Episode 163: Why Insurance Doesn’t Really Work in Dentistry

“What I do is become a consultant for the patient: I tell them what they need, listen to what they want, then deliver.” ~Dr. Bruce B. Baird

This question is often the first thing out of a patient’s mouth “What will my insurance cover?” 

I won’t sugarcoat it, this is one of the hardest questions you have to tackle as a dentist. And it can be the most frustrating and seemingly impossible question to answer as you attempt to help your patient make healthy decisions. 

As a clinician, I believe the work I do should last, so I don’t limit my diagnosis based on what a patient’s insurance will cover.

I believe every dentist should be armed with the knowledge they need to confidently share knowledge with patients so you can help guide them to informed decisions. Today, I’m going to share some techniques I learned over the years to regain control of the insurance conversation so you too can have this all-important conversation with your patients, including:

• Why patients ask this question about insurance
• How you can answer the question
• How to turn the conversation around from insurance, to what the patient needs

EPISODE TRANSCRIPT

Regan 0:00
Hi, Dr. Regan Robertson, CCO of Productive Dentist Academy here and I have a question for you. Are you finding it hard to get your team aligned to your vision, but you know, you deserve growth just like everybody else? That’s why we’ve created the PDA productivity workshop. For nearly 20 years, PDA workshops have helped dentists just like you align their teams, get control of scheduling, and create productive practices that they love walking into every day. Just imagine how you will feel when you know your schedule is productive, your systems are humming, and your team is aligned to your vision. It’s simple, but it’s not necessarily easy. We can help visit productivedentist.com/workshop that’s productivedentist.com/workshop to secure your seats now.

Dr. Bruce Baird 0:47
Where did they have their crash on and this is what I talked to patients about when they actually get in the chair. They said well, you guys are out of network, it’s more expensive. But Bob, let me explain to you why. insurance doesn’t really work in dentistry. You know, it’s not medical insurance, medical insurance is going to cover you know, 80% of everything up to 5000 or 10,000 and then they cover 100% of the rest. Dentistry always had a $1,500 limit like yours for the last 40 years. It hasn’t changed. So as dentistry prices have gone up actually the benefits of insurance have kind of gone down.

Hello, everyone. This is Dr. Bruce B. Baird and you’re listening to the Productive Dentist Podcast in this podcast, I will give you everything that I’ve learned over the last 40 years in dentistry working with 1000s of dentists. I’ll tell you it’s not that my way is the only way it’s just one that has worked extremely well for me and I’d love to share that with you so you too can enjoy the choices and lifestyle the productivity allows, more time for things you love, increased pay better team relationships, and lowered stress. Let’s get into it with this week’s episode of the Productive Dentist Podcast.

