Discussing Insurance Limitations

The dental industry faces a unique position when it comes to insurance. Unfortunately, even though dental care is an essential form of healthcare, insurance seldom covers everything for dental procedures and treatments. Sometimes, patients come in needing a significant amount of work. It’s so vital to both their health and their quality of life that they get the treatment that they need, but the financial aspect may cause conflict. 


This is where, if financial presentation is not handled carefully, conflicts can easily arise, and patients get upset. You must be upfront with patients at all times about what insurance will and won’t cover. By verifying their insurance plan and what it covers beforehand, you will be well-equipped to communicate exactly what their insurance will help them to afford. 



By keeping patients well-informed about cost expectations and copay estimates throughout the entire process, you can eliminate the possibility of a negative reaction when it comes time for them to pay for what insurance will not cover. 



Patients will often want to wait until their new insurance cycle starts before they seek treatment. It is not ethical to approve of this choice. Imagine a patient calling a medical office and saying, “My medical plan does not start for another six months, so I would like to wait for my heart surgery.”



Luckily, there are some key tips and tricks that you can implement to avoid patients from being surprised about reaching an insurance maximum. Insurance maximums should not prevent a patient from getting a treatment done — after all, cavities and gum decay won’t wait for the next insurance cycle. They will continue to worsen more and more until getting treated, which will most likely end up making treatment more expensive the longer that they go without being resolved.


Always remember . . . 


  • Dental disease grows and becomes more expensive with time. 
  • Only a dentist can make the decision that a treatment can wait, by looking at a patient’s x-rays.


Discuss insurance with patients at the end of their appointment upfront, including providing an estimate for their copay so that there is no confusion and that they are aware of the treatment cost. Additionally, if discussing the treatment over the phone, avoid surprising them about maximums. Say, “The doctor recommends taking care of your cavities to prevent root canals. Unfortunately your insurance will not pay for the necessary treatment due to limitations, and will only cover $1,000. Would you like me to go over our payment options?”