Why Relieving Patients of Insurance Confusion Is Essential to a Successful Dental Practice!


DentistAs we’ve discussed in previous posts, a number of issues can arise during the dental billing and collection process. But maybe the most common payment problem we hear from dental professionals comes as result of the patient’s confusion over their insurance coverage. In fact, just last week in a discussion we noticed on LinkedIn, according to an Endodontic Insurance Coordinator, the biggest collection issue her practice faces comes from patients not knowing how much of their bill is covered by insurance and how much they personally need to pay out of pocket. See below for her explanation:

“Our biggest issue is that insurance plans will not give us a true dollar amount, only a percentage [of the patient’s bill], therefore a lot of times the patient will owe a balance. When they call to complain, I tell them their insurance carrier will not give us an exact dollar amount and that their fee is only based upon a percentage and that their balance after insurance is x. Mind you, I’ve already told them this at least 2 times prior to their procedure, first when they call for an appointment and ask what it’s going to cost, and again when we call them back to give them their fees and confirm their appointment.

And they [patients] do normally pay the original estimated amount at the time of service. And I tell them, as they sometimes complain about how much they pay in premiums, that if the insurance pays more than the estimated amount, we’ll send them a refund. However, if they [insurance provider] pay less, then we will have to bill the patient…”

The scenario described above accurately depicts a growing problem facing many dental practices today. Many of your patients simply do not understand their dental insurance policies and are unaware of how much of their bill they will need to pay for themselves. For this reason, it is good practice to provide accurate estimates and to go over the patient’s insurance coverage before providing service. Put simply, your patients need to know how much their appointment is going to cost, and they need to know approximately how much of their bill will be covered by insurance – ahead of time!


Just remember to always remind patients that their portion of the bill is due at the time of service, and that appointment estimates are just that, estimates. Let them know their bill may exceed or be less than the estimated amount, and that regardless of the final amount, the patient will be responsible for whatever total results. Some dental insurance providers even offer pre-treatment estimate programs. This type of proactive, fact-based cooperative exchange of information might seem burdensome at first glance, but in the long run might be well worthwhile if it increases the level of patient awareness – and ultimately increases the overall percentage of payments received. 

Meaning, despite being time consuming, confirming patient’s insurance coverage and going over their bill ahead of time will ultimately be beneficial to your practice’s collection performance. Not only will you increase the frequency of payments that are made at the time of service, but will also reduce the likelihood of insurance disputes and the need to send a patient account out for collections. Your practice will also save money in overhead by having to send out fewer billing statements and will spend less time making collection calls.

So take the time to educate your patients on their insurance coverage and remember to offer accurate cost estimates for the services you provide. Your patients will appreciate having an idea of the costs associated with their appointments ahead of time – and so will your bottom line!

YOUR TURN: Does your dental practice spend lots of time and money settling insurance disputes after services have already been provided? Do you think it’s beneficial to go over patient’s insurance coverage in advance? Why or why not? Let us know in the comments!



  1. Yes I believe people need to know the exact cost of there treatment before commiting financially.. I ALWAYS research insurance before an appointment … That way I’m more confident in answering treatment and financial questions and in gaining trust

    Dolly Emerson

    January 30, 2014

    • That’s great Dolly! I am glad you take that additional step to do some investigating on behalf of the patients so you can become informed and so you can display a full picture of what’s expected/ required from the patient seeking services! What are some other ways to make sure patients are informed and understand their obligations before following through with services?

      Elizabeth Thill

      February 3, 2014

  2. Should the secretaries told them there fee by phone before the appointment or it should be discuss in the treatment room!?


    May 23, 2014

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