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Second Opinion: The Value of Patient Engagement and Cost Transparency by Robin Gelburd

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The Value of Patient Engagement
and Cost Transparency

by Robin Gelburd
Second opinions are common in health care, whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dental professionals to share their opinions on various topics, providing you with a "second opinion." Perhaps some of these observations will change your mind, while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession.
- Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

"But how much will that cost me?"

"Why was my claim for this dental service denied? I thought it would be covered."

"Can you tell me why I have been charged $300 for this procedure, when I found information online that indicated the typical cost is closer to $150?"

You might have heard these questions - or close variations of them - from your patients recently. Such patient-provider conversations are the sign of a significant trend shift: consumer education and engagement around dental costs have become a prominent aspect of delivering quality dental care.

Until recently, patients' questions about dental fees came principally from the uninsured. For insured patients, most dental practices worked largely with payers to determine reimbursement and settle claims. Discussions about costs were not common in the exam room. However, starting recently, employers and insurers have been changing their benefit structures to mitigate the financial impact of rising health-care costs. Accordingly, even insured dental patients are increasingly responsible for the cost of procedures, particularly for care extending beyond preventive and diagnostic services, and for costs exceeding annual coverage limits. And, as a result, patients want to know what they will be paying.

A recent report by the United States Government Accountability Office (GAO)1 highlighted this issue, with findings showing that dental patients increasingly shoulder more of their dental expenses out-of-pocket. The GAO study also found that the dental fees charged by dentists and health centers vary widely, even within the same communities, as well as across the country. With the enactment of the Affordable Care Act and changes in access to and financing for health care, the economics of both medical and dental practice have become dramatically different.

Patients who pay all of their own dental bills, as well as those with insurance who are increasingly responsible for more of their dental care costs, are educating themselves about their out-ofpocket exposure for dental care and becoming more proactive with their providers. But how does this movement to a more cost-aware patient impact your practice?

As president of FAIR Health, I witness firsthand this growing consumer interest in clear, contextualized information on health-care costs. As a national, independent, not-for-profit corporation focused on bringing transparency to health-care costs and health insurance information, we strive to educate consumers about the many factors that influence the cost of care and determine the extent of insurance reimbursement and the ultimate out-of-pocket costs that fall on patients' shoulders. At FAIR Health, we believe in introducing more cost transparency and education benefits to consumers, providers, payers, employers and policymakers. Offering data tools that provide these stakeholders common cost estimates from which to base their conversations about health-care reimbursement will help to create a broader, common understanding as well as enable better-informed conversation both in the personal patient-provider context and in the larger health-care sector and policy sphere. I invite you to consider the significant benefits that a growing focus on cost transparency between you and your patients can yield, both for the development and enhancement of your patient relationships and for the growth and sustainability of your dental practice.

The Case for Patient Engagement

Patient outcomes has emerged as a significant topic in the nation's health-care dialogue. It has also generally become accepted that patient engagement is an essential component of better outcomes.2 Developing and maintaining engaged patient relationships begins with offering high quality, evidence-based dental treatment. Strong patient relationships also benefit from friendly staff, reminder e-mails and loyalty cards. But these features are no longer enough in and of themselves.

Fruitful and enduring patient relationships can be bolstered by helping patients understand what their dental care will cost, including how their insurance coverage and reimbursement options fit into treatment plans. Forthright communication is an often-overlooked aspect of enhancing patient well-being and satisfaction. In addition, when patients understand their charges and insurance benefits, a practice's billing administration and insurance reimbursement can be more efficient and timely.

At FAIR Health, we have heard from patients that when they feel supported through the entire care process - from examination and treatment through billing and payment - their satisfaction and engagement also improves. Fostering a mature dentist-patient relationship will deliver positive results in the long run.

The trend is clear: the provider-patient paradigm is shifting. Communication and acknowledgement of the complex financial environment that patients face is critical.

Cost Transparency: Important for Patients and Dentists

Engage Your Patients
Use these steps to engage patients on their financial contributions and requirements.
 
  • Talk - Simply add the discussion of dental costs and coverage to your routine patient conversation. By introducing this topic you can relieve patients' concern and hesitation about raising cost considerations.
  • Know- Find out in advance if a patient has insurance coverage or is paying for everything out-of-pocket, and then lead your discussion accordingly.
  • Educate - Provide your patients with educational materials and resources regarding insurance coverage, reimbursement, out-ofnetwork costs, etc. FAIR Health offers a host of free materials for download and distribution to patients.3
  • Highlight - When recommending a procedure that might not be fully covered by a standard insurance plan, flag that possibility in your treatment planning discussion. This will support informed decision-making about moving forward with treatment, and will avoid confusion or dissatisfaction in the billing process later.
  • Guide - Direct your patients to free cost estimator tools, such as the FH Dental Cost Lookup,4 that can support them in their decision-making about a new treatment or procedure outside the scope of their insurance coverage.


Greater cost transparency will benefit both your patients and your practice. Increasingly, the cost of care is a critical factor for patients deciding their choice of practitioner, their treatment method, as well as whether to undergo optional or uninsured procedures. And, as highlighted in the GAO report, dental fees can vary dramatically within a community. Further, cost information is now at patients' fingertips through online tools. Being informed about typical rates in your practice area can help you evaluate and set fee schedules that meet your requirements in a competitive profession.

One way to assure your patients that your dental charges are fair is to reference broader market data when discussing those charges. Robust dental charge data, such as that offered on the FH Fee Estimator, can provide important insights into market conditions and can support a wide range of practice management decisions.

FAIR Health data can help to:
  • Inform strategy for out-of-network services.
  • Negotiate fair rates with dental discount plans.
  • Develop strategies for bundled payments.
  • Evaluate and negotiate payer and network participation.
  • Negotiate compensation for participation in exchanges and ACOs.
  • Assess expansion into new geographic areas.
  • Estimate insurance reimbursement when purchasing new equipment.
  • Evaluate the impact of adding a new specialty or business line to your practice.

Price transparency, once virtually taboo, now has become a source of trust between dentist and patient. As the health-care sector changes and individual practice economics evolve, meeting patient expectations for both care and cost with open communication and solid information can benefit patients and practitioners alike.

References
  1. http://www.gao.gov/assets/660/657454.pdf
  2. http://healthaffairs.org/blog/2013/08/08/patient-engagement-is-the-key/
  3. Flt Fee Estimator http://www.feeestimator.org/#who
  4. Flt Consumer Cost Lookup http://www.fairhealthconsumer.org/dentalcostlookup/
  Author's Bio
Robin Gelburd is President of FAIR Health, Inc., a national independent, not-for-profit corporation whose mission is to bring transparency to health-care costs and health insurance information through comprehensive data products, consumer resources and research tools, all powered by the nation's largest collection of medical and dental claims data.
Dentaltown Magazine
September 2025
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