As the leaves turn their beautiful shades of yellow, orange and red it not only signals the changing weather. For those of us in dentistry, and any ‘pay for service’ health care profession, it also signals the start of the busy season. The time of year when well intended patients realize time has gone quickly and they want to ‘use it before they lose it.’ Of course, what they are afraid of losing is any leftover dental benefits on their employer sponsored plans.
Traditionally this would signal busy schedules with limited openings from October to December. Then we’re faced with the challenge of encouraging people to maintain their dental health in January, despite the mounting pressure of holiday bills. Dentistry is very predictable in this way!
That predictable pattern is beginning to change. The fall season may still be busy, but in many practices it no longer produces the rush it once did. One important reason is that dental benefit maximums have rarely kept pace with the cost of care. When a patient announces at the front desk that their maximum has increased to $2,500, the news can feel significant enough to warrant congratulatory high-fives.
Is there anything we can do about it? Unfortunately, there are circumstances at play that are out of our control as dental professionals. The ADA fee guide does have marginal increases annually, but we don’t see that as the problem. Are people’s needs increasing? I would say no. I see the reports of many practices and production typically increases by a slight margin year over year.
So, what is happening?? The simple truth is that the dental benefit maximum just doesn’t go as far as it used to. I began my career in dentistry 35 years ago and I know that most people had a $1000 maximum. I haven’t done the math, but I do know that $1000 in 1991 compared to $1500 or $2000 in 2026 is a frightening percentage.
So what can we do? Let’s explore a couple of ideas…
- Provide absolute clarity about the diagnosis, treatment recommendations, fees, risks, consent and scheduling. Patients have no shortage of demands on their money, so they are unlikely to invest in care they do not understand or whose benefit they cannot see. Explain the recommendation in plain language, connect it to the patient’s goals and confirm the next step before the conversation ends. If there were ever a time to be clear with patients, it is now.
- Have an honest conversation about the role of dental benefits. I recently talked to my mom about this. I supported her to put the $250 she was planning to pay for a private plan in a separate bank account labelled ‘Dental Health.’ Why did I suggest this? Her $250 per month was going to get her a $500 worth of dentistry in a 12-month period. The math doesn’t math. Now I understand this is one plan and we could have done some research to find a plan that made more sense, but you get my point. This conversation is especially important for the seniors who don’t qualify for a provincial or federal program.
- Part two of the conversation is to get real about how far $1500 gets you. I have open conversations with my patients that go something like this: “You are fortunate to have dental benefits and we want to support you in using the benefit to it’s fullest. Our suggestion is to submit your dental hygiene appointments, any emergency visits and basic fillings to your plan until it reaches it’s maximum. That is what the benefits are essentially for. To help maintain your health. You may need a crown one day, or an emergency visit turns into something a little more extensive. For these procedures it’s best to be prepared to pay out of pocket. We can help with private payment plans, or a monthly plan with our office to ease the financial burden.”
When patients understand that dental insurance is not ‘replacement value’ like car insurance, they are well equipped to be in charge of how their benefits are used to serve them.
If this article resonates with you but you are unsure how to change the conversation in your practice, we are here to help. Reach out to explore how your team can explain benefits more clearly, help patients plan confidently and keep the focus on the long-term value of oral health.
The dental consultants at Tayden Consulting Inc. specialize in on-site coaching that helps practices create an optimal patient experience and build efficient, sustainable systems for their teams.
Contact us today for a complimentary consultation.
We look forward to learning about your practice and discussing how we can help.