowledge, experience, and insight they don’t have. You can influence the way they think about their benefits. You can expose the insurance game for what it is. You can begin the process of getting them to own the responsibility of understanding what their coverage does, and does not provide. Part of your discussion should include these two non-negotiable philosophies:

1)  The insurance company’s goal is to make money and KEEP that money.  Our goal is to have the health of our patients influence our recommendations and that is not one the insurance companies share. We have never heard this as part of the insurance company’s mission.

2) Dental insurance will play a factor in how you will pay for what you want. Dental insurance should never dictate what you want.

Now, on to those annoying questions/responses:

#1  I have XYZ – Do you take my insurance?
There should be nothing annoying about this question but when you get this call, chances are you automatically form an opinion and label the caller. They are just trying to take advantage of their benefits. Insurance is like a coupon and they are trying to find out if you take their coupon.

If you do, the next thing you need to find out is if they understand the limitations of that coupon.
“Yes we do. Tell me, what is it you have been led to believe about your coverage?”, would be a great way to find out how much they know. Then you are able to start increasing their involvement from the very first call.

If you do not “take” their insurance, find a way to answer the question without saying NO. Avoid don’t, can’t, and use affirmative language.  Tell them what you CAN offer. Here are some examples of how you might approach it:

If your plan is one that allows you to choose the dentist you think is right for you, you can come to our practice. We would love to welcome you here.”

Here is what we can promise you. We will make make sure you get every reimbursement you are entitled to. Most importantly, we won’t allow insurance to dictate our standard of care and we will be honest with you about what we recommend based on what’s important to you.”

Mrs. Jones, XYZ insurance has some interesting rules. They will allow anyone to come to our practice. This is how it works…

#2  Oh, my insurance will pay for everything.
If they think their insurance will cover everything, we will have a problem. It is a given that no plan covers 100% with no “out of pocket” expenses, in any circumstance. There will always be some limitations. So it is a given that every dental client in this country with some kind of coverage will likely be disappointed.  Shift the focus away from us to some place else where it rightfully belongs. Try a response that will begin to shift their expectations from the very beginning:

Well, isn’t that wonderful.  Almost all of our patients find that’s not the case and are very disappointed. Bring in your benefits book and I will highlight those things you will want to be aware of before we begin so you won’t be disappointed with us when they (not us) let you down. We will help you in every way to get the benefits you are entitled.”

#3  I don’t want it if my insurance won’t pay for it.
Where do they get the restrictive mindset?  The insurance company.  When they emphasize “preferred providers” or  “standard and customary”  they send messages that they know what’s best for the patient when that couldn’t be farther from the truth.  We haven’t done our job to turn that thinking on it’s head. Patients don’t understand that their employer negotiates with the insurance company and they are the ones who decide what benefits their employees will receive. They don’t understand that insurance was never meant to provide full coverage for procedures. One way to present it to patients is;

Dental benefits are designed to keep healthy people healthy.  And sadly, unlike medical insurance, dental insurance has an annual cap of around $1000. Plus, there are lots of restrictions designed to discourage you from getting the care you have chosen. Your insurance will help with some of the expense but unfortunately, the coverage your employer provided you is not comprehensive enough to do much more. I hope that will not prevent you from choosing what’s in your best interest.

So, the question should be:  “Are you prepared to pay (fill in the blank) to get what you want and have (fill in the blank) help with a small portion of that?

I hope this has made you think about how you might be contributing to the insurance mindset and how to change it.  Use these tools to shift the influence of power and get your patients thinking differently about their benefits.

What annoying comments or questions about insurance are you hearing? The following statements were among some of the other top contenders. Knowing what you know now, how might you address these comments in the future?  Use this as a team discussion and send me your responses.

Are you a preferred provider?

Just submit my insurance and I’ll pay the difference when it comes back.

I’ll decide after you do the pre-determination.

My insurance company says your too expensive.

I have to see another dentist because you aren’t in network.