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708: PPO Independence: Turn ‘Do You Take My Insurance?’ Into a Winning Conversation! – Ariel Juday & Christina Byrne

Whether you're fee-for-service or PPO, patients will ask the dreaded question, “Do you take my insurance?” If you're struggling to give a great answer, don't miss this episode! Kirk Behrendt brings back Ariel Juday and Christina Byrne, two of ACT’s amazing coaches, with tips to improve your communication, verbal skills, and understanding of dental insurance. To learn how to have a winning insurance conversation, listen to Episode 708 of The Best Practices Show!

Learn More About Ariel and Christina:

Learn More About ACT Dental:

More Helpful Links for a Better Practice & a Better Life:

Main Takeaways:

  • Have a strong understanding of the dental insurance process and benefits.
  • Get your team aligned on how to answer the dental insurance question.
  • Remember that patients like their insurance. Don't knock it down.
  • Know which key words and phrases to use and to avoid.
  • Never assume you know what patients are asking.
  • Use open-ended questions.


“If our patients are only getting insurance information from the insurance companies, from their HR, from their friends, from Facebook groups, you're not 100% sure what narrative they're being told and what perspective they're being told. As we mentioned earlier, it's not always valid information. Everyone has the best intentions, but we never know specifically that plan and that insurance. Sometimes, those patients don't get the correct information. There are a lot of nuances in the dental insurance world, so the better our team can understand it, the better we can communicate with our patients.” (11:03—11:47) -Ariel

“If we fumble the insurance conversation, the positive outcome instantly dwindles. You could have done an amazing job, clinically. [But] if we fumble that insurance and make the patients feel like we weren't helping them enough or that we weren't able to educate them, unfortunately, that experience then decreases. So, we want to make sure our teams are educated in the insurance process to improve and increase that positive experience.” (13:49—14:17) -Ariel

“We believe that you should be able to practice dentistry any way that you want — when you want, where you want, and on whoever you want. So, we don't want you to have all of these limitations because that's the flexibility and the freedom that dentistry offers. However, what we're seeing is that with more insurance participation, it's starting to threaten that freedom for a lot of doctors and teams.” (26:12—26:40) -Ariel

“Our patients love their insurance. They're so happy that they have dental insurance or dental benefits. So, the last thing we want to do is criticize that or make it sound terrible. I've been in offices where I've heard the admin team say, ‘Oh, that's the worst insurance ever.’ And I'm like, ‘Oh, no!’ We have to remember that our patients really value that — and a lot of times, that's why they're in their job. They sought out an employer with “good benefits”, good for the patient. So, it's all about re-educating our patients, but also about honoring the fact that they like their insurance. We have to remember that and not come down on their insurance.” (30:41—31:25) -Christina

“A lot of times, [patients] don't get to choose — back to, it's the employer or their HR that determined this is the plan that's available. So, if you're telling them that, ‘That's the worst insurance ever,’ well, they didn't have a choice in it, and what are they supposed to do? Now we're making them feel bad about something that they have no control over. So, instead, let's go ahead and talk to them of how insurance works.” (31:27—31:52) -Ariel

“Educate your team first. How are we going to educate our patients if we don't educate our team? Everyone in our team needs to understand the general idea and the terms of insurance — even our clinical team members. So, not just our admin team members because patients are going to ask your clinical team members, and you want to make sure that they understand the general overview, even if they have to give a hand-off to your admin team member for the more plan-specific information.” (37:42—38:11) -Ariel

“Every team member, 100%, needs to know the difference between in-network and out-of-network, what does that mean to the patient, and how to communicate that to the patient. A lot of us know, in-network, we're going to go ahead and take that adjustment. Out-of-network, we're going to go ahead and bill our patient. Well, we know that. That's not how we want to communicate that to our patients.” (39:05—39:28) -Ariel

“Some of the pros of being a non-participating provider is you present your full office fee. Many non-participating providers still present estimates to allow for patients to have an idea of what coverage is going to be. But it's much easier because you don't have to worry about, ‘What is the fee schedule? What is this?’ You can say, ‘This is what we're estimating coverage to be.’ You'll still file on the patient's behalf, so that way you're still insurance friendly. You still will submit it electronically for the patient, so they don't have to worry about that. You don't need any predeterminations because, once again, you're not limited to the insurance contract. And then, if you do select to have reimbursement sent to the patients, it is typically much faster than when you receive the payment — sometimes by several weeks.” (45:03—46:01) -Ariel

