Making Dental Insurance Work in Your Practice

Roger P. Levin, DDS

Imagine a world where all patients are fee-for-service and accept all recommended treatment. It sounds like a dentist's nirvana. However, the reality is that 89% of practices are enrolled in one or more dental insurance plans, and only 11% are still completely fee-for-service practices. Clinicians, though, should not necessarily be discouraged by this statistic. With a slight change in mindset that takes an optimistic approach to dental insurance, a dental practice can learn to effectively manage the insurance process in a way that allows the practice and insurance companies to work cooperatively to maximize benefits and opportunity.

Reframing Dental Insurance

Many dentists resent dental insurance companies because they, dentists, are paid at a lower rate. While this is totally understandable, pouting about it does not help. When dentists have a poor attitude toward dental insurance, they may fail to engage in or look for opportunities that may allow their practices to have a best-case scenario. Dentists, therefore, should reframe their approach to dental insurance; instead of seeing it as a disadvantage, they should view insurance as an opportunity for the practice to improve performance.

For dental insurance to be beneficial, the dentist must envision it more as a partner rather than an enemy. The following strategies may be considered to make dental insurance work in your practice:

1. Perform a dental insurance analysis. Most dentists have no concept of the impact that insurance plans have on their practice. Whether a practice is 20% or 80% based on dental insurance-or anywhere in between-it needs to understand the effects of each plan. Start by evaluating how many plans the practice participates in, the percentages of practice revenue associated with each plan, what percentage of the patient base each plan encompasses, how many patients are in each plan, and the discounts of each plan. This analysis should be performed annually and may reveal extensive information about the role of dental insurance in an individual practice. Once this extensive information is obtained, opportunities and choices become more obvious.

2. Work with the insurer regularly to negotiate fees. In most cases an insurance company will not increase fees, but there may be cycle times where certain plans are willing to do so. This may be because they don't want to lose a practice that participates in a plan, or there is a cycle of fee analysis by the dental insurance company. Currently, the industry is in a time where many dental insurers are lowering reimbursements, so it is critical to closely watch the fee schedule and periodically request fee increases.

3. Maximize patient dental insurance. Patients let literally hundreds of thousands of treatment dollars go unused every year, mainly because they don't realize their benefit will disappear at year's end. It is important to alert these patients about their unused benefits. Consider that many people get a new pair of glasses every year, even though they may not necessarily need them. They make sure to obtain them before their benefit expires, as they don't want to squander the opportunity. Likewise, a dental practice would be wise to let patients know when their benefits renew. There are often tens (or hundreds) of thousands of dollars waiting for treatment when insurance benefits renew at the beginning of the year. The problem is that patients don't always remember or are not always motivated to call the practice and schedule their appointments. The practice must be proactive.

4. Target marketing toward patients in specific plans or companies. Most practices do not think about marketing to dental insurance patients, but the patients with those plans and from those companies are often excellent referral sources. Part of the practice's marketing should focus on how the practice accepts and treats patients in that specific dental insurance plan. The only time this would not make sense is if the practice does not want more patients from a certain plan.

5. Help patients with dental insurance. Today's patients increasingly struggle with navigating dental insurance and often leave practices that aren't helpful in guiding them. Despite any reservations a practice may have about dental insurance or dental insurance companies, its patients need support and attention. By taking the time to walk them through the dental insurance process and answer any questions they may have, the practice will build strong relationships and loyalty.

Summary

While most practices have negative feelings toward dental insurance, the majority of them participate in one or more plans. Dental practices should stop treating dental insurance companies like the enemy and use the above recommendations to improve practice performance with both dental insurance plans and patients.