Navigating Insurance & Payment Options

Understanding how to discuss insurance with patients is an essential component of a confident financial presentation. Specifically, we’ll cover a few specific scenarios that you might encounter — specifically, the topics of insurance maximums, and what to do when a patient has no insurance coverage. Luckily, as long as your work habits include the systems recommended in our dental insurance module, patients will not be surprised by the limitations of dental insurance.


Insurance Maximums


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 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?”  


Another great way to remind patients of their insurance coverage would be to send out an email at the end of each year that reminds patients to utilize their yearly dental benefits before it resets, to ensure that patients are using their insurance plans to the fullest potential. Here’s a great example of an end-of-year reminder email


Some patients may not have any dental insurance at all. That’s okay! Your practice will have its own payment plan and financing options that are offered to those who must or wish to pay for their treatment out-of-pocket. Learn the ins and outs of these payment options with your practice manager so that you can understand how to best communicate them to your patients.