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Special Issues
September 2015
Volume 11, Issue 2

Making Smart Insurance Decisions

4 secrets to build a healthy relationship with insurance offerings

Amy Morgan

In times of economic uncertainty, some dentists start to question whether or not to participate in insurance plans. There are two specific reasons that dental practices might feel obligated to participate. The first is dentists sometimes feel pressured if they feel like everyone else in the dental community is accepting insurance, or if they read an article that says that all practices will have to accept it. Secondly, there is a mistaken assumption that insurance offers an easy way to bypass patients’ financial objections to treatment and may be perceived as a “silver bullet” solution for attracting and retaining patients.

But does insurance really increase patient flow, case acceptance, and practice profitability? The honest answers are maybe, sometimes, and no. This response is ambiguous, but every practice’s situation and needs are different. Community demographics, the mechanics of individual insurance plans, and the dental team’s grasp of their vision, goals, and strategies all play a significant role in gauging what kind of relationship with insurance is right for each individual practice.

Clinicians must take care not to foster an environment with an insurance mindset that imposes real or perceived limitations on the practice. When the author’s team at the Pride Institute goes in-office to help a dental team manage their insurance plans, it is not unusual to find that the doctor and the team are the ones perpetuating negative behaviors associated with insurance boundaries. How does the Institute spot a practice struggling with a negative insurance mindset? By looking for the seven signs of “stinking thinking.” They are:

1. The dentist and team are obviously uncomfortable recommending any treatment not covered by patient insurance.

2. Patients expect that insurance should cover 100% of the practice’s fees.

3. Patients regularly challenge statements if the treatment fees exceed the doctor’s estimate.

4. Patients insist on pre-determination even if their insurance plans don’t require it.

5. The practice’s fees are the same as the fees of the local major insurance carriers.

6. Treatment is phased to match insurance benefits instead of the patient’s clinical needs.

7. Patients expect the practice to argue with insurance companies about what is covered.

If your practice exhibits any of these seven signs, you and your team have an insurance identity crisis that could harm both patient and practice health. The good news is that whether you are considering changing your mix of insurance in the future or your practice is wrapped up in a less than healthy relationship with insurance, the author has four secrets that will help you establish the right relationship with insurance now and in the future.

Secret 1: Understand Your Financial Reality

Most dental teams do not know the total dollar amounts adjusted off of patient bills by insurance plans, which could lead to a loss in overall profits. It’s important to do the math. If your standard crown fee is $1,050, it takes the same amount of fixed expenses to deliver that crown at full-fee as it does at a reduced fee of $840 (a 20% reduction)

The author once worked with a dentist who felt the reason he was barely bringing enough money home to make ends meet was that he was overpaying his team. After investigating, it was discovered that the doctor’s average monthly production was a solid $92,000 per month. When his employee expense was compared to this number, the team was actually being paid less than the acceptable range norm percentage for employee expense. However, when employee expense was compared to adjusted production, the percentage far exceeded any range norms. So, instead of focusing on his employee expenses, the author recommended that he focus on analyzing the insurance plans in which he was participating to see if they were truly profitable.

Secret 2: Devise Clear, Compelling, Achievable Goals

Some practitioners’ only goal is a desire to never have their operatories empty, paying no mind to what type of patient fills them. It can be very difficult to achieve business goals if they are vague and not tied to clear results.

Practitioners must set specific and realistic goals such as, “I want to produce $1,175,000 per year, collect 96% of that production, spend 62% in overhead costs, and set clear goals for standard of care.” Having definitive goals allows doctors to make informed decisions about their practices, rather than operating on a general notion of wanting to bring in a lot of profit, which can leave them constantly feeling the pinch of scarcity.

Secret 3: Create and Maintain Supportive Practice Systems

For patients to rise above their own insurance mindsets and be willing to pay out-of-pocket for the best possible care, dental practices have to offer service that exceeds patient expectations. If patients are waiting for long periods of time in the reception room because the team is always late, or do not value their continuing care because of a poorly choreographed periodic exam, or can’t afford ideal care because the practice offers limited financial arrangements, don’t be surprised when they stop treatment at their insurance maximums. If patients question their treatment plan, they are telling you that something is wrong, with common reasons ranging from poor communication, service, or organization. Practice systems that support your goals for quality, productivity, and efficiency can help prevent this problem.

Secret 4: Enhance Clinical Satisfaction and Inspire Commitment to Dental Health

In today’s competitive environment, dental teams must surprise and delight. Patients who pursue comprehensive dental treatment are the same ones who write glowing testimonials and insist their friends and family visit their practitioner. They do so because they are highly satisfied. When patients no-show, cancel, or hide behind insurance benefits, it is a way of telling the dental team that their services are not up to par.

If a patient wants to postpone necessary restorative care because it exceeds her insurance maximum, she is providing the dental team with an opportunity to wow her. If the practice can offer flexible financial arrangements, as well as unparalleled service and clinical care, the patient will often be able to work with the practice to get the dentistry done.

Using Insurance Wisely

Insurance can be a gift that supports a patient’s quest for ideal health as well as a practice’s profitability and efficiency. How a dental team uses insurance in their practice should not be dependent on what the insurance contract says, but rather should be based on how the practice can use the policy to their benefit. Whether the economy is thriving or diving, dentistry will be done, patients will need care, and practices can continue to prosper. To accept insurance or not is up to individual dental teams, and how successful they are depends on how well they can navigate the insurance process and make it work for them.

About the Author

Amy Morgan is a renowned dental consultant and chief executive officer of Pride Institute. Since joining Pride Institute as a consultant in 1993, she has greatly enhanced its time-proven management systems to revitalize thousands of dental practices (both general and specialty) so they can become more secure, efficient, and profitable. More information about Pride Institute is available at

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