Dr. Bruce Baird 2:13
Hi, my name is Dr. Bruce Baird with a Productive Dentist Podcast. Good morning, in today’s podcast, I am going to kind of elaborate a little bit on a question that was sent to me from a dentist in Dubai and they said, “Towards the end of one of our previous shows that you talked to patients about insurance, and particularly about being out of network and why that costs them more, would you be prepared to elaborate on this subject on a future show?” And yes, I’m going to do that today. The dentist said that they find it hard subject to tackle and I’d love to know how to do it. I would love to talk about that because it is difficult. You know one of the things when you start talking about to a patient, and it’s almost the first thing that comes out of their mouth is, “Oh, well, I have insurance, you know, well, what will my insurance cover?”, and they bring that topic up, you know, what about my insurance and years ago, MTS Manji and I had been friends, he was a guy that kind of started spear and started a lot of things, but one of his deals were that he talked about was and kind of taught me is that, he said, “Bob, you know, I totally understand insurance is very important, but let’s pretend this is your insurance,” and I would hold up a piece of paper and I would say, “Let’s put that over here right now. We’re going to, I’m so glad you have insurance, but let’s let’s talk about kind of what’s going on in your mouth first,” and I think that that’s critical to separate insurance from the patient’s mouth, if you will, it is something that is extremely important because patients ask that question because they just don’t know any other questions to ask. I mean, it’s kind of crazy, they don’t know what else to say. So when you’re, you know, except got insurance. So tell me how much my insurance is going to cover because they believe that their insurance is going to cover everything but what about folks that call up your office and say, “I want to, you know, do you guys take my insurance?” And absolutely we take your insurance, we’re a non-restricted provider and what does that mean? And our front desk knows to say that, “We’re an unrestricted provider, we take all insurance. Now we may be out of network with yours, but we’ll explain to you everything that needs to be done before we do any dentistry and we’ll help you. We have some great ways to break payment plans. We have great ways for you to be, to get your dentistry done,” and, you know, the other thing about dentistry is, you know, there are different kinds of dentistry, you know, the PPO-driven practice that’s getting a 40 to 50% discount on their fees. I promise you, they’re not using the same lab that you are. They’re not, certainly not using the same lab that I am. Why? Because there’s no way that they could turn a profit and do that, they’re writing off an enormous amount. So where do they have their Cranston and this is what I talk to patients about when they actually get in the chair. They said, ‘Well, you guys are out of network, it’s more expensive,” but, Bob, let me explain to you why insurance doesn’t really work in dentistry, you know, it’s not medical insurance, medical insurance is going to cover, you know, 80% of everything up to 5000 or 10,000 and then they cover the 100% of the rest. Dentistry only has had a $1,500 limit like yours, for the last 40 years, it hasn’t changed. So as dentistry prices have gone up, actually the benefits of insurance have kind of gone down. Today, and when I first started in dentistry, your crown was $250 to their crowns 1500 to $2,000. So your $1,500 insurance is not is not going to effectively help you the same way it was years ago. Does that make sense? And when I say, “Does that make sense?”, I am saying that because I want a response from the patient, I want them to go, “Oh, yeah, I understand,” or they’ll say, “Well, I just really want to use my insurance.” I said, “Oh, we’ll use your insurance, we will use your whole $1,500. Don’t worry, whether you’re in-network or out of network, we will, we will make sure you use your insurance, so you’re going to get that benefit,” and in talking to patients, I try to explain the difference in the types of dentistry that’s done and especially if they want to keep the conversation going, which sometimes they do, they want to talk more about it, they want to keep this conversation going about their insurance. Remember, I’m going to set it on the side over here and I’m going to say, “Let’s just take a look at the mouth,” and we’ll look at the mouth and you know, our treatment plan might be $3,000, that’s not a very good treatment plan, that’s a couple of crowns, or it might be $12,000. Understanding that the patient’s not expecting anything, and just going in and saying, “You need $13,000 worth of dentistry insurance where you know,” patients will run, they will leave quickly and what’s important is to be able to explain to them the differences because they’ll say, “Well, I’m supposed to go to these dentists to get this work done,” and I’ll say, “You know, there’s a lot of good dentists that do dentistry, and they have their really large PPO practices and there are actually some good dentists in Mexico, that trained in the US, but that doesn’t mean that I’m going to go there. Unless I know where they’re sending their labwork to and that’s not something you should know, but if they’re reducing their fees by 40%, where do you think they’re having a Grahamstown? You know, they’re probably sending them to China to be done for $15. You know, whereas my lab is doing it for, you know, $180. Does that make sense, Bob, and then they go, “Yeah, I didn’t realize that.” Yep, so this is something where, when they’re working with you on an ongoing basis, I’m going to be working with you, we’re going to always let you know, what, what is it that needs to be done, you know, and how much your insurance in the company. Again, I don’t worry about pre-estimates, I don’t worry about any of that stuff. Why? Because my average treatment plan, I’m not afraid to tell a patient what they need and that’s something really important to say, I basically ask permission for to look at a patient, comprehensively and what do I mean by that? Well, I’ll go, “Hey, Bob, I’ve listed your insurances over here, but if it’s okay, and I know that this one tooth is really bothering you, but if it’s okay, I’d like to get some X-rays of all the teeth or we’ve already gotten them and I want to review kind of what’s going on in your mouth totally, because, would that be okay? If I’m just going to look around and just kind of give you some ideas about what’s possible?” “Oh, sure. You can go ahead.” I’ve never had anybody say no and because it’s the way you ask, “Would it be okay, I just want to kind of look around because fixing this one tooth, there may be some other things that are affecting that, the gum sometimes will affect that, the, you know, there’s lots of things and so I want to be, have a look at your mouth comprehensively and then we’ll come up with a game plan. Does that sound good?” “Yeah, sounds great.” Okay, so I’ve switched the conversation from insurance to overall health. Let’s see, let’s see what’s going on in your mouth that gives me an idea of what’s going on and let’s say I find five or six more things, and I find gum issues and everything else. I come back to that patient with, you know, “You may or may not have known this probably already knew it, that you had a lot more work that needed to be done besides that one, too.” “Well, yeah, I’m missing this tooth and this one’s broken down here, but I was kind of wanting to get this one fixed.” “Absolutely, totally understand, but what I don’t want us to do is to waste money and it looks as though you’ve lost almost all the bone around this one tooth that’s broken and the bacteria that are around that, that stuff that’s going to affect the rest of your body, it can affect your heart, it can have an increased risk of Alzheimer’s, diabetes, there’s a lot of things that go into this, the mouth is not a separate thing. It’s connected to the rest of your body and we found that, you know, there are a lot of correlations to disease and other things that are going on in the mouth.”

