Periodontal Care – Importance of Comprehensive Insurance Verification

by | Published on Mar 9, 2016 | Insurance Verification and Authorizations

Periodontal Care
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The changes taking place in the health industry have also affected dental care. Dental practices need to be alert to verifying dental insurance verification, benefits and predeterminations before patients come in for treatment. Periodontal care can range from routine treatment to treating advanced gum disease and may be covered by dental benefits plans. Proper benefits verification is crucial to avoid claim denial and ensure appropriate reimbursement.

Coverage for Surgical and non-surgical Periodontal Treatment

Periodontal (gum) disease is a bacterial infection of the gums. In the early stages, the gum infection is called gingivitis, and when it gets worse it is called periodontitis. Care can range from routine treatment to treating advanced gum disease and may be covered by dental benefits plans. Insurance may provide

  • Full or partial coverage for non-surgical and surgical periodontal treatment
  • Cost of extra cleanings to prevent gingivitis from progressing to periodontitis
  • Periodontal maintenance coverage for patients who have previously been treated for periodontal disease

In some cases, the patient may have to cover the costs of care. All this underlines the importance of proper verification of the patient’s insurance coverage and eligibility before providing care.

Importance of Proper Dental Insurance Verification

Dental benefit plans are different from medical insurance plans. Medical benefits policies cover majority of the costs incurred during the year after the deductible is met, though they require patients to share some of the costs through annual deductibles and copayments. In recent times, cost shifting to the patient has increased

Dental care not an insurable risk and the total maximum benefit is small. This makes claim submission and payment complex. Some aspects have changed recently with cost-shifting to the patient, which makes proper benefit verification before providing care all the more important:

  • Dental benefit plans now include cost saving measures like exclusions, waiting periods and deductibles
  • Employers are choosing plans with lower coverage percentages and higher deductibles
  • In many plans, periodontal surgical services are subjected to a separate periodontal maximum

Collecting the correct information before the patient comes in for treatment will save time and help prevent denials. Most patients are unaware of the extent of their dental insurance coverage and verifying it and informing them about it is essential.

Insurance Verification Specialists for Clean Claim Submission

Partnering with a reliable, HIPAA-compliant medical billing company is the best way to ensure clean claim submission with professional insurance verification and authorization services. Such companies have specialists to handle the entire process. With an in-depth knowledge regarding coverage guidelines of various providers and healthcare terminology, dental benefit verification specialists would verify details such as   type of plan and coverage details, co-pay, co-insurance, deductibles, referrals and pre-authorizations, patient policy status, effective date, plan exclusions, out of network benefits, claims mailing address, and more. The comprehensive benefits verification cycle would involve the following steps:

  • Receiving patient schedules from the hospital or practice via ftp, fax or email
  • Patient enrollment by entering or updating demographic information and prior authorizations for the office visits
  • Verifying patients’ dental insurance coverage on all primary and secondary payers
  • Obtaining authorization for dental treatment from appropriate sources
  • Contacting patients for additional information if necessary to process the application
  • Updating the billing system with the eligibility and verification details

Experienced service providers would be able to work on any type of billing software – their own or that of the dental practice. Choosing the right company for dental insurance eligibility verification would reduce claim denials and payment delays while improving patient care and workflow.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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