Majority of the patients these days rely on their dental insurance to help offset the cost of treatment. Therefore, practices who accept or are in-network with dental insurances need to be equipped with the right tools and knowledge when navigating the world of dental insurance plans.
Which is why it’s imperative that your office implements a system when it comes to verifying and obtaining insurance benefits for all existing and new patients. It is highly advantageous to have your employees familiarized with the verification process and know which vital information is necessary to keep on file. They should know and understand common limitations and non-covered services so that they are able to effectively communicate the information to the patient. This way you’ll be able to accurately predict copayments, saving you time, money, and frustration in the future.
Here are the do’s and don’ts of dental insurances to help you get ahead of the game:
1) When speaking to patients regarding insurance reimbursement, DON’T say that insurance “will pay” or “will cover”. Such statements imply that payment is guaranteed and communicate a false expectation. Thus, using the right verbiage will not only save you from a scorned patient, it’ll protect you from … DO use statements such as “your copayment is only an estimate” and insurance “payment is NOT a guarantee”.
2) DON’T volunteer information to patients about the details of their plan benefits (unless they ask for it)! The plan is a contract between the primary subscriber and the insurance, which means they can always ask the group administrator their HR department who should know the exact details about the coverage of the plan. In the case the patient does inquire more info, DO inform them of their plan benefits such as maximums and deductibles. Always refer them back (nicely) to their dental plan or HR department if your patient wants to know more than you are capable of answering.
3) DON’T settle for an online eligibility report when establishing NEW PATIENTS into your office. Always call for a breakdown of benefits. Despite being time consuming, it will save you time in the long run (especially when you have other patients with the same group plan). DO use an “insurance verification form” to record the details of the insured’s plan benefits. This will allow you to keep information in one place! After filling it out, scan it into the patient’s file for future access!
4) DON’T assume that fillings are covered at the composite rate! Most plans will downgrade posterior resin composites to an alternate benefit of an amalgam filling which reduces the amount of the reimbursement. The same applies to that of crowns, which many dental plans downgrade as well! DO read the fine print in the benefit breakdown obtained online or if you do end up calling, always ask if fillings/crowns are downgraded and what code they use to determine reimbursement.
5) DON’T assume that a patient is eligible when they come in for their 6 month checkup and cleaning! Some plans run on a fiscal year and many patients end up getting new dental coverage mid year. Others come in with inactive plans, surprised their company changed their dental insurance without them even knowing. DO verify eligibility every 6 months and ALWAYS confirm that benefits (including maximums, deductible, and coinsurance amounts) match what you have on file. Often times, the details of the plan change which if left unchecked, can cause complications (such as collecting the wrong copayment for a procedure or worse, a procedure no longer being covered by the insurance).