Kristin Pelletier -- Overcoming the Insurance-Driven Patient

Overcoming the Insurance-Driven Patient

Many dental practices tell me their number one obstacle to case acceptance is that their patients are insurance-driven. What exactly does this mean? When you’re presenting treatment to a patient, how often does the question “Will my insurance cover this?” come up in the conversation? And, when it does, are you prepared with an effective response, or do you simply take the patient to the insurance coordinator to get the answer?

While many practices think this focus on insurance is initiated by their patients, I believe most patients actually learn this behavior from the dental team. Patients absorb this message in your office every day by offhand questions such as: “How often does their insurance company allow full mouth x-rays?” Or, “Will their insurance company allow sealants?” Or, in the case of a restorative procedure, do you recommend that the patient spread the treatment over multiple benefit years to get the maximum coverage by insurance?

When patients hear us asking these questions, they think that treatment decisions are the responsibility of their insurance company. Instead, we should be communicating that our primary concern is our patients’ optimal oral health. I recommend that you have a team meeting and talk about what types of services your practice makes treatment recommendations based on insurance coverage. Then, consider these same services in terms of their impact on your patients’ oral health without regard for how much insurance will cover. What changes do you need to make in the language you’re using in your practice so your focus is on patient health not insurance payments?

Don’t just make these changes with bigger procedures. Make sure to incorporate this language in everything you do. Your patients will start to pick up on the message for the little things – the preventive and the diagnostic procedures – that this practice focuses on what we need and not what insurance allows. Then when something bigger comes up - like restorative procedures with a waiting period or a frequency limitation - your patients have already been sent a very clear message that your practice makes treatment recommendations based on what you need not what insurance allows.

When objections do come up, reply with a health-centered answer. Take them back to the consequences of leaving the condition untreated. One of my favorite responses is: “Insurance is designed to help you maintain a healthy mouth. If you need a restorative procedure or you need to go from disease to health, insurance only provides a minimal cushion to help. But, once your mouth is healthy, your insurance will help you keep it that way.” When the dentist can be the one to say this, it is so POWERFUL!

When you change this behavior in your practice, you’re on the way to training your patients to value what they need and not what insurance will pay for.