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Should My Dental Practice Accept Insurance?

Posted by Goldin Peiser & Peiser on Aug 28, 2014 9:00:30 AM

By: Erick Cutler

Dental insurance can be confusing, for both consumers and providers. For many providers, the headache of red tape, claim follow up, staff training, and reduced reimbursements outweigh the benefits of accepting insurance. It seems that more and more dentists are considering dropping dental plans, both private and publicly funded. This is not a decision that should be made lightly because there is a real possibility of losing patients. Therefore, it should be made only after a proper analysis of the financial impact of insurance on the practice, and then followed by a plan of action.

4 issues to consider before dropping dental plans

1. Freeing up your staff’s time

Eliminating insurance from the equation can greatly cut down on the time your staff needs to devote to your accounting and billing process. By choosing to no longer accept assignment of benefits, you’ll accept pay for services from patients up front. The patient’s insurance provider will reimburse for services rendered, and your dental practice is almost entirely excluded from the interaction. Of course, you’ll need to provide patients with all of the information they need to be reimbursed, including the ADA codes for all services rendered.

You already provide patients with payment statements, so adding in these codes shouldn’t be difficult. Even if you do have to spend a little more time providing information to patients, you’ll spend much less time wrangling with insurance companies.

2. Being prepared for loss of revenue

You will, though, have to be prepared for the initial pinch.  If you have a large number of insured patients, it is likely that some will decide to move to other practices which do accept their coverage. With most plans, insured patients can still visit out-of-network dentists, but they’ll have to pay up front for services and wait for reimbursement from the insurance company.

That initial large expense may be difficult for patients to swallow, especially if they are experiencing financial difficulty. Transitioning patients away from a co-pay system is possible, but it does require good communication. Ditching insurance can provide you with ways to be more financially flexible with your patients with options like payment plans and discounted fees for a combination of services. You’ll be able to help save your patients money without hurting your practice’s profits.

3. Slowly phasing out insurance companies

The transition away from insurance will take some finesse in order to be successful. If you participate in a number of PPO networks, it may be a good idea to do a slow phase-out. It isn’t necessary to drop all insurance carriers at once; if you anticipate a drop-off in patients, it’s best for that to occur over time. If only a few carriers are causing the majority of your insurance headaches, choose to work with the companies that have a proven track record of good service.

4. Appointing an “insurance” expert in your office

You’ll still want to be your patients’ advocate with their insurance companies. An in-office insurance expert can minimize your patients’ anxiety about having to deal directly with their dental insurance providers. Ensuring that your patients have all the information they need to file claims and receive the appropriate reimbursements is beneficial for your practice. Knowing that the dentist is on their side is extremely reassuring to patients, and will keep them coming back.

Ultimately, the decision to move away from accepting insurance is one that must be made by closely evaluating your particular situation. Some practices may benefit immensely, and others could struggle. Analyzing your patients’ unique demographics, along with considering how your practice will be affected in the long and short term is the only way to make an informed decision.

About the Author

As a partner at Goldin Peiser & Peiser, Erick focuses on tax compliance and consulting work in the healthcare and real estate industries, where he oversees the preparation of all annual federal and state compliance and regularly reviews the client’s financial statements. He also consults his clients on the health of their practice or business—making sure they understand the business and tax aspects of their strategy—and suggests new ideas they may not have considered. Erick provides his clients with a year-end tax plan, which includes an in depth summary of their current tax year, strategies, and opportunities to help mitigate their current and future tax liabilities for both their business and personal lives.


For additional information on this topic, contact Erick Cutler at ECutler@GPPcpa.com or 214-635-2541. You can also visit his Google+ profile or connect with him on LinkedIn.

Topics: Dental, General Business