Best Practices for Discussing Finances with an Insured Patient!


The rapid growth of the insurance industry, accompanied by the complexity in which they operate, causes significant loss and distress in all healthcare businesses. They have become what I call, the necessary evil of our time. Whether we like it or not, insurances are here to stay. Just look around you; from a consumer’s perspective, most of us have insurance, and we certainly all want to save money by using it.

As a business owner and healthcare provider, understanding the basics of insurance companies not only benefits your bottom line, but it also improves the overall patient experience, which allows you stand out in this highly competitive market. Avoid stressful situations and loss of revenue by implementing the following 6 tips on how to properly discuss out-of-pocket responsibility with your patients!


1. Collect as much information as possible from the patient.

When a patient calls an office, we tend to be very task-oriented. We may use a script for answering the phones properly, but when it comes down to it, if we fail to connect with our patients during that initial conversation, we risk missing out on information that could help us customize the insurance verification process and prepare accordingly. Ask questions like, “What brings you to our office?” or “ Tell me a little about your last experience at an office.” This is a great opportunity to connect, collect, and prepare for the next steps.


2. Use a tool to verify patients’ benefits prior to confirming their visit.

You may want to customize and implement the use of an Insurance Verification Form to collect the relevant information from the patient. This includes their personal information, insurance information, and notes regarding the reason for their visit. With this information at hand, reach out to the insurance company and confirm:

  1. PT eligibility and complete breakdown of benefits. Focus on the special notes taken and go the extra mile for your patient and your dentist.
  2. Your office’s participation status and assignment of benefits.
  3. Any out-of-pocket responsibility is specific to the purpose of the visit.


3. Review and explain findings with patients.

Upon arrival, make sure to greet your patient with enthusiasm. Energy is contagious. Have the information ready to review and present to your patient. Ask them questions like, “Mr./Mrs., do you understand how your insurance works?” If they say yes, continue with, “Great! Let us then review what we’re expecting to do today and how that will be covered by your insurance.” If they say NO, take the approach of the teacher, the educator. Say something like, “Let me show you how your plan works. I’m here to answer any questions and help you understand how everything connects.”


4. Advise patient of payment options available and collect.

I remember a script I inherited from a 40-year-old practice back in 2003. The script went something like: “For today’s visit, which you can choose to pay for via check, credit card, or cash, we will be doing a root canal, which you can pay for using cash, credit, or check. Is your preferred method of payment cash, check, or credit card?” You may want to modify that by adding the expected coverage from the plan but still stressing your payment options. You may also want to add that in order to facilitate faster checkout, you recommend they pay prior to starting treatment. This will ensure they are not standing around in discomfort after treatment and the exit conversation is being structured around their experience, potential reviews and referrals to your practice.


5. Maximize your internal communication.

Oftentimes, treatment plans change and we have to modify the patient’s out-of-pocket responsibility. Nothing is more frustrating to a patient than being quoted a fee and then sitting in the doctor’s chair to find out the cost is more. Some patients tend to only want to receive the services covered by the insurance company, and this is where an outstanding office separates from the masses. Having the skills to educate your patient in the importance of treatment and making their insurance compensation secondary to care is a key determinant to your success. It is imperative that all members of your team, clinical, administrative, are all trained to reinforce the importance of care and work in congruence with one another. Aim to have a clinical team updating the front desk of any last-minute treatment plan changes have that financial conversation prior to any work being done.


6. Predetermine large treatment plans.

After the patient’s initial visit, once you have been given a treatment plan from the dentist, for any procedures exceeding $300 it will be a good idea to request a predetermination of benefits from the insurance. A pre-authorization is how a procedure code is covered, while a predetermination is a comprehensive alternative, which provides far more information to both the patient and the provider for case presentation and financial discussions. Are you enhancing the perceived value of your practice by mastering your insurance participation and improving patient satisfaction?


Competition is fierce and insurance companies are complicated. We owe it to our business, our team members, and most of all, our patients, to understand and address insurance-related costs of treatment with certainty and professionalism. If you want your patients to recommend their friends and family to you, let a beautiful smile be the only surprise they get in your office. Remember, an educated patient is your best client!