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Inside Dentistry
December 2014
Volume 10, Issue 12

No Insurance, No Problem: Overcoming a Common Obstacle to Case Acceptance

Smart communication strategies for addressing patients’ affordability concerns

Naomi Cooper

Let’s start by asking a question: what is the best part about being a dentist? For many, it is the gratification that comes with a job well done. Dentists possess the ability to improve the well being of their patients and make a meaningful impact on the overall health of the local community. However, affordability concerns and insurance constraints are ubiquitous problems that dentists—and their patients—face every day, and it can become difficult to do the job when patients seem to be constantly delaying treatment because of up-front out-of-pocket costs.

These challenges, while frustrating, don’t need to derail the practice or your patients’ oral health. With the right systems, training, verbal skills, and internal processes in place, dentists can overcome these daily obstacles to keep their practices thriving.

The Insurance Conundrum

As most dentists and dental office managers know, there is a pervasive lack of patient understanding when it comes to traditional dental insurance benefits. Patients have been trained by medical insurance companies (and medical doctors) to believe all health insurance works according to the same comprehensive/catastrophic model, wherein all medical visits, treatments, and procedures are covered unless they are deemed elective or experimental. This leads to the mistaken and misinformed belief that when it comes to healthcare, if insurance doesn’t cover it, it must be unnecessary.

The potential for misunderstanding arises when dental patients need costly treatment and they’re informed that the majority of their treatment isn’t covered by their PPO and will have to be paid for out of pocket. It’s not that the treatment is experimental or even elective, but merely that dental insurance has a maximum benefit rather than a maximum out-of-pocket expense. Unfortunately, the patient doesn’t always understand that.

This situation, though common, puts dentists in a tough spot. The dentist is simply recommending an optimal treatment plan, what he/she feels is best for the patient. However, a patient in this scenario may leave the practice with the false impression that the dentist is recommending unnecessary treatment (because if insurance doesn’t pay for it, it must be unnecessary) just to line his or her own pocketbook. Meanwhile, the patient’s oral health issues remain untreated—a lose-lose situation.

So how can dentists address insurance coverage and affordability issues while still providing a high standard of care? It all comes down to the proper systems and communication.

Earning Patient Buy-In

Here’s an almost universal truth: whether they have insurance coverage or not, patients just don’t value dentistry the same way dentists do. Some may not understand the importance of keeping regular hygiene appointments and instead only call in case of emergency. Other patients, especially those who are not able to afford comprehensive care, may come to view dentistry as a luxury rather than a necessity. It can be incredibly frustrating for dentists to hear “no” from a patient who desperately needs dental work, especially when the patient appears able to afford things that one would consider luxury items.

Should a dentist automatically recommend a less expensive treatment plan based on a lower standard of care for patients who don’t have dental insurance? Not necessarily, but it’s difficult not to pre-judge patients or develop a treatment plan based on a perception of their financial situation. Most practice management experts advise practitioners to provide treatment options or perhaps a “phased approach” to a treatment plan rather than having a “take it or leave it” approach to case presentation. However, it’s important to remember that because patients may not always see the immediate benefit in accepting, their buy-in must be earned.

Building Patient Trust and Loyalty

Open lines of communication between the dentist and the patient are critical, especially when addressing affordability issues. Financial conversations can be very uncomfortable, but two-way communication is important to earn the patient’s buy-in.

The reality is that even patients on a tight budget will spend money on the things they want. To overcome financial concerns, it’s the dentist’s responsibility to educate patients so they understand not only what the treatment plan is, but also why it is necessary and what the benefits will be to the patient. They need to find out what the patient’s motivators and concerns are so the “why” can be discussed along with the “what.” This can help patients understand how the treatment will positively affect their ability to bite, chew, kiss, and smile—and helps avoid sticker shock, resulting not only in better case acceptance, but also improved patient retention over time.

The dentist should make a point of going over the full treatment plan, including the timeline, insurance coverage, and any out-of-pocket expenses, no matter how intimidating the conversation might be. Cultivating an atmosphere of open and honest dialogue keeps patients fully informed while earning their trust. Patients who trust their dentist are loyal, because they know that they won’t get this level of service anywhere else.

Providing Patients with Options

Sometimes, a patient who says “no” is really saying, “I’m not ready to say yes—yet.” Paul Homoly, DDS, speaks to colleagues about the concept of “patient readiness,” where patients forgo treatment because of personal circumstances or beliefs. No amount of education or follow-up will have any effect on such patient until they have reached the tipping point of readiness. In this type of situation, it is important for the dentist and the team to continually reinforce the benefits of the recommended treatment plan to these patients. The dentist should have a consistent message, building value for the treatment, so these patients understand that the dentist will be there for them when they are ready to proceed.

For patients with limited insurance benefits, or those who go without insurance entirely, dentists should consider several types of programs. First, in-house dental savings plans or membership programs such as Quality Dental Plan ( have proven success in helping independent dentists make preventive and restorative care feel more affordable to new and existing patients, while helping the practice remain in charge of its own fees.

The unfortunate reality is that many patients believe dentists—like many medical doctors—don’t want to see uninsured patients. They also worry that without insurance, they are relegated to paying “retail rates” rather than insurance companies’ pre-negotiated rates.

An in-house dental membership program not only ensures that these patients will feel welcome in the practice, but also unlocks patient spending by providing “members-only” savings. Perhaps most importantly, savings plans offered by dentists directly to patients also provide peace of mind by empowering patients to provide quality dental care for their entire families, all while tightening recall intervals and increasing case acceptance for the practice.

Another important offering that quickly and easily improves case acceptance among uninsured or underinsured patients within the dental practice is providing financing options. Whether the practice offers outside patient financing through companies like CareCredit ( or CitiHealth (, or in-house financing through a company like Comprehensive Finance (, flexible payment terms are critical when it comes to affordability.

Many dentists worry that patients don’t value dentistry, when in fact it’s simply a matter of being able to fit monthly payments into their household budget. Giving patients options within the practice enables more patients to say “yes” to comprehensive dental care and good oral health for a lifetime.

About the Author

Naomi Cooper is president and founder of Minoa Marketing and chief marketing consultant for Pride Institute. She is a respected dental marketing strategist, consultant, author, speaker, and industry opinion leader. Naomi teaches Pride’s groundbreaking marketing courses and works with individual dentists to craft and implement a customized modern marketing plan. She also consults for leading companies across the dental industry, developing a cohesive marketing approach and creating momentum for their marketing efforts aimed at the dental profession and the consumer. She can be reached via email at naomi@, and she blogs regularly at For regular updates from Naomi, follow her on Twitter (@naomi_cooper) or “like” Naomi Cooper – Minoa Marketing on Facebook at

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