“Be aware too, if you're not participating with certain plans, they may not allow you to accept assignment. If it's only the patient who can receive the assignment of benefits, then you will need to collect that upfront, if that's what your system is. The patient could get a check in the mail, and they haven't paid you — and they don't know — and they go out and spend it. And now, you're waiting to collect it from the patient. So, be aware of that, that there are some plans that do not allow the doctor, if you're not participating, to accept that assignment.” (46:03—46:38) -Christina

“If the patients are paying you in full, they potentially will have to wait for the reimbursement. Typically, it's only a con right in the beginning as you're making this transition. It's just new behaviors for the patients. But at first, that is something that you're going to have to overcome as a team. You'll have to go over the verbiage of patients who say, ‘Well, I'll just come and pay you when I receive my check.’ You'll have to make sure that your team is very comfortable at saying, ‘Actually, our policy is that we're going to collect at time of service. And then, you're free to do whatever you want with that check.’ You also have to make sure that your team's verbiage is very strong while being empathetic. They have to really understand and have the confidence to work with those patients because, as we all know, patients can be very strong in their opinions of when and when they're not going to pay. So, we want to make sure that we're even stronger, that we understand our policies, and we understand the ins and outs of being a non-participating provider.” (46:44—47:51) -Ariel

“We're educating our team on being either participating or non-participating and what that means. So, I really want you to reserve time in your team meetings to review this. It can't be a one-time-and-done, or in passing, ‘Hey, Ariel. Just so you know, I want you to read over this and understand it.’ It's really going to take time in your team meetings, and I would say a couple of team meetings, to go through this. And I'm not a fan of role playing. I get it. But we have to because that's the only way. You have to practice to gain those skills and to gain that confidence, and the only way you're going to do that is by sometimes fumbling over your words. And so, you want to fumble with your team members versus when you get to your patients.” (48:56—49:47) -Ariel

“Doctor too, if you would be uncomfortable yourself speaking to the patients about this, imagine how your team members are going to feel. So, this is probably the thing that takes the most amount of time, is having your team be comfortable and confident in having these conversations. And you don't want to mess that up, because if we go back to the journey of the patient, if we make that one misstep in how we communicate this, we're going to lose them on the loyalty side. So, while this seems like it takes a long time, it does — and it’s worth it.” (49:48—50:22) -Christina

“We also want to remove “insurance” from our vocabulary. I know sometimes we say it, but we want to really get into “dental benefits” because we all know there's a difference between medical insurance and dental insurance, and patients are much more familiar with what it means to be medical — and we all know that dental does not work the same. So, if we start saying “dental benefits”, it really triggers in our patient's mind that it is different.” (50:29—50:55) -Ariel

“We all have our own personality, but we want to make sure we're using the same verbiage to have a clear, consistent message to our patients. So, some examples for the question of, ‘Do you take my insurance?’ A lot of what we'll hear is, ‘Nope. We're not a participating provider with your insurance. But do you still want to schedule?’ And what I heard was “no”, so what I'm thinking is no. So, we want to instead say that, ‘We're an insurance-friendly practice, and we file to almost all insurances for our patients. Tell me more what you're looking for in a new dental home.’ So, I acknowledge that they have the insurance, and now I'm turning it to, ‘Okay. But what are you wanting, what are you needing, and what are you valuing as a patient?’ So, you change their mindset.” (52:05—52:54) -Ariel

“I heard a good quote about a year ago. They said, ‘We will work with any insurance who will work with us.’ I thought that was really, really great. So, just think about that. Sometimes, insurances are not as friendly as we want to be, but we are going to do our best to work with every single insurance company that wants to work with us.” (52:56—53:16) -Christina

