The Role of Insurance in Your Practice
Dental insurance has helped many patients access care and allowed practices to grow. However, frustrations persist—for both patients and providers. Patients want more coverage; providers want fairer compensation.
Common challenges include:
Stagnant or inadequate annual maximums.
Insurers dictating fees, treatments, and coverage.
Awkward conversations about fees.
Managed care’s significant impact on dentistry.
Today, about 85% of dental insurance is through PPOs. Most dentists accept at least one PPO, and fee-for-service practices are increasingly rare.
If you participate in insurance, it’s essential to manage it well. While this article isn’t a deep dive into insurance, you can reach out to our consulting team at info@jamesonmanagement.com or visit jamesonmanagement.com for more detailed guidance. Also consider Dr. Charles Blair’s books Coding with Confidence and Administration with Confidence.
According to the ADA, over 50% of your income flows through insurance. Handle it with excellence.
Handle Insurance with Care
Patients are emotionally tied to their benefits. Whether the plan is great or limited, never criticize it in front of the patient. They’ve either paid for it or received it through their employer. If you’ve chosen to file insurance, or to participate in managed care, do so with a positive mindset—it’s your choice.
Insurance is a system, and it needs to be managed systematically.
Key Systems to Put in Place
1. Insurance Verification
Verify benefits before treatment. Confirm eligibility and coverage to avoid surprises.
2. Pre-Determination of Benefits
Avoid pre-determinations unless:
The insurer requires it.
The patient specifically requests it.
The patient refuses to be accountable for their plan’s limitations.
Note: Half of the patients who wait for a pre-determination never proceed with care. Don’t use this as a stall tactic.
If a case requires a pre-determination, consider starting restorative work while awaiting the insurer’s response. Always track pre-determinations as carefully as claims.
Best Practices When Accepting Assignment of Benefits
Quote the entire fee up front and explain that patients are responsible for the full amount—insurance is a supplement, not a guarantee.
Collect the estimated patient portion at the time of service. Never wait until insurance pays.
Clearly communicate that the patient is responsible for any remaining balance after 45 days (or your stated time frame), regardless of insurance outcome.
Use a written financial agreement. Most people forget what they agreed to.
If a balance remains, follow up immediately—via phone, card payment, or statement.
Use patient financing or bankcards to manage balances not covered by insurance.
Apply these systems for ongoing therapies (e.g., ortho) or in transitioning accounts receivable.
Clarifying Common Insurance Misconceptions
Patients often misunderstand their coverage. Here’s how to respond:
Q: “Does my insurance cover this?”
A: “We’ll do everything we can to help maximize your benefits. If we can help you with the financial aspect, is this the care you’d like to move forward with?”
(If yes, explore financing: “How much could you comfortably invest per month?” Then walk them through financing options.)
Q: “Why recommend treatment my insurance doesn’t cover?”
A: “Dental insurance supplements care—it doesn’t determine it. Your benefits depend on what your employer paid for the plan.”
Q: “My insurance pays 100%.”
A: “That’s usually 100% of the insurer’s fee schedule—not ours.”
Q: “Your fees are higher than usual.”
A: “Our fees reflect our commitment to exceptional care. Insurance plans base their fees on premiums, not quality.”
Q: “This costs too much.”
A: “Tell me—how much too much is it?”
(Use this response to determine their comfort level and work from there.)
Q: “How did my dental health get this bad?”
A: “Let’s focus on restoring your health moving forward. Then we’ll partner with you to keep it that way.”
Manage Insurance Like the Business It Is
Half of your annual revenue may come through insurance. Treat it with the respect it deserves.
Your insurance system should be efficient, consistent, and trackable. Poorly managed claims lead to cash flow delays and lost revenue. If you lack a 7–10 day turnaround, have many overdue claims, or lack visibility into claim statuses—get help. A management expert can help streamline and optimize your system.
To Summarize…
Be insurance aware, not insurance driven. Don’t let coverage limitations dictate care decisions. Insurance companies focus on what’s covered, not what’s best.
The Rule of 10: Insurance Musts
Decide whether to accept assignment of benefits—and manage accordingly.
Train your team to handle objections and communicate clearly about insurance.
Verify benefits before appointments.
Avoid unnecessary pre-determinations.
Collect the patient’s portion at the time of service.
Make sure every patient understands they’re ultimately responsible.
Develop a foolproof claims system.
Ensure payments are received within 7–10 business days.
Immediately collect any remaining balances after insurance pays.
Manage insurance collections with the same care you give to patient care.
Make it easy for people to pay.
Insurance has helped many people afford dental care. Patient financing now helps them cover the rest. Combine both with solid systems, and you’ll thrive.
Read the Collect What You Produce 10-part series here
