Here’s How Insurance Affects Dental Treatment


One of the most common complaints we hear in the dental clinic is this: ‘The patient only wants what the insurance covers!’ Time and again we suggest specific treatments only to hear a negative reply from the patient. How often have you had to change the proposed plan to make sure the insurance covers it, rather than considering what’s best for the patient?

While it is unfortunate, insurance coverage does influence case acceptance, billing practices and coding. But it doesn’t mean you can’t change the situation.

Don’t Make Assumptions

Dental professionals complain that insurance dictates treatment plans for patients, yet continue to treat all patients the same way. We all know some patients have financial difficulties but not all of them do. How do you know if a patient will have issues with the bill? The simple answer is you don’t.

All too often, we have trained ourselves to think about what will the insurance cover as the first question when proposing treatment plans. That is the perspective we have to change. Unless you are extremely familiar with a patient’s insurance and their financial situation, don’t assume that insurance is the deciding factor.

Code and Bill Every Procedure

Some billing administrators make their own assumptions about codes, treatments and insurance. They won’t submit all the codes for completed procedures because they ‘know’ the insurance won’t pay for it anyway. Not only will this cost your clinic valuable revenue, it can also add up to insurance fraud. Patients are more aware of their health plans and benefits than ever before. Suppose they find out that their insurance wasn’t billed even though the procedure was covered. How would you explain the error to them?

Every Dental Insurance Plan is Different

Another common mistake we make is to think that dental plans don’t have copays or deductibles. The front desk employee will tell the patient that they will get a bill after the insurance pays. What we are doing is training the patient to think that they can get treatment now and pay later. Always look up the particular plan if you don’t have the details on hand. You’ll be surprised to see how many plans require copays you can bill for immediately.

After years of working in the field, you might think you know most of the common insurance plans. However each patient who comes in might have a slightly different copay/coverage/rollover benefits under their plan. Even when employers offer group plans, employees might have the option to upgrade or customize the benefits for their own needs. So don’t make the mistake of thinking that a procedure is not covered under some plan – you may find that it is, for this patient at least!

Remember the Narrative

Narrative is crucial to getting claims approved from the insurer. But many clinics don’t bother sending them in until the claim is denied. This creates needless delays in the process and you won’t get paid on time either. It also creates extra work for everyone as you need to track the claim through the system and wait for it to come back and then remember to add the narrative, send it through again etc.

You can avoid all the stress and delays by including the narrative the first time round. No one wants to read a lengthy story here. Keep it short, accurate and simple. If you are not sure about how to write narrative, there are many resources (books, websites, seminars) available for you to check out.

So there you have it. Insurance does affect dental treatment but you shouldn’t fall into the trap of putting insurance first. Focus on the patient’s needs and the rest will automatically follow.