Dental patients are often confused by their dental insurance benefits. Since dental insurance often comes with a long list of limitations and exceptions, dental patients may be caught off guard by the low amount their insurance will cover at the dental office. Many dental insurance plans still maintain a maximum annual benefit of $1,000, a number that hasn’t risen in decades. When you throw in the confusion over UCR and treatment downgrades used by dental insurance companies, the frustration patients face can become overwhelming. It is ultimately the patients’ responsibility to be familiar with their individual plans, but it is important for dental front offices to take the time to research and educate patients on their benefits. This knowledge allows the treatment co-pay estimate to be as exact as possible and avoids ill feelings from patients who are surprised by a bill that arrives after dental insurance fails to pay what they expected.


After following the steps to create an accurate treatment plan estimate, an educated treatment plan coordinator can present patients with the information they need to understand what portion of the treatment will be paid by insurance and what portion will be the patient’s responsibility. We have designed a Dental Insurance Explanation Brochure which can be found on our Dental Practice Management Tools CD. This brochure provides our patients with information on UCR, amalgam downgrades, maximums, exclusions, deductibles and other information they may need to know regarding typical dental insurance benefits.


To make the treatment plan estimate process easier, Dentistry’s Business Secrets created an Insurance Benefit Verification Checklist. This checklist provides all of the questions that should be asked of the dental insurance company when initially verifying a patient’s dental insurance benefits. Taking the time to ask all of these questions in the first call avoids the hassle of having to call an insurance company back for information that is vital and needed immediately when creating a treatment plan estimate. We also created a Checklist for Creating Accurate Treatment Plan Estimates which is used in conjunction with the Insurance Benefit Verification Checklist to calculate the most accurate co-pay estimate possible. Both of these forms can be found on the Dental Practice Management Tools CD. The information we used to create the Insurance Benefit Verification Checklist can be found on page 241 of Dentistry’s Business Secrets: Proven Growth Strategies for Your New or Existing Practice.