Gregory A. Winteregg, DDS
I remember the first time a patient brought me a letter from an insurance company. For all intents and purposes, this letter indicated that I had “overdiagnosed” and “overcharged” the patient.
I was floored.
I had been in practice for about three months and was new to the community. And I certainly didn’t want the idea that I overcharged and overdiagnosed patients being spread around!
To confuse matters further, I hadn’t raised my fees when I bought the practice. The insurance company was complaining about the same fee structure that the previous doctor had. There was no question about it: the patient I had treated absolutely needed the dentistry I had delivered.
I wondered: how could a doctor at an insurance company—who had never seen my patient—refute my diagnosis with merely an x-ray? (And, by the way, it was the fall of 1981. This was way before intraoral cameras, so there were no photographs.) The insurance company had effectively put me in my place.
I don’t have an exact percentage, but I would venture to guess that more than half, if not three-quarters, of new patients you might see will need more dentistry than their insurance will cover this year. This factor has made breaking a comprehensive treatment plan down into phases a common scenario. It also spurs us to keep our fees in line with what the insurance company considers “acceptable.”
We see a patient who needs six crowns. Insurance will only cover two this year, and that’s with us participating in the insurance company’s reduced-fee plan. So, we present the patient’s treatment plan of six crowns. We explain diligently why all six need to be done, and the only question left from the patient is, “What will my insurance cover?” This is our cue to get the office manager or financial coordinator. We turn the patient over to that person, make our exit, and move on to the next treatment room or our office, because everyone knows “doctors don’t talk about money.”
The staff member sits down with this patient and does his or her best, but the patient only wants to do “what the insurance will cover.” Maybe you go back into the room to explain more. But in the end, the patient agrees to do two crowns this year, two the next, and so on. A typical scenario. Both you and the financial coordinator feel relieved that you even got those two crowns scheduled, because the patient was upset that there was going to be any out-of-pocket expense.
Does any of this sound familiar?
Well, let’s turn the tables for a minute and take a look at this through the eyes of the patient.
“I really like this office. The staff is friendly, and the doctor has a gentle touch. This is the first time I’ve had dental insurance, and I’m excited to get my teeth fixed and not have it cost anything. When the lady in human resources gave me my benefit book, she was very clear when she said that I should see a dentist who participates in the plan and not do more treatment than what insurance covers. That’s how I prevent getting overcharged and overdiagnosed.
Now, this dentist is saying I need all this work! I’m shocked at how much I need and how much it is going to cost! Glad I had that talk with human resources. All I had to say was, ‘I’m only doing what the insurance covers,’ and my treatment plan was cut way back! Obviously, I didn’t really need those other four crowns right now. They can wait till next year after all, and I’m only doing these two now because the insurance is going to cover part of it.
I still have a pretty big co-pay, but I like the office and don’t want to go somewhere else. Thank goodness for this insurance plan!”
With patients like these, have we created dental missionaries—patients who will refer all of their friends and family? Or have we created patients who will leave the practice as soon as their dental insurance changes?
In the interest of “being a good person,” we often don’t hold the line with our diagnosis and treatment planning. We break treatment plans into phases so that our patients won’t get it into their minds that we are overdiagnosing or overcharging . . . even though we aren’t! At that moment, we make everything that the insurance company says about us 100% accurate in the eyes of our patients. We may even lose our patients’ trust and, quite possibly, get bad online reviews.
I used to play this game. I remember a patient who needed six crowns. I agreed to do only the two on the lower left in January. Naturally, in July, one on the lower right broke. The patient was upset. I had obviously “done the wrong ones.” And, of course, the patient didn’t remember the long conversation we had as to why all of the crowns should be done at once, and that there was no way I could predict which teeth would break first.
This brings me to the crux of this article: We think we are doing the right thing when we agree with patients to do only what the insurance covers. In reality, we are making the insurance company look right, hurting our public image, and damaging our relationship with our patients.
My advice? Persist a bit more during your case presentations. Make your patients understand why treatment is needed regardless of what insurance coverage they do or do not have. And discuss the fee!
I like to have my financial coordinator there with me. Then, if I have to step away for a few minutes, she can continue. Will this work every time? Of course not. But it will work more often than you might think. Worst-case scenario? Your patient will do only what insurance covers, which is what’s happening now anyway in many cases. At least give it a try, because getting your patients’ full treatment plan done is really what’s best for them!
GREGORY A. WINTEREGG, DDS, is an internationally recognized practice management speaker and author. After transforming his small-town office into one of the top practices in the nation, Dr. Winteregg joined MGE Management Experts as a partner in 1994. Since then, he has personally consulted and lectured to tens of thousands of dentists across the US and Canada. Visit or call (800) 640-1140 to complete Dr. Winteregg’s Effective Case Acceptance Course online.