Reclaim your practice’s independence by leveraging medical insurance for broader care—and encouraging patients to take ownership of their dental insurance.

By Laurie Owens, CPB, CPC, COC

Laurie-Owens-PPO-Profits-1TRADITIONAL DENTAL INSURANCE has long been a double-edged sword. While it provides patients with access to preventive care, its limitations—such as low annual maxi­mums, narrow coverage options and frequent denials—often leave patients and providers frustrated. Additionally, insurance-dictated reimbursement rates can restrict profitability and the ability to invest in advanced technology or expanded services. This dynamic often leads to a focus on volume over quality, patient dissatisfaction due to unexpected out-of-pocket expenses and administrative headaches from processing claims and managing denials.

Empowering patients with dental insurance ownership shifts the balance of power. Educating them is key. When patients purchase their plans directly from insurance carriers, they have greater control over their benefits. This approach has several advantages for your practice. Patients gain the freedom to choose out-of-network providers, enabling you to offer care without restrictive contract terms. Transparency is improved, so patients better understand their coverage and are more likely to participate in treatment planning. Finally, it streamlines your operations by reducing reliance on direct insurance contracts, cuts administrative tasks and allows your team to focus on patient care.

You can also bill medical insurance for procedures not covered by traditional dental plans. This is one of the most significant untapped opportunities in dentistry. Many dental conditions have systemic health implications, making them eligible for medical insurance reimbursement. Some examples:

  • Sleep apnea treatment: Oral appliances can be billed to medical insurance.
  • TMJ disorders: Diagnosis and treatment often qualify for medical coverage.
  • CBCT imaging: These are diagnostic, and most medical plans will cover them based on necessity.
  • Surgical procedures: Biopsies, bone grafts, membranes, surgical guides, night guards and treatment for oral infections can sometimes be classified as medical necessities.
  • Dental trauma: Injuries to teeth and surrounding tissues frequently fall under medical coverage.

Transitioning to this model requires careful planning and patient education. Here are some steps to follow.

  1. Train your team. Ensure that they understand how to verify benefits, file claims and educate patients about using their medical insurance. If this exceeds your comfort level, you can
    take a two-day course like the ones I offer to build confidence.
  2. Collaborate with patients. Clearly communicate how medical insurance can supplement dental care, and the potential cost savings.
  3. Highlight comprehensive care. Market your practice as prioritizing whole-body health by integrating dental and medical care.

Empowering patients with dental insurance ownership shifts the balance of power. Educating them is key.

It’s time to step out of the shadow of insurance companies and take back control of your dental practice. This dual strategy not only strengthens your financial foundation but also positions your practice as a leader in comprehensive, patient-centered care. I know this strategy works because I’ve been helping practices execute it for years. It can work for you too.

LAURIE OWENS, CPC, CPB, COC is the director of medical billing for PPO Profits, one of the market’s leading providers of dental fee negotiations. She has more than 20 years of experience educating dental practices on billing medical insurance and increasing practice revenue. PPO Profits is part of Benco Dental, the publisher of this magazine. Contact Owens at laurieo@ppoprofits.com.