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What to Do If You’re a Insurance Zombie


I recognize that many dentists feel that their patients have become insurance zombies – mindlessly repeating that they will only do what their plan allows. In the past year, several dentists I work with have decided to leave their worst plans or to get out of managed care entirely.  But how do you know if you should leave? How do you determine if your practice has become so subsumed by the insurance mindset, that you have also turned into an insurance zombie?

Here are 7 symptoms that your practice has an unhealthy relationship with insurance:

  1. You and the team are uncomfortable about recommending treatment not covered by insurance
  2. Patients believe that insurance should cover 100% of the practice fees and their treatment
  3. Patients don’t understand the word “estimated” and regularly challenge statements indicating an extra balance
  4. Patients demand pre-determination even if their insurance companies don’t require it
  5. The practice’s fees correspond to the local insurance carrier
  6. Treatment is phased to match insurance benefits not necessarily clinical needs
  7. Patients argue with you about doing any treatment “not covered” by their plan.

It is possible that everyone in your practice – you, your team and your patients have allowed insurance companies to dictate treatment and be the main factor in determining care. Clearly, this is not healthy for anyone, so how do you change everyone’s mindset about insurance regardless of whether you are in or out of network?

Uncover Myths, Beliefs and Facts

First, you and the team need to unpack your own beliefs about insurance, dental care and fees. How do you feel about the following statement?

We are a values and vision driven practice. The focus of our practice is providing excellent oral health care, not managing the insurance bureaucracy.

We will always do everything to maximize patients’ benefits but ultimately paying for their healthcare is their responsibility!

If you want to adopt this mindset in your practice, then you will need to examine the systems and attitudes that both help and hinder this philosophy. Imagine presenting this philosophy to your team and patients, how would they react? If your team would say, “Heck yes” but your patients would say “Hell no” then you have some re-education to do with your patients. Let’s look at some common beliefs about insurance and how to address them:

Dental and medical insurance work the same way: Your patients may think that insurance is insurance, but dental and medical insurance function differently. Dental insurance is usually relatively low cost but frequently used while medical insurance is more expensive but ideally, rarely used. Many medical plans cover up to 80% of medical expenses but dental insurance plans “cover” much less. That’s because although medical plans have been updated to move with the times, the dental insurance maximum benefit of $1,500 a year, hasn’t changed in over 50 years! If it had kept pace with inflation and the changes in dentistry, that maximum would actually be $10,000 a year.

“Not Covered” procedures mean they aren’t necessary or advisable: Patients interpret a not covered procedure as something that is therefore discretionary.  Although you do not want to disparage the insurance company, you can note that the company’s decisions about covered procedures stem not from health considerations but from a profit mindset. But you can get out of the whole argument about what is and isn’t covered by telling patients that their yearly benefit of $1500, will reduce their out-of-pocket costs for their necessary treatment.

The dental practice is the insurance company’s client.  Patients generally assume that is the dental office’s job to understand their benefits and argue for better ones. To get patients to take more responsibility for their own benefit plans, you may need to engage in some tough love and education. Your front desk can say, “We have found with working with other patients who have this plan, that you are the most powerful advocate for your benefits. So that you understand exactly your plan’s limits, I encourage you to call your benefits administrator.”

Patients will only do what their insurance allows. This belief permeates many teams because so many patients say this when presented with a treatment plan. But this is the most crucial myth to address because if you and your team really believe this, then you will undercut your expertise, undermine your relationships with patients and ultimately damage your practice. Patients use this as a reason to avoid scheduling treatment they don’t understand or value.

How to Stop Being an Insurance Zombie

The first step to regaining your sanity, is to see if your practice displays any of the seven symptoms I listed. Every symptom can translate into a new decision and action on your part. The critical first step is analyzing your philosophy of care and challenging any behaviors that compromise your own values in favor of the insurance industry.  Next, your treatment decisions should be based on your diagnosis of the patient not your diagnosis of their insurance plan. And finally, your patients need to understand a new term called “insurance limits” with a more realistic view of the role insurance should play in their treatment decisions.

To do this, you will need to have more frequent and more personal conversations with patients about the value of dentistry and how they make their treatment decisions.

Let’s say your patient wants to delay treatment until next year when she can use her benefits. Here is how you could respond:

“Yes, I can see that it would be tempting to wait to do this. This treatment represents a significant investment. Naturally you want to be sure that you really need this treatment and that you need this now. Tell me, is your concern about the fee or about the need for treatment?”

This response demonstrates that you understand the patient’s viewpoint. You acknowledge that the patient would need to make a financial investment. Notice that the dentist doesn’t “yeah, but” the patient. He isn’t lecturing the about why the patient should do this despite her financial misgivings. In fact, the dentist is engaging in inquiry: learning the patient’s main concern.

Let’s say the patient responds, “Yeah, it’s about the price. I don’t have $2,000 to spend on this right now when I could wait 8 months and get insurance to cover it.”

Here is how the dentist could respond.

I totally get it. It does seem to make logical sense to wait until insurance will cover this expense. And, with many things, waiting won’t make a big difference. But health is an issue where waiting can cause more problems. Let’s pretend I was a termite inspector instead of a dentist and having examined your house, I found there was a significant infestation. In fact, I showed you significant damage to your house’s foundation. What would happen to your house if we waited 8 months to remove the termites?”

Note that this dentist is not directly addressing the costs of the treatment. Instead, he is focusing on changing the patient’s belief that waiting won’t have consequences. By using an analogy and asking questions, the dentist allows the patient to come to her own conclusions.

The bottom line is that whether you are in or out-of-network provider, you don’t need to act like an insurance zombie.  Your role can be to change your patients’ mindset about the role of insurance and the value of treatment.

Does this take a little longer? Yes. But then you won’t be eating brains for lunch anymore.

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Inspired Us to Dream Bigger, and it Works

“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.

Last year, in August we produced $88,000. This year we’re on track to produce $111,000 this month. I know it’s because we learned how to follow through with patients and communicate our expectations while building our systems.

Sharyn has gotten us out of our comfort zone and inspired us to dream bigger and it works.”

–Sharon St Pierre, Sperbeck Dental Care

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