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Are We Our Own Worst Enemy

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Dental insurance is often cited as the number one issue plaguing the industry. Is insurance really the number one issue or is it our in-grained, knee-jerk response to the word “insurance”?

More Knowledge … Better Results!

Why are there so many misplaced expectations that lead to negativity when it comes to dental insurance? Most challenges and fears in life come from a lack of knowledge. Fear of the unknown is one of the worst fears for our minds to deal with. The prior challenge with estimates really stems from a lack of knowledge of what insurance would have reimbursed. Many of the other challenges we face with insurance come down to a similar lack of accurate information and understanding.

For example, let’s talk about the number one topic asked about insurance: Downgrades. I see the question weekly from all over the country about an EOB that came back paying less than expected due to a policy “downgrading” a service. A common response seen posted online is “you should drop insurance!” While there may be other legitimate reasons to drop insurance, a downgrade clause in the insurance contract will not change whether your office is in or out of network. And most importantly, downgrades do not affect the amount your office collects, it only affects how much the insurance carrier and the patient contribute to the total fee. 

Why are downgrades perceived to be a problem? If you know up front that insurance will downgrade a specific treatment, then your initial estimate will be accurate, the patient will not have an unexpected balance, the team won’t get yelled at by the patient, and everything turns out well. The same outcome will result with almost every challenge concerning insurance: downgrades, disallows, reimbursement, network leasing, denials, etc. These concerns can be solved by knowing why they exist and when they will be applied. Insurance is complex, but most of the time it is very predictable.

Managing Expectations

When we were pregnant with our second child, my daughter spent the first half of the pregnancy asking for a sister. When we had our reveal party (wife’s idea), my daughter bawled her eyes out after seeing the blue confetti.

My daughter loves having a little brother, they play together all the time. She loves having someone who will do almost anything she wants to do. He is basically her living doll. So, why was she so upset?

Expectations. When we want one thing and get another, it can be quite disappointing. Was our second child being a boy really a problem? No, he is a huge blessing (although I cannot wait to get out of the 3-year-old stage). The problem was in dashed hope and expectations.

Insurance is often not the problem so much as our expectation of what insurance should or should not be. If you provide an estimate for a patient that their insurance is going to pay $500 for a crown and yet their insurance only pays $400, this is a challenge with expectations. If the patient had known up front reimbursement would only be $400, it wouldn’t be much of an issue. 

Learning to manage expectations for your office and the patient when it comes to insurance can make a massive difference. 

Turn Negativity to Positivity

I had this problem years ago and it took a while for my treatment coordinators to get me to change. Most of us want to talk about insurance in the way we choose to see it: as a negative thing, a massive problem. 

However, we need to recognize that to the patient, their insurance is a BENEFIT to them. They chose that benefit, they are paying for that benefit, and they want to utilize their benefit as best as they can. As a result, patients tend to take ownership of their benefits and when you talk negatively about it, they can get defensive.

“You have crummy insurance plan; it is only going to cover $400 of your treatment.” Focusing on the negative like this is a great way to disincentivize patients from moving forward with treatment. It also doesn’t tend to foster a lot of positive feelings from the patient toward you and your team. I know, when we convey our belief that a patient has a limited-benefits insurance plan it is because we believe it and we want the patient to see the problems we see. However, that is not the message that often gets received, nor is it the message that helps the patient in any way get the care they need.

Instead, we should be focusing on the positive aspects of dentistry, insurance, life, our office, etc.

How much better is it to say, “Your insurance is going to cover $400 towards your crown, that is great! (It is $400 you didn’t have before). When would you like to get scheduled?”

Focusing on the positive aspects helps patients feel better about their care, which in turn ends up with them accepting treatment more often. We all understand that many patients do not WANT dental treatment. Treatment is scary, annoying, invades personal space, and can potentially be uncomfortable. There are enough negatives already without us inserting more.

People naturally gravitate towards positive aspects in life. Why not give them as much positive as we can? If you do, you should see the same response I did years ago: higher treatment acceptance.


Yes, insurance does cause problems and issues in the industry. Some of them are major problems that need to be corrected on a more systemic basis. However, most of the common daily issues can be solved with improved education. The more we know, the better prepared we can be for our patients and our office. Our patients fear and misunderstand dentistry, often due to a lack of knowledge. Teams often fear and misunderstand insurance due to a lack of knowledge as well. With effective training, and a positive attitude, we can better manage expectations and avoid being our own worst enemy!

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Understanding Dental Insurance: A Guide for Dentists and their Teams

by Dr. Travis Campbell

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Dental insurance is complex and has generated multiple myths over the years. This course will uncover the truth behind these common myths so that you can better understand the dental insurance arena.

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Old habits die hard. If your current dental insurance claims process hasn’t been updated, it’s likely outdated.

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