Dr. Bruce Baird 11:19
So my suggestion is this, “Hey, you know, we’ll get this fixed. In fact, I’m just going to patch it because it’s rough right now and so I’m just going to kind of patch it up. I’m not going to charge you anything, I just want to get get it’s kind of stable for a little, but then I’m going to recommend that we do first let’s get these gums healthy and we’ve got a way to do that. We use a laser, we actually use the laser that can actually help new grown, new bone growth, and can get rid of these bacteria and give you a much better chance of long-term success.” It’s kind of frustrating in it, you know, when you get dentistry done, and it fails because yeah, I’ve been doing that my whole life. I said, “Well, let’s, let’s get a plan together. Do you know why this tooth is breaking like this?”, and I go into our risk factor conversations, which you can go back and listen to other podcasts about our risk factors, you know, because what I want to do is by going through these risk factors with the patient, I want them to understand that, first of all, it’s not my problem, it’s their problem, they have something going on, I am now a consultant for them. I’m not a dentist trying to do a crown, I just don’t care about that. I don’t want to do a crown on somebody if I think it’s going to fail in the next three years, or the to scope fail. What I want to do is give them an overall picture of what their oral health is, whether they do it or not. In a couple of podcasts, I talked about having a healthy new patient flow. That’s why I have a healthy new patient flow, that’s why I market so that I can tell people what they need, what they have listened to what they want, and then deliver for them. You know, and I want to do it in such a way that their dentistry, in my opinion, all our dentistry, it should have a chance to last the rest of their life, but if they’re drinking Dr. Pepper all day long, I want to explain to them why Dr. Pepper means they have to keep coming back or Mountain Dew, they have to keep coming back to see me and it becomes more and more expensive and it’s more costly and that’s going to continue. It’s going to continue if you don’t get if we don’t follow a protocol to get you healthy. Does that make sense? And I’ll ask them that. Does that make sense? And I’m asking you guys, does that make sense, because you don’t want to just jump in and say you need $12,000 worth of work and remember, I always do a ballpark estimate. “Bob, I know you probably already knew this, but you have $14,000 worth of work,” and they’re only gonna say one of three things, “Yeah, I knew it was all on two. I didn’t know it was that much,” or they’re gonna say, “There’s no way in hell, I can do that.” Well, that’s okay. I want to know which three? If they say, “Yeah, I knew it was a lot.” That means let’s go to work. If they say, “Well, I didn’t know it was that much.” I’ll say, “Well, Bob, how much do you think it was going to be?” “I didn’t notice. I didn’t think it’d be 12. I thought it might be seven or 8000.” Oh, good. Well, you can use that as a down payment and we’ll work out some convenient monthly payments on the rest and then if they say there’s no way in hell, I can do it.” I said, “I totally understand that. Let’s do this. Let’s just step back a little bit and let’s look at what things we have to do. Let’s get your gums healthy, that’s going to help you. Let’s get you a quick drink and the Dr. Pepper. Let’s get you in on regular re-care. Let’s fix this one too that has an abscess because that is affecting your body. Let’s go through a protocol. Let’s do it the right way because otherwise you’re going to be wasting your money and I don’t want you to do that here. Does that make sense?” So anyway, I hope you guys have enjoyed today’s podcast. Send me questions, this came from like I say a question from a dentist in Dubai duck shot. So, thanks Jeffrey, send me some more questions. I love it. Thank you for joining me for this episode of the Productive Dentist Podcast. If you found this episode helpful, make sure you subscribe, pass it along to a friend. Give us a like on iTunes and Spotify or drop me an email at podcast at productive dentist comm don’t forget to check out other podcasts from the Productive Dentist Academy of productivedentistpodcast.com. Join me again next week for another episode of the Productive Dentist Podcast