To Accept or Not to Accept Dental Insurance Benefits? 3 Questions You Need to Answer First

It never fails, especially in times of uncertainty — dentists start to question whether to participate in dental insurance benefits or not.

(Before we continue, I want to make a point about terminology. I use the word insurance here, as that is how it is commonly referred to in the industry. But as my colleague, Dr. Gary DeWood, often points out — and we suggest you point this out to your patients — there is no such thing as dental insurance in the strictest sense of the term. What we are talking about are benefits designed to help with the costs of dentistry, not “insurance coverage,” which implies that procedures should be “covered.” It’s an important distinction to keep in mind.)

Balancing the Pros and Cons of Accepting Dental Insurance

So, getting back to our main point — why do dentists get conflicted about the “insurance question”?

One reason you might be thinking about joining a plan is because it feels like all the practices around you are accepting insurance. Or maybe you read an article that said everyone was going to have to accept insurance, and you don’t want to feel left behind.

There is also the (usually mistaken) assumption that accepting insurance is an easy way to get past a patient ’s financial objections. In this sense, accepting dental insurance benefits may be perceived as a “silver bullet” solution for attracting and retaining patients.

Then there is the flip side of the coin. Maybe you and the team are so frustrated with benefit limitations or other issues that you decide to drop an insurance plan – without a clearly defined strategy to retain patients and support them moving forward. That can also be a recipe for disaster.

In the end, it comes down to the “big question”: does accepting benefit plans really increase patient flow, case acceptance, and practice profitability so you can “keep up with the Joneses”?  The honest answer is maybe, sometimes, and no.

I apologize for the ambiguous response, but the facts are that community demographics; the mechanics of individual plans; as well as your and the team’s grasp of their vision, goals, and strategies all play a significant role in gauging what kind of relationship with insurance (if any) is right for your practice. In this article, I suggest three questions to ask yourself to get to the bottom of that “big question.”

But before we get to those, let’s talk about how dentists and their teams tend to think about insurance.

The 7 Signs of “Stinking Thinking” About Dental Insurance Benefits

Everyone has heard the saying, “Physician, heal thyself.” At Spear Practice Solutions, when we analyze practices, it is not unusual to find that the doctor and team are the ones who are perpetuating the negative behaviors associated with insurance benefit boundaries.

How do we spot a practice struggling with an “insurance mindset”?  We look for the seven signs of “stinking thinking.” They are:

1. The dentist and team are uncomfortable recommending any treatment not covered by a patient ’s benefit plan.
2. Patients expect that insurance should cover 100% of the practice's fees.
3. Patients don’t understand the word “estimated” and regularly challenge statements indicating an additional balance due.
4. Patients (or the dental team) insist on pre-determination, even if their plans don’t require it.
5. The practice’s fees are the same as the fees of the local major dental benefits carriers.
6. Treatment is phased to match insurance benefits instead of the patient ’s clinical needs.
7. Patients expect the practice to argue with their insurance companies about what is covered.

Confess! If your practice exhibits any of these signs, you and your team have an insurance identity crisis, which could harm both your patients’ and your practice’s health.

The Three Questions to Ask Yourself When Thinking About Insurance

The great news is that whether you are considering changing your mix of insurance in the future or you and the team are wrapped up in a less-than-healthy relationship with dental benefits, there are three simple questions that will help you establish the right relationship with insurance now and in the future. Answer these questions honestly, and you will be much closer to answering the bigger question about accepting benefit plans.

1. Do I know how to spot the real signs of my practice’s economic health?

Many dentists and their teams never know the total dollar amounts they adjust off due to benefit plan fee schedules. This might feel like an ice-water dip but do the math. Say your standard crown fee is $1,250. It takes the same amount of fixed expenses to deliver that crown at the full fee as it does at a reduced fee of $1000 (20% reduction). And this can have a real impact on how you perceive production and expenses.

For example, I once worked with a dentist who felt he was overpaying his team and thought that was why he was barely making ends meet. After investigating, I discovered that the doctor’s average monthly UCR production was a solid $112,000 per month. And when we compared his employee expenses to UCR production, the team was being paid less than the acceptable Spear range norm. However, when we compared his employee expenses to adjusted production, the percentage was 55%, which far exceeds any range norms! So, instead of focusing on his employee expenses, I recommended he focus instead on analyzing the dental benefits plans he was participating in to see if they truly were profitable.

2. Am I creating clear and compelling goals that guide my practice to new levels?

If your only goal is, “I never want my operatories empty and I will accept any type of patient as long as they are breathing,” all I can say is careful what you wish for. Nothing is more stressful than dealing with patients who don’t share your values and commitment to care.

Set specific and realistic goals like, “I want to produce $1,175,000, collect 96% of that production, and spend 62% in overhead costs, while setting clear goals for standards of quality care.” Goals like these will allow you to make informed decisions about your practice rather than operating on the vague notion of, “I’d like to produce …a lot”, which just leaves you constantly feeling the pinch of scarcity. And that scarcity mindset can lead you to make ill-advised decisions about insurance.

3. Am I providing a patient experience that inspires patients to value — and pay for — the care we provide?

If you want your patients to rise above their own insurance mindsets and be willing to pay out-of-pocket for ideal care, then you have to offer something that exceeds their expectations. 

If patients are wasting away in your reception room because the team is always late, or they do not value their continuing care because of a poorly choreographed hygiene therapy visit and periodic exam, or they can’t afford ideal care because you offer limited financial arrangements, then don’t be surprised when they stop treatment at their benefit maximums.

The positive counterpoint to that is that people will always pay for what they value. So, your job, as a team, is to make them see and appreciate your value.

In today’s competitive environment, you and your team must surprise and delight! Patients who say enthusiastically say “yes” to treatment write glowing testimonials and insist their friends and family do business with you. When patients no-show, cancel, or hide behind their insurance benefits, it is their passive-aggressive way of saying they do not value your dentistry or the experience.

Do you honestly believe that a patient chooses to postpone $3,500 worth of necessary restorative care until next year strictly because of their benefits limitations? The answer is no.  When patients are committed to their oral health and you offer flexible financial arrangements that make your dentistry affordable (and you can find a great online course on that subject here, if I do say so myself), the dentistry can always get done.

Making the Right Choice About Dental Insurance Benefits

Dental insurance benefits can be a great asset — not only to your patients but to your practice. It’s a gift that can support a patient ’s quest for ideal health as well as support a practice’s profitability and efficiency. How you use benefits plans to achieve your practice’s vision should not depend on what the insurance contract says but on how well you embrace your goals and values. Whether the economy is thriving or diving, dentistry will continue to be done, patients will continue to say “yes,” and practices can continue to prosper.

Whether to accept dental insurance benefits is, of course, a choice only you can make — the important thing is that when you make those decisions, you make the right choices for the right reasons after asking yourself the right questions.

Amy Morgan is Vice President of Practice Growth Strategy at Spear, a member of Spear Resident Faculty, and former CEO of Pride Institute.