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Case acceptance: How do I move beyond what insurance pays for?

I'd like to spend a few minutes with you discussing case acceptance and how do we increase case acceptance, working around the limitations of insurance.

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How can I implement this type of care into my practice?

Many practices are involved in dental insurance. As a matter of fact, most dental practices in the United States are in-network. So when many dentists start coming through The Dawson Academy and start looking at patients in a more complete fashion, we'll start to see that many times patients needs go far beyond what insurance will pay for within a calendar year. And so the dentist, a lot of times, will become frustrated, wondering how can they implement this type of care into their practice, understanding that most patients are going to be very motivated by strictly what insurance will pay for, or solely driven by how much of the benefit that they may have left for their calendar year.

It's only a limitation you've placed on yourself

I think what we need to realize is that this limitation that most dentists are feeling is really a limitation that they're placing on themselves. Whether or not your practice is a fee-for-service practice that takes insurance, where you collect the insurance benefit but the patient still must reimburse you for the remainder of the fee, or whether or not you're in-network, there's a commonality between the two. And that is a yearly limit on whatever the insurance maximum would be. So both practices are running into the same obstacle.

The difference between the practices that are able to move through this barrier versus the insurance-based practices is simply taking your communication to another level with your patients. And what that does is, is it starts with expressing concern for the patients.

Educate the patients before any treatment is recommended

Most patients have been accustomed to one tooth or single-tooth dentistry based on what insurance will pay for. So what's happened is the insurance industry and what their limitations are has really been programming how the patients have been accustomed to accept care and at what level.

So, all this starts with expressing concern to the patients by making sure that you fully educate them. Go through the process of co-diagnosis, so they have an understanding that their needs may be far greater than what they've been accustomed to in the past. Allow yourself to be able to have compassion for your patients, because many times they're going to become overwhelmed by what it is that you're telling them through this educational process.

Let the patient own their problem

Once patients can accept ownership for what their condition is and if they understand the long-term implications of what it is that you're talking about with this diagnosis, then many times patients will move beyond the limitation of insurance because once they're educated and allowed to choose to do what's best for themselves, I think you'll be overwhelmed by how many patients will actually choose what the correct treatment plan is and they really will not care what insurance benefits they have or the limitations that the insurance benefit plan would have for them at point in time. And I think you'll be seeing your patients move forward with their treatment.

Dental Patient Communication Quiz

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Picture of Dr. Leonard Hess

Leonard A. Hess, DDS is the Clinical Director at The Dawson Academy and joined the faculty in 2009. He owns Union County Center for Comprehensive Dentistry in Charlotte, North Carolina, and practices full time in addition to teaching continuing education courses. He is a member of the editorial board for Inside Dentistry and has had over 17 articles published in peer-reviewed journals. He is also a member of the American Academy of Restorative Dentistry, AACD, ADA, AES, and NCDS. Dr. Hess began teaching continuing education courses in 2005 on topics including occlusion, smile design, treatment planning, preparation design, and practice integration of Complete Care Dentistry. He’s taught full-day continuing education courses at the American Academy of Cosmetic Dentistry’s national meeting, The Greater New York Dental Meeting, AACD National Meeting, Pacific Dental Conference, Ontario Dental Association meeting, and The Yankee Dental Conference. Dr. Hess has taught courses in Japan, Germany, Poland, China, and Canada.