“We know that since patients are valuing their insurance, a lot of times they're going to ask, ‘Will my insurance cover this?’ And so, we want to acknowledge that. ‘It sounds like you want more information about your investment. We're able to help you understand any limitations that your insurance may have towards this treatment that will help you achieve X, Y, and Z.’ So, we're saying, ‘We're going to help you.’ We're going to understand that because we have to remember that patients want to know how to utilize their benefits because they either have that job for it or they're paying additional for it, so they want to utilize it. So, let's help them. Instead, you could say, ‘Well, your insurance only pays 50% on this, which is $500. Would you like to go ahead and book this?’ So, you're telling them the truth and you're being very honest, but you're not explaining to them that, ‘This is a value. We're going to help you.’ It's just more of a negative mindset towards the patient.” (54:02—55:05) -Ariel

“I wouldn't even say “fee” or “cost”. It's an “investment” because your smile, your teeth — we know how everything is related in the body. That is an investment in your future health. And so, I think it starts with educating the patient from that perspective too about the value of keeping their mouth healthy and keeping the rest of them healthy.” (55:10—55:34) -Christina

“When you give that estimate and the patient is like, ‘Oh. Well, that's a lot,’ I could be like, ’Well, yeah. It is.’ Or I can say, ‘Yes, I understand. It is an investment.’ And now, I'm acknowledging that, to them, it is more than what they were thinking. It's saying it's not a cost. That's how I started saying it because patients were coming back at me, and I'm like, ‘Okay. How do I help this?’ And as we were saying, language matters.” (55:40—56:07) -Ariel

“So, we get the, ‘My hygienist said I should come back in three months instead of six. But will my insurance pay for this?’ We can say, ‘I understand. No problem. I'll find a time in six months so that we can follow your insurance frequency.’ Well, one, we just devalued what the hygienist and the doctor has said the patient's care is, and we're letting insurance dictate that. Or we can help educate the patient and say, ‘I understand how you feel. Other patients have felt this exact same way. We found that making our hygiene recommendations based on the individual risks versus what insurance restricts creates better long-term health. It also will help manage the risk of gum infection. I'm happy to help you understand what your investment would be for that.’ So, letting them know that we're not recommending this based off of what insurance says you need, but based off of your individual risks. And if they're coming back in three months, they have some gum infection that we really need to manage.” (56:10—57:17) -Ariel

“We have this bolded for “feel, felt, found” because that is the way that we can empathetically manage objections to whatever it is that we're presenting to the patient. So, we understand how they feel. We're empathizing. We're saying, ‘I get it. This may be a larger investment than you were considering originally,’ and then letting them know that there are other patients who felt the same way. So, now they feel like they're not all by themselves out on an island, that there are other people who have had the same circumstance. And then, what we found, this is the solution to what it is that they are feeling, is that we need to align with the hygienists’ recommendations based on their own individual needs. So, I think if you think about it in terms of that, try to use those three words in your response to an objection that a patient may give you, or even a question that they may give you. Understand how they feel, understand that other patients have felt the same way, and here's what we have found works for them and, ultimately, for you. It's a really great way to manage those objections in a very empathetic way and let the patient know that you're on their side.” (57:20—58:35) -Christina

“Yes is always the right answer. We always want to let our patients know that, ‘Yes, we can do this,’ so that they have a better understanding. And it keeps the conversation open, because as soon as you say no, there's really nothing else. I mean, yes, you can add in the question. But if you say no, that's what the patient hears, and that's what they're going to say. So, we want “insurance-friendly experience”, and we “want to help them”. Whether you participate with 10 plans, 20 plans, none, you can say yes to helping your patients understand and maximizing their benefits. So, ‘Do you take my insurance?’ ‘Yes. We have many happy patients here with that dental benefits plan. I'd love to learn more about you and your dental needs so I can share how we can help maximize your benefits.’ So, even if you're telling them that you're an unrestricted provider and what that means, it's always, ‘Yes. This is how we can help you.’” (58:43—59:46) -Ariel

“The main focus is your patient, not their benefit plan. So, yes, we want to be honest, and we want to be concise when answering questions. A lot of times, we explain and we're answering everything that we can. However, sometimes that also overwhelms the patient. So, be concise, and let them drive the conversation back to what they're wanting and what they're needing to help with that value.” (59:51—1:00:18) -Ariel

