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Answering Insurance Questions Part 2


Even if you’re not a PPO provider, I’m betting that responding to your patients’ insurance related questions is not your favorite activity. In my last article I described a 4-step framework that can be used to respond to any “difficult” patient question-including those related to fees, payments and insurance. In this article,  I’ll show how to use this framework with more insurance related questions.

As a refresher, here is the 4-part response you can use to respond to any patient question.

Respond to the feelingMany questions originate from an emotion such as anxiety, frustration or overwhelm. If you respond only with logic, you miss the subtext and the patient won’t feel heard. Your first step is to show you understand and have compassion for how the patient feels.
Share your philosophySharing your philosophy of care can answer patients’ “why” questions and provide a context.
Focus on the benefitsNow link your overall philosophy to specific benefits that the individual patient will value. It’s the WIIFM component.
Redirect with a questionThis should be dialogue, not a monologue. Ask check-in questions such as: How do feel about this? or What are your thoughts? Often, patients’ money questions mask a real concern about the value of treatment. The redirect question can also be used to move the patient to make a decision or take action.

Now let’s use the framework to develop scripts.

Why don’t you know if this is covered?

  • Respond to the feeling: I sympathize with how frustrating this is for you.
  • Your philosophy: We want to do our best for you while at the same time not get completely overwhelmed with the details of every insurance plan. Our patients have many different plans and they all have different benefits and restrictions. In fact, patients with the same plan can have different benefits.
  • Focus on benefits: We do the best we can to estimate your plan’s benefits and because you are the insurance company’s direct customer, you’re in the best place to research what your plan provides. Typically, they’re more responsive to you than us.
  • Question Redirect: Would you like some help with what questions to ask them?

Could You File a Pre-Authorization?

  • Your philosophy: Our goal is to protect your health and make sure you feel better. Remember your plan’s  preauthorization is just their estimate and not a guarantee and it may take several weeks to come back.
  • Focus on Benefits: Because this treatment is essential for you, I’d hate to see you delay this while we waited for their estimate.
  • Question Redirect: So, before we file the paperwork let me ask you, how do you feel about this treatment? Is this something you feel ready to do?

Which Insurance Do You Recommend?

  • Your Philosophy: We absolutely agree and we want you to spend the least amount of time, energy and money here too!
  • Focus on Benefits: Every plan has its benefits and limitations and we can’t really recommend one over another. We have found that the key to lower dental bills is being diligent with your home care and taking care of any treatment needs while they’re relatively small.
  •  Question Redirect: What small changes do you think you could commit to, to prevent you needing extensive care?

Why Do I Need to Pay You Up Front When I’ve Never Had to Do That Before?

Respond to the feeling: I recognize that this must feel confusing.

Your philosophy: We’re moving to a process to make the payment process as seamless and easy as possible for both you and us.  We want our focus more on providing great care for you instead of navigating insurance bills and invoices.

Focus on Benefits: Our goal is to reduce our admin costs so that we can keep our fees as low as possible. By taking care of the payment today, you won’t need to worry about getting bills from us and mailing us a check

Question Redirect: Let’s plan ahead for your next appointment. The fee for your next appt will be XXX. We can make a financial arrangement for that today,  if you like. Is this something you’d like to arrange?

The Art of the Question

You may have observed that these examples end with a question to the patient. If your patient has expressed an objection or concern, you want to engage in a dialogue with them – not a monologue. The “question redirect” focuses the patient’s attention towards the action you want the patient to take. It also allows you to gauge the patient’s level of commitment to their treatment.

If you’d like a Verbal Skills Cheat Sheet that provides scripts for all sorts of patient questions, email me at [email protected] and I’ll send you the guidebook.  

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“As an Office Manager, I’ve seen a great difference in my practice since starting with Sharyn. Three years ago our staff was in turmoil with a lot of infighting and gossip and some jealousy directed towards me.

I had given up because everything I did was judged. Now I have learned to have more one-to-one communication and by being more vulnerable with individuals I found my leadership voice. As a team, we’re all focused on the same goals.

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