Dental Insurance Verification – A Key Strategy to Reduce Denials due to Eligibility Errors

Dental Insurance VerificationWhen handled efficiently, dental insurance verification benefits both the patient and the practice. Verifying the patient’s insurance during scheduling, reminder or check-in is the starting point in accounts receivable (AR) management. It is a key strategy to reduce or eliminate denials that occur because the patient was not eligible for the service or some other similar reason.

Having an insurance verification specialist check patients’ eligibility for a dental treatment is crucial for the provider’s and patient’s peace of mind. Insurance eligibility verification begins when the patient calls to schedule the appointment. Once it is confirmed that they do have insurance, they will be asked for their insurance information so that their insurance plan and benefits can be verified prior to the appointment.

After the dental insurance verification company gets the information from the patient, they will call the insurance company to verify coverage. The following details will be verified:

  • Subscriber name and social security number
  • Insurance company name, address, and phone number
  • Effective date
  • Maximum benefits
  • Calendar year/benefit year
  • Deductible amount and whether deductible has been met
  • Any waiting periods
  • Missing tooth exclusions
  • Maximums and deductibles
  • Type of plan and fee schedules
  • Coverage percentage by category
  • Tooth cleanings, crowns, build-ups
  • Bone graft coverage
  • Tooth implant coverage
  • Coverage for night guards, occlusal adjustments, and frenectomies
  • Posts for the teeth
  • Frequencies of coverage
  • Necessary documentation

If patient insurance eligibility is not checked before the point of service, it would create a massive amount of work for the practice to try and resolve unpaid claims. Insurance eligibility checks avoid denials due to expiry of insurance coverage. It helps providers bill to the right plan when the patient is covered under multiple health plans or when the patient changes his/her health plan. Insurance eligibility verification avoids losses, delays and rework and also saves valuable time by avoiding unnecessary billing work for claims likely to get denied due insurance coverage issues.

Most patients have no idea about what their dental insurance company will pay for, and that there are percentages, fee schedules and exclusions involved. Comprehensive insurance eligibility verification reduces uncertainty, increases transparency, and improves patient satisfaction. Patients are informed of their financial responsibilities and out-of-pocket costs, which will allow them to better manage their healthcare care costs. Once their coverage is known, the dental office can work with them to maximize their benefits so that they obtain the dental treatment that they need.

Preventing claims denials due to eligibility errors can optimize revenue capture. Dental insurance verification by a reliable service provider will ensure that the benefits from the upfront work will be much greater than the cost of the service.