Are You and Your Team Limiting Your Patients’ Treatment Choices?

My bet is “yes” if you discuss the following concept too much … but there’s hope!

When we started seeing patients in dental school, we either inherited ones who were already there or saw new patients who had been “prescreened.” Then we did a comprehensive exam, reviewed the findings, and developed a treatment plan for them. 

When I was in dental school, the school discounted student fees to one-third or one-fourth of what private practice was, and the financial coordinator behind the desk dealt with the insurance and the money part of things. We’d set up a series of appointments, and the patients would return to get started on their treatment plan so we could earn our credits to graduate. Sound familiar? 

If you’re like me and have decided to start taking continuing education courses as you’ve progressed through your postgrad dental career, you’ve started learning a lot about things that we didn’t spend much or any time on in dental school. 

As your education and experience begin to blend together, and you get a lot more comfortable dealing with or at least diagnosing the many problems and concerns your patients have, you start to find out that the dental “insurance” or “dental benefits” they have don’t cover much of the care they need!

Approaching the question of treatment costs

Inevitably, during our discussions with patients about treatment needs, at least one question arises: “Does my insurance cover it?” or “What will my insurance cover?”

If you’re not careful, insurance can become the center of attention in your discussions with your patients, and sometimes it’s not even our fault that we lose sight of what we were even discussing. The conversation usually goes like this:

Doctor: “Mrs. Jones, you need to have this crown replaced on this tooth before it begins to hurt or, worse, you lose the tooth.” 
Mrs. Jones: “OK, but what will my insurance cover?”
Doctor: “I’m not sure. A lot of times, insurance will cover a portion of the crown.”
Mrs. Jones: “Is there any way we can find out for sure?”
Doctor: “Sure. We can have Melinda in the front office do a pre-estimate.”
Mrs. Jones: “Thank you. I’ll talk to her.”

Mrs. Jones does, but she doesn’t get scheduled because we’re waiting on her pre-estimate.

It’s not long before we start to figure out that interjecting the insurance stuff is almost second nature, because we know that many patients will ask about it. So we start conversations like this during treatment recommendations:

Doctor: “Mrs. Jones, we can take care of the XYZ treatment for you, which is why we must do it.  Your insurance will take care of this portion for you as well. Did you have any questions?”
Mrs. Jones: “It doesn’t hurt, but if I need to get it done and my insurance will cover XYZ, I’ll talk to the girls up front about scheduling.”
Doctor: “That sounds great.”

As you can see in these conversations, we have lost focus on the one thing we want our patients to value — their oral health!

This can happen when the doctor or one of the team members doesn’t focus the discussion on a patient’s treatment needs and how it can affect the patient’s well-being and overall oral health. In doing so, we have effectively moved our focus from helping our patients desire the best and healthiest choice to what the insurance will cover.

Don’t let insurance costs impede treatment 

Unfortunately, our patients have been misinformed and taught that treatment must not be that important or necessary if insurance doesn’t cover it. This is learned all too well from how insurance has worked in medicine for years, and it’s rapidly becoming a bigger part of discussions in the dental office as well. 

Here ‘ a great example that just happened to me and my wife in a doctor’s office recently. My wife had some tests run and we came in for the results. After the family nurse practitioner read the results to us, the first words she said were, “Even though you have this medical condition, insurance won’t cover this treatment, so really there are not a lot of choices for you.” 

Not a lot of choices? Really? Wow. Needless to say, it struck a tone for me, and I kindly responded: “I understand that some treatments are not covered by insurance, but we need to know what her treatment options are and what is best for my wife so we can make the best decision for her treatment.” 

When dental team members focus our discussions on insurance-based situations, limits, and coverage tables, we effectively prevent our patients from knowing all their options. If we don’t offer them what would be best or cover options that may not be covered by insurance, we’re not allowing our patients to give informed consent and we’re effectively taking away their right to say yes to what is best.

Making oral health the priority

A typical example nowadays is implants: Many insurance companies don’t cover them when tooth loss is imminent, but they will cover a fixed or removable partial denture.

Let’s tell our patient, “Mrs. Jones, you will lose this tooth. You could have an implant done to replace it, but insurance won’t cover it. It will cover a portion of a bridge or a partial bridge. So we can do either a fixed or removable partial denture.” We have effectively steered Mrs. Jones toward what insurance will cover and not what may be her best treatment option. 

So what do we do? We focus our conversations on what we’re here for: helping our patients maintain oral health. Do we acknowledge insurance/dental benefits during our conversations? Yes. Do we focus on them? No. For example:

Doctor/Staff: “Mrs. Jones, we can take care of these few crowns and fillings for you; this will benefit you in the long run. Without treatment, you may ultimately have pain, infection, or even lose your teeth and not be able to chew as well.”
Patient: “OK, but will my insurance cover this?”
Doctor/Staff: “Yes, it may cover a portion of this treatment, and we’ll do our best to ensure you get the maximum benefit from your plan. But, ultimately, we want you to keep your teeth and help you maintain your oral health. Isn’t that your goal, too?”
Patient: “Yes, I want to keep my teeth, but I need to know what I will have to pay.”
Doctor/Staff: “We will help you figure that out so you can get this done and keep you from having any problems with your teeth.”
Patient: “OK. I’ll talk to them at the front about scheduling.”

Now, is that always easy? Nope, rarely. Why? Dentists and dental professionals don’t want to discuss it for various reasons. Sometimes the reason is fear of upsetting patients; other times, it’s the mindset that patients only care about what insurance will cover. For various reasons, patients don’t take your recommendations and run with them to the front desk to schedule. 

Communicating the true value of dental treatment 

One of the biggest things is this: value. Simply put, if patients truly valued their oral health, they’d brush three times daily, floss twice daily, come to the dentist regularly, and do whatever it takes to maintain their teeth and oral health. However, for many patients, their value on maintaining their teeth (and sometimes their overall health) is influenced by many things, including past, present, and future experiences and expectations. 

Emotions and other core values (including cost, embarrassment, fear of pain, and shame) affect “silent” decisions within the patient. As we focus our conversations on health-based values, we must learn to listen to our patients on a deeper level — one that comes from developing relationships and trust. 

When patients say “no,” it’s more than just “no, my insurance won’t cover it.” Also, “no” is not forever; it simply means “no” right now, and “please respect my decision right now.” 

One of the keys to our conversations is focusing and directing our discussions and conversations on the benefits of maintaining their teeth and oral health. As we strive to develop relationships with our patients, we begin to understand them and can help them have hope and value for their oral health. Through this constant process, we look for different ways to connect with our patients about their wants, needs, desires, fears, and many other things. Then, we move from discussing insurance as a main topic to how we can help our patients maintain their oral health and teeth for a lifetime.