Does my insurance cover that?

Aug. 15, 2014
After a truly persuasive case presentation, how many times has a patient turned to you and asked, "Does my insurance cover that?"

By Kevin Burniston

After a truly persuasive case presentation, how many times has a patient turned to you and asked, "Does my insurance cover that?"

One simple question may dramatically affect treatment acceptance in a dental office. When a patient asks, "Does my insurance cover that?" how do you respond and how does your team respond? Many patients will focus more on your response to this question than the treatment plan. To best answer your patient, we need to understand what prompted this question.

When patients ask about insurance coverage, what they really want to know is whether the treatment is necessary, and how much will it cost. In the patient's mind, if the insurance company does not pay for it, then it must not be necessary. Patients tend to compare their dental benefits to their medical insurance. If you tell a patient that his or her insurance may not cover it, what the patient hears is that the treatment is not important.

Why are some necessary dental procedures not covered by dental insurance?

The reality is that dental insurance does cover all dental treatment. If a patient's dental benefits do not pay for a procedure, it is not because the insurance company does not believe the procedure is necessary. It's simply because the patient or his or her employer chose a policy that does not cover the procedure.

A couple years ago, while driving down the freeway, some debris fell out of a truck and shattered my vehicle's windshield. I told my father about the broken windshield and said I would reach out to my insurance to get the windshield replaced. My father told me that he has a policy from the same insurance company, and their policies do not cover windshields.

It turned out we were both right. When we purchased our separate policies, I chose a plan that covers windshields and he chose a plan that did not cover windshields. The more comprehensive the policy is, the more expensive the policy tends to be.

In an effort to save money, many employers and patients have chosen to purchase dental benefits with more restrictions. This trend has driven the market from 35% PPO insurance in 2005 to more than 80% PPO insurance in 2014.

Be aware that many patients in your office can be covered by the same insurance company. But the coverage could vary greatly. One patient might be covered for four periodontal maintenance visits a year while another patient with the same insurance company might only be covered for two.

To help patients understand how their benefits work, it is important that the dental team is on the same page, and can articulate the message. Any member of the team might be asked by a patient, "Does my insurance cover that?" The team member's response could influence the patient's treatment decision.

When a patient asks this question, team members might respond, "Yes. Insurance does cover this procedure, and it is very important that you get this taken care of before it affects your overall health. Your employer may not have purchased coverage for this procedure, but I would still highly recommend we take care of this before it becomes even more serious."

At Henry Schein we believe in improving the lives of those we touch. We focus on practice care so dental professionals can focus on patient care. Dental insurance is one of many areas we focus on to help dentists navigate the changing market. For more information, reach out to your local Henry Schein representative or visit

During his 10 years with Henry Schein, Kevin Burniston has had the opportunity to meet with more than 1,000 dentists. Each one has unique hopes, dreams, and concerns about his or her practice and family. Kevin's goal is to help each dentist reach those dreams. Contact him at (800) 372-4346 or [email protected]. Learn more at

More DE Articles
Past DE Issues

Sponsored Recommendations

Clinical Study: OraCare Reduced Probing Depths 4450% Better than Brushing Alone

Good oral hygiene is essential to preserving gum health. In this study the improvements seen were statistically superior at reducing pocket depth than brushing alone (control ...

Clincial Study: OraCare Proven to Improve Gingival Health by 604% in just a 6 Week Period

A new clinical study reveals how OraCare showed improvement in the whole mouth as bleeding, plaque reduction, interproximal sites, and probing depths were all evaluated. All areas...

Chlorine Dioxide Efficacy Against Pathogens and How it Compares to Chlorhexidine

Explore our library of studies to learn about the historical application of chlorine dioxide, efficacy against pathogens, how it compares to chlorhexidine and more.

Enhancing Your Practice Growth with Chairside Milling

When practice growth and predictability matter...Get more output with less input discover chairside milling.