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Insurance Estimate Strategies That Convert to Confident Patient Care

Struggling to find a balance between reasonable treatment estimates and patient acceptance? Don’t worry, understanding the nuances that build patient confidence can lead to better outcomes for everyone. Let’s break down the strategies necessary to provide clear and confident treatment estimates that set your patient up for success, while protecting your practice.



Simplify Complex Insurance Jargon

Insurance terminology can often feel like its own language, and as dental professionals we can be much more familiar with that language than our patients. That’s why it’s so important to empower our patients to make informed decisions about their treatment with the use of more common terminology.

For example, some patients may not be familiar with an In-network Write-off, but if we’re able to explain it as an Insurance Discount offered to the patient as a result of seeing an in-network provider – this can go a long way in bridging the communication gap. One of the best ways you and your team can develop patient-friendly language is to have conversations with your friends and family about insurance coverage. Learn where they struggle and create common terminology that speaks to both parties.

Clear and concise language when explaining insurance details is key to establishing a strong patient-provider relationship. As a patient, when you understand the verbiage used, you can trust that your dental team has your best interests at heart and is dedicated to your oral health journey.



Conservatively estimate when possible

It’s to the benefit of your practice and your patient to present conservative estimates and manage expectations throughout the treatment estimate process. Insurance often reimburses in an unexpected way which makes creating accurate treatment estimates a challenge – especially for an Endodontist that is sharing benefits with a General Dentist who has pending/unpaid claims to date.

Patients often do not understand the complexity of shared benefits and how their insurance coverage plays out in a year, especially if they are seeing multiple providers in a benefit period. As the specialist office, it’s up to you to explain that all providers share the same benefits that subtract from the same annual maximum. This results in the patient likely running out of benefits some time during the year. While this is not the case for ALL, it is the case for MOST patients.

Additionally, specialized care often increases the frequency of uncovered services which can impact the patient’s out of pocket. It’s important to head off these uncovered services in the beginning. Informing the patient that these services are more likely to not be covered and will therefore be an upfront cost will more accurately prepare them for their financial responsibility. Best case scenario, the insurance reimburses for the procedures and you are able to credit the patient back. Credits are always better than balances – for both you and the patient.



Forecast the entire treatment journey

Endodontic treatment often requires subsequent restorative care to set the patient up for long-term success. Restorative care often looks like a dental crown which can be a costly treatment, especially if the patient has already utilized their full benefits for the year. As a result the patient’s financial challenges do not end in your practice.

While it’s not your responsibility to provide a calculated estimate for the crown treatment, it is wise to prepare the patient for it when reviewing costs. The patient should be reminded that the estimation presented by your team is just an estimate of services in your practice and that the patient will need to prepare for costs at the general dentist once they return for final restorative treatment. This gives the patient the opportunity to contact their general dentists to get an idea of those costs.

Unprepared or uneducated patients can often find themselves in financial limbo – juggling between proper post-operative care vs avoiding getting a crown until they can afford it. Ultimately, this results in suboptimal post-op care. Giving the patient the opportunity to weigh these options before the start of Endodontic care will ensure they are set up for long-term success.



Estimation Transparency: Building Patient Confidence

Insurance estimation is not an exact science – every insurance plays by it’s own set of rules dictated by your contract, and it’s impossible to head off every financial scenario for each patient in a busy practice. This is especially the case for last-minute emergency appointments. That’s why it’s so important for patients to understand the limitations that challenge these estimates.

Inform your patient when information provided from the insurance company is limited and that there could be changes once the claim is processed for payment. Fall back on pay in full or conservative estimate policies when you are unsure about the patient’s costs or you lack the proper information. Assure the patient that due to lack of time or information, this is the closest you can get to their out of pocket costs. At the very least you could rely on in-network fees to help you get closer. Be sure to let them know that you will claim and process any reimbursements that come in on the patient’s behalf, promptly informing them of any balances or credits that remain.

Ultimately, you will want to emphasize the word estimate as many times as possible. Insurance companies never make a guarantee of payment and neither should you. So rather than over promise on behalf of the insurance, it’s better to simply ensure the patient knows that the estimated cost could always change.




Transparency is the cornerstone of patient confidence in the estimation process. When all aspects of insurance verbiage are laid out clearly and honestly, it fosters a sense of trust between your patient and your practice.

Open communication about estimates, coverage, and potential out-of-pocket expenses empowers your patients to make informed decisions about their treatment. This level of transparency ensures that there are no hidden surprises along your patient’s dental care journey, even if the insurance pays in an unexpected way.

Always welcome questions and provide clear and honest answers to establish trust. This open dialogue not only clarifies any uncertainties but also strengthens the bond between your patient and your practice, resulting in a smoother and more collaborative treatment experience.

Interested in implementing DentalEMR in your Endodontic practice?
Our Practice Success Team can help you strategize the possibilities in DentalEMR.

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