With all of the rules, restrictions and limitations of insurance, sometimes just figuring out how much a patient’s responsibility is for their treatment can be a nightmare.
It's important when you're presenting the fee or the patient’s responsibility of what they need to pay for dental treatment, that you know all of the details about their insurance plan, but you don't bring those to the conversation.
When you're presenting the fee or what their responsibility is for treatment, give them your very best estimate of what their out-of-pocket portion will be based on what you know about their insurance.
What's not important and could actually be harmful to your communication with the patient, is to bring all of those details into the conversation to explain how you got to that number.
Let me give you an example of the process:
Do your homework.
Know what’s covered and what’s not.
Be aware if they’re going to go over their maximum.
Take all of these things into consideration.
Come up with what the patient’s total out-of-pocket will be.
When you present it to the patient, it should sound something like this:
“Kristin, the total fee to get you healthy is $3200. Your estimated out-of-pocket is $1950.”
That is all you need to say.
You don't need to say that you came to this number because they are maxed out, or that there's a missing tooth clause, or that maybe there's some other limitation that is affecting their coverage. You just simply want to let them know the full fee for treatment and what their estimated out-of-pocket is.
This will allow you to keep the focus on health, and on the why behind the treatment and not get lost with the insurance limitations.
When patients hear about these insurance limitations, it talks them out of treatment and they tend to let the insurance companies dictate based on the policy what they want to move forward with in terms of treatment.
Your role is to be a leader and to help influence them by focusing on the health benefits so they can make an educated decision about what they need to do to get healthy.