Most dental patients don't fully understand their insurance benefits—and leave money on the table every year. Here's how to educate patients and help them maximize their coverage while increasing your case acceptance.
How Maximums Work
Key concepts to explain to patients:
Annual Maximum
- Total amount insurance will pay per year (typically $1,000-2,000)
- Resets January 1 for most plans (some reset on anniversary date)
- Unused benefits do NOT roll over
Coverage Tiers
| Service Type | Typical Coverage | Examples |
|---|---|---|
| Preventive | 100% | Cleanings, exams, X-rays |
| Basic | 80% | Fillings, extractions |
| Major | 50% | Crowns, bridges, dentures |
Deductibles
- Amount patient pays before insurance kicks in (usually $50-100)
- Often waived for preventive services
- Resets annually with maximum
$1,500
Average annual maximum that patients forfeit if unused
Benefits reset each year—use it or lose it
Timing Strategies
Split Treatment Across Years
For patients needing multiple crowns or extensive treatment:
- Do some treatment in November/December
- Complete remaining treatment in January
- Use two years' worth of benefits
Example: Patient needs 4 crowns at $1,200 each. Instead of $4,800 in one year (using $1,500 max = $3,300 out of pocket), split into 2 years ($3,000 covered = $1,800 out of pocket).
Use Preventive First
Preventive services often don't count toward the maximum. Encourage:
- Two cleanings per year (usually covered at 100%)
- Annual exams
- Bitewing X-rays annually, full mouth every 3-5 years
Start Early in the Year
For patients with known treatment needs:
- Start January to maximize time to complete treatment
- Avoid December crunch when everyone remembers their benefits
- More flexibility if complications arise
Communicating with Patients
At Treatment Presentation
Frame insurance as a discount, not a limit:
Script: "Your insurance will cover about $1,200 of this treatment, bringing your out-of-pocket to $800. The good news is we can spread this over two appointments, and I can show you some financing options that make this very manageable."
Benefits Reminder Calls
Proactive outreach in Q4:
- "I'm calling because you have $800 in unused dental benefits that expire December 31st."
- "Dr. Smith noted some treatment you might want to complete before year-end."
- "Would you like to schedule before the holiday rush?"
Visual Aids
- Create a simple one-pager explaining how benefits work
- Show remaining benefits on patient statements
- Use charts showing cost with vs. without insurance
End-of-Year Benefits Campaign
October: Awareness
- Email blast about expiring benefits
- Social media posts about "use it or lose it"
- Train team on benefits conversations
November: Urgency
- Phone calls to patients with unused benefits
- Text reminders about remaining coverage
- Add evening/Saturday hours if possible
December: Last Chance
- Final push for remaining patients
- Focus on quick-turnaround procedures
- Confirm all year-end appointments
Dentplicity Insight: Our platform helps you communicate with patients about their benefits through automated reminders and educational content. Start free.
The Bottom Line
Helping patients understand and use their benefits is good for everyone. They get needed treatment at lower cost, and you increase case acceptance and production. Make benefits education a year-round effort, not just a December scramble.
