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Handling Dental Insurance Conversations

Named one of the Top 25 Women in Dentistry, Teresa Duncan is an undisputed authority on insurance in dentistry. For more than 20 years, she has advised dental offices on how to correctly use insurance to their advantage and how to discuss insurance with patients. She wrote the book “Moving Your Patients to Yes: Easy Insurance Conversations” with the goal of improving conversations within dental offices to help patients accept care and fully utilize their benefits. In this video, she talks to Patient Prism CEO Amol Nirgudkar about the best way to discuss what a patient’s dental benefits will cover – and what they won’t cover.

At the end of their dental appointments, patients are ready to get out as soon as possible, but a billing conversation may be needed. Composure and confidence are needed. “And, there are witnesses everywhere,” says Duncan. “Even if no one is in the waiting room when you are talking to them, somebody could walk in. So, you always have to make sure that it is a calm area and you are calm yourself.”

If a patient is angry, move them from the front desk to an operatory or conference room that isn’t in used. Plan ahead for this.

Avoid Surprises

When a patient is coming up to pay their bill, they should be completely aware of what their responsibilities are. Not only is calmness needed then, but also when presenting treatment and the estimated fees. When a team member is presenting the treatment plan and telling them how much the patient’s responsibility will be, patients will often respond with, “Well, I didn't think it was going to be like that,” or “I thought my insurance covered everything 100 percent.”

“You start to see them get upset. You start to see their blood pressure rise,” Duncan said.  

Duncan has this advice: If the patient’s voice starts to rise, keep yours steady. It their voice elevates again, lower yours and slow down the conversation.

Duncan suggested using this phrasing: “I'm so sorry. I know this is a surprise to you, and we don't like surprises at all. So, let’s talk about how we can handle this.”

You don’t need to apologize when their benefits don’t cover their treatment, because it’s the patient’s benefits. Your dental practice didn’t set the limitations; the dental plan did. Just move onto the next point which is talk about how much the patient can afford per month. Is the patient open to using third party financing?

Accurately Estimate Fees

Presenting why treatment is needed is one thing. Helping the patient afford treatment is another. “If somebody doesn't want to have that bridge and we know they need the bridge, I'll say, ‘You know what? We have found that when people get their teeth extracted and they don't replace them, then they end up having more issues down the road,’” said Duncan.

If there is pushback, it’s likely about the cost. “You have to address that,” says Duncan, “and make it convenient to be able to pay.” Under-estimating the insurance reimbursement to gain case acceptance destroys patient trust, so it’s important to clearly and correctly explain the anticipated amount. “Inherently, it’s challenging,” says Duncan, “especially when out-of-network. Basically, it is all about crisis management.”

De-Escalate the Situation

Duncan has learned a lot from studying crisis management. The first step is to calm an angry person and distract them from the problem to put them in a different mindset. One way to do that is to change the environment. Even just walking down the hall to a different room can change the dynamic and give the person time to cool down. Also, sitting down across from the person, as opposed to one standing and one sitting, changes the dynamic.

“I think the front office team must have training in how to handle upset patients,” said Duncan. It also helps to hire people who are calm, can easily calm others, and will not shrink from financial conversations. There are many training resources available to offices, including on Duncan’s Odyssey Management website. Role playing is a great way to start.

“I recommend it,” said Duncan. “It works well.”

About this Industry Leader:

Teresa Duncan, M.S. - Profile Pic

Teresa Duncan, M.S.

Dental Insurance Expert

Teresa is founder of Odyssey Management, author of Moving Your Patients to Yes: Easy Insurance Conversations, and a contributing author to the ADA's CDT 2017 Companion Guide. Teresa is a frequent contributor to The Observer, The Progressive Dentist, and Dr. Bicuspid publications. She served as a founding Trustee for the auxiliary-learning focused DALE Foundation. Teresa is a member of the Academy of Dental Management Consultants and the National Speakers Association. She has been named one of the Top 25 Women in Dentistry by Dental Products Report Magazine and is recognized as a Leader in Consulting by Dentistry Today. Most recently she provided consulting assistance in the development of the American Dental Association's Guidelines for Practice Success™. Teresa received her master's degree in Healthcare Management from Marymount University.

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