Do you take “my insurance plan?”

We in the business of dentistry know that dental insurance is not insurance at all. Real insurance is designed to cover catastrophic losses such as a life threatening medical crisis or a totaled car. Routine dental care is certainly not catastrophic, so “dental insurance” is the wrong terminology for the product the patient has purchased.  Getting insurance companies to change the name of their product to Dental Maintenance Plan would benefit dental practices as they struggle to explain coverage to the patient, but that probably will not happen.

At all times keep your eye on providing the best comprehensive care but realize that it starts with the chief concern to gain the patient’s trust. These chief concerns are most often cleanings and broken teeth. If the patient’s referral was that of the PPO plan, then use it to the patient’s advantage and they will thank you. Here are some verbal tools that may help along the way to establishing the right connection and securing the appointment.  This scripting is designed to give you words of communication to patients that helps the patient understand enough to make a decision to schedule an appointment in your practice. Taking the time with the patient on the phone is vitally important to making a positive connection resulting in an appointment.

Some scripting provided by Belle DuCharme, Training Consultant.

Patient: “Do you accept or take my insurance?”  They probably want to know if you accept assignment of benefits. If the practice accepts assignment of benefits (you agree to receive payment from the insurance company) the answer would be: “We accept assignment of benefits from all dental PPO insurance companies after verifying your eligibility and benefits. Estimated copayments and deductibles will be due at the time of service.”

Patient: “Are you a CIGNA (or other company) provider?”  The patient wants to know if you are a “contracted provider” ­ this will mean less out of pocket for them because you have agreed to charge the plan’s contract fees and not your usual fees.

If the practice is not a contracted provider you can state: “No, we are not contracted with CIGNA but we can file your claim to CIGNA and they will pay according to the contract they have with your employer. You will be responsible for any co­payment and deductible today.” OR ­ “You will be responsible for payment in full today and the insurance company will reimburse you. Do you have any other questions you would like to ask?”

If the practice is a contracted provider, say: “Yes, we are contracted with CIGNA (or other insurance company). Upon verification of your eligibility and benefits, we will provide a written treatment estimate. Co­payments and deductibles are required as services are rendered. Do you have any questions in regard to this information?” (Proceed to get insurance information.)

Create good, clean claims on the first submittal and avoid costly delays in appeals.