Balancing Patient Care with Insurance and Benefits Verification
Insurance affects patients’ relationships with dentists. According to Elicia Lupoli, “the owner of a small LinkedIn group called ‘Dental Mentors,’” “Dental insurance policies are frequently changing. Patients are leaving their dental homes after years of service because of new insurance plans, or lack of any plan” (2016). Unfortunately, “Reimbursement rates have not kept pace with rising costs associated with providing high-quality dental care, and some reimbursements have even been reduced,” causing patients to feel they must unnecessarily pay more or even refuse treatment (Watterson 2014). While insurance may dictate patients’ decisions in their oral health, Dr. Bobby Haney, a retired dentist, says, “It is the responsibility of the dentist to provide the best treatment. It is the insurance company’s responsibility to save (make) money” (2016). Dentists and employees must not only verify insurance and benefits, but also take care of their patients’ oral health.
While insurance and benefits verification remains integral to determining the cost of treatments and services, clinics must not neglect their patients. From a financial standpoint, clinics need to verify insurance and benefits in order to create medical bills factoring in the patients’ coverage. Laura Hatch, “the founder of Front Office Rocks,” cautions against solely concentrating on the patients’ insurance and coverage (2016). Clinics must also keep in mind how treatments affect their patients’ oral health (Hatch 2016). Consequently, dentists could potentially not only increase retention rates, but also develop relationships in which patients trust them to better their oral health.
Whenever dental insurance provides little to no coverage for treatments, dentists should communicate with their patients about them. In the event of a denied claim, Dr. Dianne Glasscoe Watterson, “a professional speaker, writer, and consultant to dental practices across the United States,” advises to appeal the claim and converse with the patient about the treatment’s significant effect on his or her disease or infection (2014). Though, she also says, “When benefit carriers deny coverage for procedures, sometimes it is necessary to get the patient involved. Patient complaints to an employer-sponsored benefits coordinator may carry more weight than complaints from dental professionals” (2014). For example, her insurance company did not cover her crown’s treatment because it did not believe that her teeth showed previous signs of decay and fracture (2014). After she clarified that her crown alleviated her pain whenever she bit down, her insurance then covered the treatment’s costs (2014). When patients deny treatments because they have little to no coverage for them, dentists should underline the treatments’ positive outcomes, such as “a brighter smile, the elimination of pain, a healthier mouth, etc.” (Levin 2012). By developing “more meaningful, professional [relationships]” with patients, planning
“the [patients’] future dental goals,” and “offering… financial options,” such as “Credit cards” and “Outside patient financing,” patients may be more willing to go through treatments, regardless of costs (Levin 2012).
Verifying whether patients’ insurance plans covers certain benefits remains significant. However, dentistry’s goal is to improve the patients’ oral health. Dentists must balance the clinics’ finances with their mission.