But Doctor, Does My Insurance Cover It?

Real World Insights from AADOM Authors - Yvette Medellin

How many times have you heard these words from a patient while they are sitting in the dental chair? They could be sitting there with their face swollen, tooth broken, oozing stuff we wish we had never smelled, and yet the first thing they ask is, “Will my insurance cover it.” Now, I can almost guarantee that if that same person were sitting in the emergency room, with part of their leg bone protruding from their body, they never once would ask this question. They would ask for the “good drugs” and how soon it will be fixed.

Why is the dental office different?

I have spent the last eight years scratching my head, wondering why this is the first question we hear. And although my example might be a bit overdramatic (as I often am), it never changes. In March, I had a patient that needed a root canal with all the fixings—it was her second for the calendar year. She tells me, “Well, I can manage the pain for nine months until my insurance covers it.” Really? You will be happy wandering around for months, knowing your tooth has an active infection. Knowing at any moment the dull pain could turn excruciating? You’ll hang on until January of next year? Because let me tell you – my doctor can’t, in good faith, let you leave here knowing there’s an infection in your tooth.

I’ve tried every trick in the book to help them pay for care – shown them the payment options with CareCredit, and Sunbit and offered them steps to use my limited in-office flex pay plan (limited but better than nothing) to help. But they won’t budge. This same patient walked out of the specialist office we sent her to last month because her “insurance” wouldn’t cover a CT scan. She then came back to me and complained about the other office, saying how ridiculous it was that they would try and insist on doing a CT scan when it wasn’t a covered benefit. I tried explaining to her, as gently as possible, that just because her dental “insurance” wouldn’t cover it did not mean it was not a necessary procedure. I wasn’t trying to play devil’s advocate or anything – I just wanted to make sure she fully grasped that her dental benefits provider could not care less about her or her teeth. If their bottom line was glowing at the end of the fiscal year, and their shareholders were getting richer, they were good with whatever decision she made. She assured me her decision to wait wasn’t financially motivated. She said if her tooth reached unbearable and constant pain, she would come in and pay for the root canal. But then she reasoned with herself and said, “Why should I pay for the whole thing if my insurance company could be paying for at least half?”

Before I continue, I must confess something to you. I’m a social media junkie. When I don’t feel like working, I look at Facebook. When I go to lunch, I’m up to my eyeballs on Instagram. My husband calls me the reporter, posting pictures and discussing our fabulous beach weekend. But when I need to know something quickly, I turn to one of the many dental-related FB groups. And you know what I see repeatedly? My fellow office managers complain that their patients don’t know diddly-squat about their dental benefits and don’t think it’s their job to educate themselves. Well, I have news for you – it is. As you are an in-network provider with their dental benefits company, it is in your contract. Don’t believe me? I’ll wait while you go and find the contract and read it. Find it yet? No, not the clause. The contract! Because I also would wager some serious coin that you don’t know where your doctor’s signed network participation contract is. But I’m getting off track because that is a whole other can of worms that needs to be opened outside of what I’m here to discuss today. I also don’t want to start the in-house membership plan conversation. These are valuable topics, and some of my fellow AADOM members are tackling those issues much better than I could.

I want to make sure that everyone is educating their patients. Stop referring to dental benefits as “insurance.” Explain to them the difference between medical insurance and dental benefits. And yes, it is the patient’s responsibility to know their benefits. But do you think what Mrs. Mary Smith heard at her annual HR meeting last October stuck with her enough so that when her husband, Mike Smith, comes in next week, he knows exactly what is covered, at what percentage, and at what fee? I’m pretty sure he doesn’t. He will walk into your office next week, and if you’re lucky, he will have at least remembered that he has some “dental insurance thingy” through his wife’s employer.

Be willing to help them. Create a sheet in your office that is sent with forms ahead of their visit. Have several copies of it laminated so patients can reread it (for the first time when they come in). You’ve already gone through the trouble of verifying their insurance. So, share everything with them. Ensure they know that only the first $1,500 expenses will be covered. Go ahead and remind them that if they had seen that same policy 30 years ago, it still would have only covered $1,500. Take the jab at the insurance companies. They don’t care! But make sure you’ve done your part by explaining and educating them. Maybe you don’t fully understand it yet yourself. That is okay! Seek advice from your fellow AADOM members. Look for online learning opportunities. Hint, hint – AADOM has them!

I work in a small office, so I am the treatment coordinator and manage the day-to-day work. I try to make sure my patients understand that maybe some of their procedures will be covered, and if they are covered, how much. I do my best to give them an accurate estimate before we do anything, and then they sign their treatment plan; they know that it is their responsibility to pay the bill at the end of the day. And I’m also standing there with a brochure in my back pocket for when they finally hit that “ah-ha” moment of “my insurance company doesn’t give a hoot about me even after I paid all this money to them.” Then I can have the in-house membership plan discussion. But for those that live and die by their employer benefits, I will fight to maximize them all day long so that my patients can afford the treatment they need, regardless of what “their insurance covers.”

Join AADOM today!

About the Author

Headshot of Yvette Medellin

Yvette S. Medellin, FAADOM, graduated from Pepperdine University in 1998 with her MBA. Before her life in dentistry, she was a business consultant in the entertainment industry for more than 16 years. Yvette has spent the last eight years helping her husband, Joe, build their dental practice, OrthoGrace Dental, along with their newly minted dental lab, 4M Dental Labs. She earned her Fellowship in 2022 and is aDSBN AADOM Chapter board member. When she isn’t in the office, Yvette volunteers as an Uber ton cheer from the sidelines of her kids’ basketball and soccer games, tennis tournaments, and cheer competitions.

Become an AADOM Author

Leave a comment:

Your email address will not be published. Required fields are marked *