Alright, fellow dental warriors, let’s talk about one of the trickiest, hair-pulling-est conversations you’ll ever have in your dental practice: how to explain out-of-network dental benefits to patients to patients. It’s like trying to explain why the tooth fairy pays some kids in quarters and others in crisp $5 bills—confusing, frustrating, and just plain messy.
But don’t worry, I’m here to help you break down this complicated mess in a way that’s simple, effective, and maybe even a little bit fun. Because let’s face it: Nobody loves dental insurance (not even the people who sell it, probably), but if we approach this conversation with a little humor and a lot of clarity, everyone walks away happy—or at least not totallyconfused.
And hey, if your patients are tired of insurance nonsense, we’ve got a shiny solution: patient membership plans! More on that later. First, let’s dive into our 7 pro tips for explaining out-of-network benefits.
1. Start with a Relatable Metaphor
how to explain out-of-network dental benefits to patients – Insurance lingo can sound like a foreign language to most people, so it helps to use a metaphor. Try this:
“Dental insurance is a bit like having a gift card for a fancy restaurant. Sure, the gift card covers part of your meal, but it’s got all these weird restrictions. And if you’re out-of-network, well… it’s like showing up to a burger joint with a gift card for sushi.”
This little analogy does wonders in helping patients understand that their insurance will help but won’t necessarily cover everything—and definitely not without a headache.
2. Explain the Difference Between In-Network and Out-of-Network Simply
Keep it simple. Here’s how how to explain out-of-network dental benefits to patients:
“In-network dentists have agreements with insurance companies to charge pre-negotiated rates, like a special club with rules and discounts. Out-of-network dentists—like us—aren’t part of that club. We charge fair rates for the best care we can offer, but your insurance might cover less because they prefer we play by their rules.”
Make sure your tone is friendly, and avoid sounding too bitter about insurance companies (even if you want to rage against the system internally).
3. Give a Heads-Up About Reimbursement Delays
Patients hate surprises, especially when they come in the form of an unexpected bill. Be upfront:
“When you see an out-of-network dentist, your insurance company may take longer to process the claim, which can delay any reimbursement you’re expecting. It’s not us—it’s them. We do everything we can to make it smooth, but sometimes insurance companies like to take the scenic route.”
Let them know you’ll help in any way you can, like filing claims on their behalf or following up with their insurance.
4. Talk About Insurance Limitations (Without Sounding Too Negative)
How to explain out-of-network dental benefits to patients – We all know dental insurance is not like health insurance. Most plans cover basic care but fall short when it comes to major treatments. Here’s a pro tip on how to explain this:
“Dental insurance is designed to cover basic preventive care and maybe a couple of minor procedures each year. Think of it as a safety net, not a comprehensive wellness plan. And unfortunately, most dental plans haven’t kept up with the rising costs of high-quality care.”
This frames the limitations in a way that’s easy to digest—and might just get patients on your side.
5. Emphasize the Value of High-Quality Care
Out-of-network doesn’t mean “not worth it.” Remind your patients why they chose you:
“At our practice, we focus on giving you the best care possible, without cutting corners to meet insurance company demands. We use top-notch materials, the latest technology, and spend the time needed to make sure you’re happy with your results. Insurance doesn’t always care about quality, but we do.”
Boom! You’ve just made your practice sound like the luxury experience it is.
6. Introduce a Patient Membership Plan as an Alternative
Here’s where we save the day! After you’ve explained the less-than-thrilling news about out-of-network benefits, offer a better option: a patient membership plan.
“Insurance is confusing and often not very helpful, especially if you need more than just a cleaning. That’s why we created our membership plan. For a low monthly or annual fee, you get your preventive care covered and big discounts on everything else. It’s affordable, transparent, and way less stressful.”
Membership Plan Perks:
- No Deductibles or Waiting Periods: Get care when you need it.
- Transparent Pricing: Know exactly what you’re paying for.
- Significant Discounts: Save on everything from fillings to crowns.
Learn More About BoomCloud™: BoomCloud™ – Membership Plan Software
7. End with a Clear Call to Action
Make it easy for your patients to take the next step. Here’s what you can say:
“If you’re tired of dealing with insurance headaches, ask us about our membership plan. We’d love to show you how it can save you money and give you peace of mind.”
Make sure your front desk team is trained to answer questions about the membership plan and has handouts or a simple brochure ready to go.
Why a Membership Plan is a Game-Changer
Still on the fence about offering a patient membership plan? Here’s why it’s a must:
- Increased Patient Loyalty: Membership patients are more committed to their oral health and more likely to stick around long-term.
- Higher Patient Spend: Members tend to accept treatment more frequently and invest in high-value procedures, boosting your revenue.
- Monthly Recurring Revenue (MRR): Say hello to predictable income! Membership fees create financial stability for your practice.
- Annual Recurring Revenue (ARR): Long-term revenue growth means you can plan for the future without worrying about insurance cuts.
Case Study: Bright Smiles Dental implemented a patient membership plan through BoomCloud™ and saw incredible results:
- New Members: 350 patients paying $35/month
- MRR: $12,250
- ARR: $147,000
- Increase in Patient Spend: Membership patients spent 2X more on additional treatments compared to non-members.
BoomCloud™ made it easy to manage everything, from automated billing to tracking who referred whom, and even rewarding staff for their efforts.
Final Thoughts: Be Honest, Be Clear, Be Compassionate
Explaining out-of-network dental benefits doesn’t have to be a nightmare. Be honest, use relatable metaphors, and always emphasize the value of high-quality care. And when patients are fed up with insurance, offer them the sweet relief of a patient membership plan.
Ready to transform your practice? Sign up for BoomCloud™ today and make explaining benefits—and growing your revenue—so much easier.
Get Started with BoomCloud™ Here: BoomCloud™ – Membership Plan Software
Now go out there, have those tough conversations, and turn confusion into commitment. You got this!
