Have you ever had an oil change at one of those drive-through express oil change places? You’re in a hurry and ready to move on with your day as soon as possible, but inevitably the mechanic comes into the waiting room to show you that you need a new filter or something. Luckily, they just happen to be having a special on filters that day. There always seems to be a markup situation that happens.
Dental hygienists often find themselves in a similar scenario, but from the other side—the role they play is the same as the mechanic who is recommending an upgrade at a higher fee. We know as dental professionals that oral health is a serious healthcare issue, not on a level with a clogged air filter, but that is not how our patients see it a lot of times. We think we’re making a compelling case for additional treatment that is in their best interest in terms of long-term oral health. But unlike the scenario with the air filter, patients tend to say no to any additional care we recommend because in their mind, they only came into the office for a quick oil change (their six-month hygiene appointment). They want the basic maintenance package with no frills...and they want their insurance to pay for all of it.
That’s why patients tend to respond negatively when they see the x-ray or the intraoral picture, or they hear from their hygienist those three words “Is this sensitive?” when probing an area. When the hygienist seems concerned about an area of their mouth or asks a lot of questions about gums bleeding, suddenly the patient is viewing the hygienist the same way as we view the mechanic holding that recommended air filter. The patient has moved from a relaxed time getting their teeth cleaned to having to decide about whether they value and trust your professional recommendations, as well as how much will it cost to follow your suggestion. They thought the money question wouldn’t be raised during this “routine” visit, and they are less than thrilled someone brought it up.
As a hygienist, you are more likely to face the “Does my insurance cover it?” question more than any other clinician on the team. Patients do ask the other clinicians, of course, but many times the doctors and the assistants defer to the front office to answer. That’s not necessarily right or wrong, but if you want to help your patients get the care they need, every hygienist should get comfortable with the money and insurance questions that patients ask. Case acceptance comes from handling the two big elephants in the room: “How much does it cost?” and “Will my insurance cover it?”
Here are a few tricks to help you address these questions in a way that leads your patients to accept what you present, so they can achieve healthy teeth and gums.
1. Don’t present while the patient is lying back.
Remember, knee to knee and eye to eye. When you are speaking with a patient about their dental needs, sit them up and face them without your gloves and mask. It is important you get them into the best “state” possible to accept the treatment plan, which is not lying back in a chair.
2. Be confident with your fees and what you provide.
They did not teach most clinicians in dental school how to discuss money, but it is vital to be able to quote a fee and be confident about it. If you are speaking with a patient about needed work and they ask how much it will be, you should be able to quote a fee confidently. This is not easy for some clinicians. If that’s the case for you, then practice until you are comfortable with it, or get some training. It is important to be able to quote fees, because a patient is not ever on board until they know how much it will cost. Once you handle the question of cost, will you be able to close the dentistry or periodontal treatment.
3. Don’t skirt insurance questions.
Insurance is something the oil change business does not have to deal with, and it’s an element that throws a wrench in the process for hygienists (ha ha). It’s true that you might not know if a specific kind of treatment is covered or not under a patient’s insurance, but there is a good chance you know some basic information about how a procedure is typically covered. When the patient asks what their insurance covers, it is important to not skirt that question and avoid it or to use insurance as a crutch. For example, if presenting periodontal treatment and you are not certain what the insurance will cover, don’t avoid the issue by saying, “I’m not sure, but the front office team will look into that for you.” Even worse, don’t assume or imply that insurance will cover this cost. Instead, use a matter-of-fact and straightforward approach while utilizing your personal connection with the patient. For example: “That’s a great question. We will do our best to help you maximize your insurance, and typically, we find that insurance will cover a portion of this procedure, maybe 50%. But it’s important for you to know, Mr. Smith, that no matter what the insurance covers, our job is to help you keep your teeth for life. I am concerned that if we don’t do something in this area or with this tooth, that might not be the case long-term.”
4. Under-promise and over-produce.
Too often dentists and dental teams try to be heroes by over-promising. We may find ourselves telling the patient there is a pretty good chance the insurance will pay for something, even though there’s reason to believe that is not true. It’s easier to say things like this and push off the money discussion, which will only make it worse. I would rather see you under-promise with something like this: “There is a good chance that your insurance will find a way not to pay for this or downgrade, but let’s discuss why it is still necessary.” Then when the insurance pays more, you look like the good guy. Patients are more willing to open their wallets (and less mad about it) when they pay an amount up front than if they are getting a bill after the fact, when they assumed or hoped the entire treatment was already covered by insurance.
5. Work with your front office team and walk a mile in their shoes.
This is probably the best piece of advice I have. Your front office team needs to deal with these questions all day and the better you are at helping them or setting up the patient with the right mindset, the better your work life is going to be. The worst thing you can do as a hygienist is to present a treatment plan to a patient (or even worse, do a treatment right away) and then send the patient up front where they will unexpectedly face a discussion about out-of-pocket cost or what the insurance will cover. The more you get involved in this discussion, the better life will be for you, as well as for your patient and your front office team.
We are here to take care of our patients. Put yourself in their shoes and the shoes of your front office team. Think of ways you can become a better communicator and salesperson to help patients understand what they need, and that insurance does not cover it all. If you grow in this ability, you will be happier as a hygienist, your patients will respect you and your front office team will love you.