“If we are out-of-network and the patient is asking, ‘Are you in-network?’ I would say, ‘We are considered an unrestricted provider with that dental insurance. Do you mind if I explain what that means and how those benefits will work, or how we can help maximize those benefits?’ So, I want you to be honest. We don't want to say, ‘Oh, yeah. We're happy to bill that for you.’ They're asking, ‘Are you in-network? Do you accept this insurance?’ ‘Yes, we accept it. We are an unrestricted provider. What that may mean is . . .’ Then, you go into the explanation. And teams always may say too, ‘Oh. Well, that means your reimbursement will look different.’ I want to say “may look different” because until you know the patient’s plan, you don't really know. Some of those non-participating providers are still getting paid very well, and very good reimbursement rates.” (1:00:37—1:01:36) -Ariel

“I would actually stay away from the term “co-pay” when you're talking about a dental visit, because a co-pay is $20 for an office visit at your medical doctor, and that is not what we're talking about. So, I would actually strike that from your vocabulary and use “patient portion” or “patient investment”, like we talked about earlier. Co-pay has such a connotation of $20 for an office visit or $10 for an office visit in people's minds because they're thinking of it like medical insurance — and that's not what it is. So, I would definitely lean into the “patient portion” or “patient investment” when you're explaining that to them. Try not to say co-pay at all.” (1:01:40—1:02:24) -Christina

“If you are moving towards becoming unrestricted or non-participating, you're going to get the question, ‘So, you aren't taking my insurance anymore?’ Just be honest. ‘We've changed our relationship with this insurance company so that we're less restricted by their terms.’ And then, let them know what that means. ‘This means we can better work with our patients to make decisions about their care that best supports their oral health goals. Would it be okay if I share how this may change or affect your visits?’ And sometimes, it doesn't affect it. But I want to let them know that, yes, we've changed our relationship with it. A lot of times, I'll have teams tell them, ‘We do not want to sacrifice the quality of care that we provide for our patients, and we were unable to do that while still being a participating provider.’” (1:04:11—1:05:01) -Ariel

“We don't want to ever do the bait-and-switch to make patients feel that we tricked them into seeing us because that doesn't set a trust foundation. So, ‘We're insurance-friendly. We'll help you maximize your benefits. Here's how we can help.’ And if they have an HMO plan, we're not able to maximize their benefits, so it's going to be their choice. ‘We're happy to bill your dental benefits plan. We want to maximize your available benefits.’ All in the positive, what can we do to help you and maximize those benefits. ‘We understand that your benefits are important to you. If you're willing, I would like to start with some important information about you and what you're looking to accomplish as a patient here. And then, I can share more with you specifically how your dental benefits work.’ So, if you get that new patient phone call and they're specifically asking you about insurance, I really want your team to build a relationship the best they can on the phone prior to going into dental benefits. Because, once again, the more we talk about dental benefits, the more patients are going to value it.” (1:07:44—1:08:51) -Ariel

“There's a question about, ‘What if they just want to go to an in-network provider?’ And that's totally fine. You don't have to see every single patient who is coming to your door or picking up the phone. You have to be a little bit picky about who you plan to spend your time with. That's the whole freedom part of it. There are plenty of fine, fine offices who can take that patient and do a great job with them. You don't have to see them if that's all that they're asking for.” (1:08:52—1:09:23) -Christina

“We always want to be proactive instead of reactive whenever possible. If you are switching to go to an unrestricted provider, I would say, ‘Hey, insurance is probably going to send this letter.’ So, do the work ahead of time to be able to communicate with your patients, letting them know that, ‘We're changing our relationship with your insurance company. This is what that means. Don't be surprised if you receive a letter from them saying that you can no longer come here. I want to let you know that that is false, and that you are able to still come here. You are able to still utilize your benefits. We've checked your plan. You do have out-of-network benefits.’ So, just letting them know, communicating in person. If you can't communicate in person, give them that phone call. We have a lot of teams that send a letter ahead of time, because we all know that we don't read a ton of letters. So, if you read mine first, hopefully you ignore the second one that comes. Or the patient says, ‘Oh, yeah. I knew they were going to send this,’ and then they disregard it.” (1:09:44—1:10:47) -Ariel

