Great, You Have Dental Benefits to Help You Pay!

Are you putting your patient’s dental insurance company between you and your patient?  Many of your colleagues are, you can see it by reading the comments that they post in threads on just about any dental forum out there on the web.

 When someone posts a question, to gain advice on how to figure out a way to “get around’ the policies and restrictions, the General response is to cry FRAUD, in many colorful ways.

The people debate if you can wave patient co-pays or if you have to reduce fees when you submit claims. Some say you can if you show intent by writing it on the claim when you submit, while others disagree. Some argue that you should always submit using your full fee because if you do not, it messes up your UCR, while others say that is not true. I was a bit surprised when I read a comment from a Doctor who said that he redid treatment to show the insurance company that he did it after the patients waiting period had expired, redoing all his work to help his patient save a few bucks.

As I read through these threads one thought kept crossing my mind, WHY?

Why are these Doctors putting these insurance companies in between their services and their patients?

 Dental benefits are a tool that your patient uses to help them pay for your services, not your problem. You sell your service to people, people with teeth; and they use a variety of ways to pay for it, one of those ways just happens to be dental insurance.

When they hand you their insurance card, you verify their benefits, let them know how those benefits will HELP them pay for their care and you get started. Place the importance on their dental health, if they can’t afford their out-of-pocket, they aren’t ready to proceed and you walking on any sort of thin line named fraud is definitely not worth the risk. If they weren’t ready to begin with, who do you think that they will point their finger at if something goes wrong, say the tooth aches a little or even worse, the insurance company comes a knocking at the door?

Another thing you should think about if you find yourself trying to decide how to work around your patient’s waiting period or how to reduce their portion to pay out-of-pocket while still submitting full fee to their insurance company, are you prepared to do the same for all of their friends?

People talk, give them a really great deal, they will refer their friends and those friends will want the same deal.  I remember a time when I smashed my car and my neighbor told me about a really great auto body guy who would “work” with your insurance to help you avoid the high deductible. My neighbor didn’t have a clue if he did quality work; he just knew that this auto body guy was willing to bend the rules to give him a deal. While saving money was important to my neighbor, it was not to me. I like my car and I wanted quality work done. Did you know that there are dental patients out there who feel the same way about their teeth?

Is a really good deal the reason that you want your patients to refer you to their family and friends? Do you want to be known as the dentist who will bend the rules? Think about it and do what you feel is right for you.

With your success in mind, 



  1. The Dental Warrior | | Reply

    Whenever a patient asks why I won’t “bend the rules” (commit fraud) like the other dentists, I say this:

    If the dentist was willing to defraud the insurance company, who else might he be willing to defraud?

  2. Michael Perpich | | Reply

    Great post Nomi! Dentists can’t pick and choose if and when to bend the rules! That’s why they are rules and they are for everybody!

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