This is the second installment of a series of articles on implementation. The first article is called “Are you a CE Junky?” I’d recommend reading it prior to proceeding.

I’ve asked numerous doctors: What holds you back from doing comprehensive care in your practice? What holds you back from implementing the type of care we learn at Spear?

dental insurance for comprehensive patient treatment

The number one answer? You guessed it: INSURANCE. In particular, the reimbursement from insurance. 

We've all heard it from our patients … ”Will my insurance cover that?”

It can become painful to hear, but the truth is, as long as we live in a world where dental insurance exists, they’ll never stop asking.

So, is insurance a roadblock to implementing comprehensive dentistry (like we learn at Spear) in a general dentist’s office? I believe the answer is yes and no.

‚ÄčThe role of insurance in comprehensive dentistry

I believe that participating with SOME insurance companies that reimburse at a fair rate is a logical consideration. However, I also think that each and every practice should do a thorough production analysis in regards to the following three types of patients: 

  1. In-network patients
  2. Out-of-network patients
  3. Cash-paying patients

I, along with the rest of the owners in our practice, meet once a month with our accountant. We are constantly evaluating the value of these three types of patients.

In our experiences, the patients with insurance tend to accept double the amount of treatment. This may be a sign that we aren’t doing a good enough job of instilling value to our cash patients OR it could be that these patients feel a level of comfort knowing that their benefits will contribute to their overall cost.

We’d love to be totally insurance independent; however, in our area, that’s just not reality. Some patients won’t even give us a try unless they know we’re in network with their plan. The key is that we don’t fall into the insurance trap.

What is an insurance trap?

  1. You and the rest of the team have to understand that dental insurance is not insurance. It’s a benefit. And this needs to be explained clearly to your patients. I love the video by Imtiaz Manji titled “Talking To Your Patients About Insurance.” It will really help your team understand that dental insurance isn’t insurance at all, it’s a benefit. And the benefits patients receive are really meant to maintain their current health, NOT bring them to health.
  2. The biggest problem with dental insurance is that it’s an infection in a dental team’s mindset. Over time, when team members (including dentists) hear that question, “Will my insurance cover that?” they start to change their presentation style with patients. Instead of presenting what patients need, they start presenting what patients may accept based on their coverage. 

This is a tough battle, because dental benefits do play a role in some patients’ case acceptance. But the reality is that it doesn’t play a role in ALL of our patients’ case acceptance.

The 5 types of dental patients

This is where the Spear patient pyramid really comes into play.  Understand that different patients are on different levels of the pyramid and have different value systems. As a quick overview, here is the pyramid:

five types of dental patients
  • Event-Driven (Emergency Patients) are looking for us to perform triage and usually aren't coming in for hygiene .
  • Reactive Patients are very insurance-driven and are coming in for hygiene sometimes, but definitely only accept single-tooth care, and sometimes they won’t even accept that.
  • Proactive Patients are still somewhat insurance-driven but typically come in every 6 months for hygiene and complete the treatment they’ve accepted.  For these patients, there is definitely a gray area when it comes to accepting comprehensive care.
  • Discretionary and Regenerative patients are typically looking for esthetic and the best rehabilitative care they can receive. They may have dental insurance, but they understand that it has minimal impact on their treatment costs.

The Spear Patient pyramid teaches us some incredible lessons:

First, it has nothing to do with how much money a person makes. I have school teachers that have done full mouth reconstructions and I’ve had doctors and lawyers that only come in for emergencies. The pyramid has everything to do with how much people VALUE dentistry.

Second, the pyramid is present in EVERY dental practice. The shape of the pyramid may depend on the type of practice you have. 

Obviously most of us would like to see and treat more Discretionary and Regenerative patients; however, in a general dental office like mine, we need to keep our chairs full and can’t pay all the bills waiting for those people to walk through the door. We rely on every tier to help keep our schedules full and keep ourselves profitable (including patients that rely on their dental insurance).

Finally, understand that just because someone may be reactive today, it doesn’t mean they can’t become regenerative tomorrow.

For example, if a patient is proactive their whole life, they’ll most likely never need to be regenerative because they’ve been taking care of all of their problems as they arise PROACTIVELY.  The reality is, patients that are regenerative are most likely patients that were at one time event-driven or reactive in nature.

‚ÄčCommunicating the true value of dental treatment to patients

College, weddings, kids, health issues, family problems … the list goes on. Can you really blame patients for sometimes putting off their dental care to get through these times in their life? These aren’t excuses, these are reality.  

Our patients will value different things at different times in their life.  Labeling someone as reactive doesn’t mean they’re stuck there. It just means they are there for now. It’s important to recognize this and work AS A TEAM to figure out the barriers to their treatment. Be there for your patient when they’re ready to move forward.

We try to do this at our 15-minute morning huddle to start the day. We don’t want to just know outstanding treatment. We want to know the barriers. Sometimes it is just a financial hurdle, but sometimes it’s more complex than that.

Now, if the barrier to dental health is the newest iPhone, a Mercedes Benz, or a vacation to Hawaii, you and your team should strive to show your patients the true value of a dental investment. Valuing products and social status over dental health should not be something WE view as a barrier to a patient’s dental treatment. 

This doesn’t mean we put down those materialistic things, it just means that we have to continue to stress the importance of dental health so that patients value it more and more.

The take home message of this article is that the pyramid exists within your practice. Unfortunately, patients aren’t walking in with nametags on to tell you what tier they’re in.  It’s up to you and your team to figure out what they value.  It’s up to you and your team to encourage patients to invest in their dental health, ignoring what insurance may or may not cover.  Also, understand that life events WILL get in the way of people accepting treatment.  If a patient truly wants the care, they will eventually find a way to get it done.

Mike Monokian, D.M.D.