Saying 'yes' to total treatment!

Feb. 1, 2003
If we want patients to accept responsibility for their treatment, we must first stop telling them about their dental plans.

Tom Limoli Jr.

Dental plans sure aren't what they used to be! On second thought, maybe they are. Let's all beat that dead horse one more time and maybe it will come back to life!

"I remember when dental insurance first came on the scene. The patient had a $1,000 annual maximum, and that covered two crowns and two cleanings each year. Now it's 2003 and the annual maximum is still $1,000! Don't the insurance companies know that barely covers a crown? When is the insurance industry going to change the annual maximum?"

Get over it! It's the patient's plan. The patient's employer selected the plan, and the base plan has a $1,000 annual maximum. If companies want more coverage, they can purchase it. The more a company pays for a dental plan, the richer the benefits. In other words, you get what you pay for. Nothing more, nothing less.

So how do you get the patient to say "yes" to treatment, and, most importantly, "yes" to your total fee? It's easier than you think if you will just take a break from beating on the poor deceased horse. Patients must understand that their dental plan is a financial benefit to help them offset the cost of care. The plan is not intended to cover the dentist's total fee.

If we want patients to accept responsibility for their treatment, we must first stop telling them about their dental plans. When we start talking to a patient about his or her individual benefit plan, we come off as being the responsible authority. It's not your plan. It's not your responsibility.

Too many offices unknowingly waste valuable time on the phone, researching the specifics of their patients' various benefit plans. This doesn't help the patient and, most importantly, it does not help your bank deposit and bottom line. The patient's benefit plan need not become your administrative and financial responsibility.

As an example, let's say the patient needs a root canal and crown on tooth number six. Your fee for the root canal is $500 and the crown fee is $600. The patient must acknowledge and agree to be responsible to your office for the total fee prior to insurance considerations. Then, and only then, will the patient's benefit plan be there to help offset the cost of dental care.

Ask the patient point blank, "How will you be handling your commitment to our practice for $1,100?" At this most critical moment of truth, don't simply look at the patient — look through the patient. Look and see deeply into the dark recesses of the patient's soul and wait for him or her to say the magical phrase, "I have insurance." The patient must initiate the subject of insurance benefits.

Once the patient makes the acknowledgement, follow up with something along the lines of "That's wonderful that you have a benefit plan. Many patients in our practice do not have insurance. We will do all that we can to help you make this treatment as cost effective as possible by working with your benefit plan to help offset the total cost of dental care."

The patient must make the correlation that the benefit plan will help offset the cost of care. We have the ability to make this happen when we make the patient bring up the subject of dental benefits.

Start building your tool box now. Get a fresh grip on presenting financial arrangements to patients, and stop being so anxious to tell them about their benefit plans. See you on the road!

Tom Limoli Jr. is the president of Atlanta Dental Consultants and the editor of Dental Insurance Today, a bimonthly publication that addresses third-party reimbursement in the dental office. He also is the author of Dental Insurance and Reimbursement Coding and Claim Submission. He can be contacted by phone at (404) 252-7808. Visit his Web site at

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