The world of health insurance is complex and navigating the information and changes is a major challenge for most people. When it comes to dental insurance, the landscape is forever evolving. Insurers offering standalone dental plans are moving to partner with health insurers and bundle coverage. Individuals may pay for their insurance themselves or receive group coverage as a student or employee. It is important that patients understand the nuances of their insurance coverage and how it works. By taking the time to educate your patients, you can eliminate any confusion they may have about their coverage, which will help them get the care they need and avoid surprise bills.

Features of Dental Insurance Coverage

  • Dental insurance covers the costs of dental treatment for issues related to the teeth and gums, accident to teeth, tooth extraction and preventative care such as annual cleanings.
  • There are many different plan types and contracts
  • Most plans provide full coverage for preventive care, cover basic procedures at 80%, and major procedures at 50%.
  • Each plan specifies what procedures are covered. Cosmetic procedures, such as veneers or whitening, are usually not covered. On the other hand, some dental plans do not cover sealants or even certain procedures that are dentally necessary.
  • Dental insurance varies by insurance company and may change annually
  • Costs and coverage vary by geographic region
  • Deductibles, co-pays, and coinsurance may apply

Patients with dental insurance are more likely to accept prescribed dental treatment, seek regular dental visits, and get preventative services. When a patient schedules an appointment, the dental practice needs to review their coverage with them so that they know what services their insurance will cover and what their financial obligations are.

Why educate patients about their insurance coverage

According to one study, only 14 percent of American adults with health coverage understand deductibles and other key concepts of insurance plans.

  • Growth of High-Deductible Insurance Plans and Rising Co-Pays: HDHPs are health insurance plans with lower premiums and high deductibles. HDHPs generally have low monthly payments and only cover preventive care, an accident or emergency. HDHPs could result in very high out of pocket costs. When patients find that they lack coverage, they may turn down a treatment even if it is necessary. The dental office needs to explain to patients that the non-covered procedure is an essential one and that not having coverage should not be a reason to refuse the treatment.
  • Convey Patient Financial Responsibility: With changes in insurance plan reimbursement models, patients now have a financial responsibility in their health care costs. It is important that patients understand their financial responsibility before services are provided. A co-pay means the patient has to pay a certain amount of money up-front when they register for an appointment. Co-insurance is the percentage of their total bill for the covered service that the patient has to pay after the deductible is met. A deductible is the set amount the patient pays out-of-pocket for the services and prescriptions before their coinsurance kicks in. Providers will collect co-pay and co-insurance balances from patients at the time of registration. When patients are educated about these key concepts of their coverage, they will understand why they have to pay a portion of their bill at the time of service.
  • Avoid Patient ire about High Bill Amounts: Patients should have clear information about whether providers they receive care from are in or out of their network and what costs they may face. Dental offices should clearly explain insurance plan details to their patients as well as the practice’s payment policy. They should communicate up-front with patients to educate them about how their insurance works and what they are likely to owe before services are rendered
  • Help Patients make Informed Decisions: Practices must provide patients with dental treatment estimates and thoroughly explain them. Provide full transparency about their costs of care will help patients make informed decisions.

Having an expert to handle verifying your patient’s insurance before their date of service can also be a tremendous help. This allows you to get a heads up on what is covered and gives you the opportunity to provide patients with a clear idea about their coverage and their financial obligations. With the right information, patients will feel comfortable, valued and happy, and can confidently go ahead with the treatment they need. Taking time to educate patients on their coverage will also have a positive impact on dental office revenue.