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

My bet is “yes” if you are talking about the following concept too much...but there is hope!

When we started seeing patients in dental school, we either inherited ones that were already there or saw new patients that had been “pre-screened.” 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 would set up a series of appointments and then the patients would come back to get started on their treatment plan so we could earn our credits to graduate. Sound familiar? 

If you are like me and have decided to start taking some continuing education courses as you’ve progressed through your post-grad 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 lots of problems and concerns that your patients have, you start to find out that the dental “insurance” or “dental benefits” they have don’t cover a lot of the care they need!

Approaching the question of treatment costs

Inevitably, during our discussions with patients about treatment needs, at least one of these questions that comes up: “Does my insurance cover it?” or, “What will my insurance cover?”

If you are 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 talking about to begin with. The conversation usually goes like this:

Doctor: “Mrs. Jones, you need to have this crown replaced on this tooth here before it either begins to hurt, or worse, you lose the tooth.” 

Mrs. Jones: “Okay, 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: “Okay. Is there any way we can find out for sure?”

Doctor: “Sure. We can get the girls at the front office to get a pre-estimate done.”

Mrs. Jones: “Okay. Thank you. I’ll talk to them.”

And, so Mrs. Jones does, and she doesn’t get scheduled because we are 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 a lot of patients are going to ask about it. So we start conversations like this during treatment recommendations:

Doctor: “Mrs. Jones, we can take care of xyz treatment for you and this is why we need to do it.  Your insurance will take care of this portion for you as well. Did you have any questions?”

Mrs. Jones: “Okay. It doesn’t hurt, but I guess if I need to get it done and if my insurance will cover xyz, then I’ll talk to the girls up front about scheduling.”

Doctor: “That sounds great.”

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

This can happen when the doctor or even one of the team members doesn’t focus the discussion on a patient's treatment needs and how it can impact 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 if insurance doesn’t cover it, it must not be that important or necessary. This was learned all too well from how insurance has worked in medicine for years, and it is rapidly becoming a bigger part of discussions in the dental office as well. 

Here is 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 make the best decision for her treatment.” 

So, as you can see in this brief story, when we and our dental team members (who are also our trusted advisors for our patients) focus our discussions on insurance-based situations, limits and coverage tables, we are effectively not allowing our patients to know all their options. 

And if we are not offering them what would be best or covering options that may not be covered by insurance, we are not allowing our patients to give an informed consent (uh-oh; "informed consent;" yes, this is a form of lack of informed consent, in my opinion) and we are effectively “taking away” their right to say “yes” to what is best. 

Making oral health the priority

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

Let’s say we tell our patient, “Mrs. Jones, you are going to 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 partial. So we can do either a fixed or removable partial denture.” 

In a case like this, 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 are here for: helping our patients keep and maintain their 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 and this is how it 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: “Okay, but will my insurance cover this?”

Doctor/Staff: “Yes, it may cover a portion of this treatment and we will do our very best to make sure 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: “Yes, we will help you figure that out so you can get this done and keep you from having any problems with your teeth.”

Patient: “Okay. I’ll talk to them at the front about scheduling.”

Now, is that always easy? Nope. Almost never. Why?

We dentists and dental professionals do not want to discuss it for a variety of reasons. Sometimes the reason is fear of upsetting patients; other times, it’s the mindset that patients only care about what insurance will cover. And patients, for a variety of reasons, 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 placed a high value on their oral health, they would brush three times a day, floss twice a day, come to the dentist regularly and do whatever it takes to maintain their teeth and oral health. But for many patients, the value they place on maintaining their teeth (and sometimes their overall health) is impacted and influenced by a multitude of things, including past, present and future experiences and expectations. 

Emotions and other core values (including cost, embarrassment, fear of pain and shame) impact “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 is 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. It is then that we move from discussing insurance as a main topic to one about how we can help our patients maintain their oral health and teeth for a lifetime.  

(Click this link for more dentistry articles by Dr. Jeff Lineberry.)

​Jeff Lineberry, D.D.S., F.A.G.D., FICOI, Accredited Member-AACD, Spear Visiting Faculty, and Contributing Author - http://www.cccdds.com