“We often use open-ended questions from the clinical aspect. But as an admin team member, that's a great opportunity for you to learn more about the patient, why they're asking the question, and what it is that they hope to gain. So, don't think that open-ended questions are just for clinical conversations. They can be for administrative conversations as well. So, try not to close those conversations off with yes and no responses. Let the patient talk. Listen to them and find out where they're coming from. The more you learn about them, the more you're going to help them to be motivated by the treatment you can provide and not by what's part of their network.” (1:14:14—1:14:53) -Christina

“Use those open-ended questions, and don't assume you know what the patient is asking. Because a lot of times, they ask, ‘Are you taking new patients? Do you accept my insurance?’ because they don't know what else to ask to start the conversation. So, it's just that opening for them because they haven't been educated on, ‘You need to call and ask this.’ They don't know. So, don't assume, and use those questions to see more of what they're wanting from you before you get into a solution.” (1:15:02—1:15:31) -Ariel

“Our clients who drop Delta or drop all of their insurance do not lose all of their patients. In fact, sometimes they do it because they're so over capacity. And they are still over capacity after they drop. They did it the right way. And it takes a long time, as we said. You can't just make this decision, send your letter off to Delta, and hope that your team is going to be ready in 30 days. You really need to plan this out and be very, very strategic about it if that's your goal. If it's not your goal and you want to stay in-network, that's totally fine. But use the verbal skills that we talked about. Do those skills trainings with your team to understand and communicate about what insurance is and isn't with the patients.” (1:17:45—1:18:34) -Christina

“Even if you're participating and you're never going to be a non-participating provider, you still have to know the dental insurance benefits. You still have to know how to communicate with patients and understand how to have those conversations.” (1:19:16—1:19:30) -Ariel


0:00 Introduction.

5:19 ACT’s To The Top Study Club and BPA.

10:28 Why this is an important topic.

12:27 The patient engagement cycle in a dental office.

14:22 Know the basics of dental insurance.

23:10 Understand the insurance process.

27:18 Don't shoot down patients’ insurance plans.

32:52 Benefits of non-participation.

35:51 How to educate and talk to patients about dental insurance.

42:51 Q&A: If insurance downgrades, can you collect the difference?

44:22 Out-of-network and non-participating provider, explained.

45:03 Pros and cons of being a non-participating provider.

47:52 Q&A: Bill everything to insurance, whether it’s covered or not.

48:54 Reserve time in team meetings to review the basics.

50:29 Key phrases to use: Dental benefits.

51:33 Key phrases to use: Insurance-friendly practice.

56:10 Key phrases to use: Feel, felt, found.

58:37 Key phrases to use: Yes.

59:49 Be concise when answering questions.

1:00:20 Q&A: Unrestricted provider, explained.

1:01:37 Key phrases to use: Patient portion or patient investment.

1:02:29 Q&A: How do you respond to, “Which insurances do you take?”

1:03:20 Q&A: What's the verbiage for, “Do you take my insurance?”

1:04:10 How to answer, “So, you aren't taking my insurance anymore?”

1:06:25 Q&A: What to tell patients with HMO plans when we are non-participating providers.

1:09:25 Q&A: How to explain the out-of-network letter to patients.

1:11:37 Get rid of your limiting beliefs.

1:14:06 Use open-ended questions and listen to your patients.

1:15:33 Q&A: How to help patients whose portions are too high.

1:16:48 Be proactive and strategic.

1:18:35 Q&A: Focus on what you can control.

1:20:19 Conclusion. 

Ariel Juday Bio:

Ariel has a master’s in healthcare administration and several years of dental experience in all aspects of the administrative roles within the dental office. Her passion is to work with dental teams to empower team members to realize their full potential in order to better serve patients, improve office systems to ensure a well-functioning team/office, and to help everyone have fun in the process!

Christina Byrne Bio:

Christina Byrne has been involved in dentistry since 1985. Over the years, she has held many positions on the dental team, including dental assistant, business office, and dental hygienist. Christina’s extensive knowledge of the front office and clinical procedures is a great asset, and she loves to impart her knowledge to guide dental teams do the best they can to achieve a Better Practice, Better Life!