Lie #1: I Have Dental “Insurance”

This post is our first in the Biggest Lies in Dentistry Series. Things the dental industry repeats to itself until they sound true. See the full series here.

One of the biggest communication problems in dentistry starts with five innocent words.

“I have dental insurance.”

Every dental office hears it every day. The patient isn’t trying to create a problem. They’re simply repeating something they’ve believed for years. The problem is that we’ve all been repeating it too.

What Insurance Actually Does

Let’s forget about dentistry for a minute. What is insurance?

Insurance transfers financial risk. That’s its entire purpose. You pay someone else to assume the financial burden if something expensive and unexpected happens. If your house burns down, homeowner’s insurance rebuilds your house. If your car is totaled, automobile insurance pays for the loss. If you break both legs skiing and spend a week in the hospital, your medical insurance doesn’t send you a check for $1,500 and wish you good luck. Once you’ve met your deductible, it covers the cost according to your policy.

That’s insurance.

The $85,000 Question

Now imagine something different. You break both legs skiing. Your hospital bill is $85,000. The insurance company says, “Good news! We’ll contribute $1,500 toward your hospital bill. The other $83,500 is your responsibility.”

Would you call that insurance?

Of course you wouldn’t.

You’d call it a benefit. You might even call it a lousy benefit, but you certainly wouldn’t call it insurance.

A Benefit Is Not Insurance

That’s exactly how dental insurance works. It doesn’t transfer financial risk. It contributes a limited amount toward treatment. Those are two completely different products.

The annual maximum makes the point better than any argument can. A large share of plans still cap out somewhere between $1,000 and $1,500 a year, and the ADA has pointed out that the $1,000 ceiling many carriers still promote was set roughly four decades ago. Think about what else in a dental practice costs what it cost forty years ago. Nothing does. The cap didn’t move, but the cost of care did.

Somewhere along the way we started calling one by the name of the other. Calling a benefit plan “insurance” was brilliant marketing, but it also created decades of confusion. Patients have heard that word for so long that they naturally assume dental insurance works like every other insurance product they own.

Why Patients Believe They’re Covered

Medical insurance. Homeowner’s insurance. Automobile insurance. They all teach the same lesson. If something expensive happens, you’re covered. So when your patient says, “I have dental insurance,” what they’re really telling you is, “I’m covered.”

Can you really blame them? That’s exactly what the word insurance means everywhere else in their life.

Two Frustrated People, One Bad Word

Then we diagnose the treatment they need and explain that their insurance only contributes a portion of the cost. The patient is frustrated because they thought they were insured. The practice is frustrated because the patient “doesn’t understand their insurance.”

Both sides are victims of the same misunderstanding. The confusion started long before the patient walked into your office. It started with one word. Insurance.

What to Say Instead

It’s time we changed the conversation. The next time a patient tells you they have dental insurance, don’t start by explaining what their insurance covers. Start by explaining what it is.

“I’d like to explain something because the name is a little misleading. Dental insurance doesn’t work like your medical insurance or your automobile insurance. Those products are designed to protect you from major financial loss. Dental insurance isn’t really insurance at all. It’s a dental benefit.”

Let that land. Most patients will react, and the reaction is the opening. Then finish the thought.

“Think of it as a contribution toward your dental care. We’ll make sure you receive every dollar you’re entitled to, but the responsibility for your oral health is still yours, not the benefit company’s. There’s really no such thing as true dental insurance in the way you’re probably thinking about it. There are dental benefits, and they can certainly help, but they don’t decide what treatment you need.”

Then Take the Conversation Where It Belongs

Now continue the conversation where it should have started in the first place.

“Now let’s talk about your goals. Let’s figure out what your mouth needs to become healthy. Once we know where we’re going, we’ll help you maximize every dollar of your dental benefit, and then we’ll figure out together how to make the rest affordable.”

That’s a very different conversation. The patient no longer feels like the insurance company has failed them. They understand what the benefit was designed to do from the beginning. Instead of allowing a benefit plan to dictate healthcare decisions, the conversation returns to where it belongs.

The patient. Their health. Their goals. That’s exactly where it should have started all along.

If you'd like to find out more about how Smile Care Claims handles billing, insurance verification, and accounts receivable management for practices like yours, book a consult with one of our billing specialists.

This is part one of “The Biggest Lies in Dentistry” Series. Read the full series here.