According to a study in Health Affairs, patients reported that they did not get the dental care they needed because of cost, fear, inconvenient locations or appointment times, and trouble finding a dentist who accepts their insurance. One of the main challenges facing dental offices is dental insurance verification. Some of the issues that a dental practice’s front office has to deal with when it comes to insurance benefits verification are:
- Length of time involved in making calls to the insurance company for benefits verifications for both new and existing patients
- Frequent insurance plan changes by employers, leading to increased number of phone calls that need to be made to obtain new coverage details
- Risks of insurance misinformation by insurance reps
- Time involved in updating the insurance information and fee schedules to set up the new plan in the system
Verifying coverage and benefits is not only important for the practice but for patients as well. These patients rely on their insurance to help pay for their treatment. Here are some tips to help practices streamline their insurance eligibility verification process.
- Set up an insurance file for each patient: Each patient should have an insurance file with all the relevant details entered into it. All insurance information should be obtained during the initial phone call or before the point of service. Returning patients should be asked if their insurance has changed, and if it has, new coverage and benefits should be verified. The most frequently used procedure codes and other necessary details should be entered in the office’s insurance verification form. The best option would be to include all of the patients with the same insurance plan. Verifying dental eligibility in advance of treatment saves time and allows the practitioner to provide them with a cost estimate at the visit.
- Call the insurance company: Providers should call the insurance company to obtain accurate and up-to-date information on patient benefits.
- Document all coverage details: All major insurance eligibility aspects should be verified and documented such as: patient’s name, policy holder’s name and Social Security number, policy number and/or group number, employer’s name and phone number, and insurance company name, address, and phone number. Coverage aspects to verify include: coverage percentage by category, tooth cleanings, crowns, build-ups, tooth grafting coverage, tooth implant coverage, and x-ray frequencies.
- Communicate to patients in advance about what’s covered:
Patients do not understand their coverage and benefits of all coverage and out of pocket costs. It is therefore necessary to tell them about what’s covered and what’s not. According to a PolicyGenius survey conducted in 2016, only 4 percent of Americans who have private insurance believe that they understand their insurance coverage, and only 14 percent of them actually understood all four of the basic insurance payment concepts – deductible, co-pay, coinsurance and out-of-pocket maximum. Patients need to be educated on these aspects, informed about the details of the dental service provided during their visit, what the insurance will cover, and what the patient’s responsibility will be. This will help avoid the problem of surprise bills. - Inform patients about claim processing guidelines: Inform patients about how their claims will be processed before their first appointment. An efficient way to do this would be to provide the details on an information sheet at the consult, get it signed by them, and retain the sheet in the patient record.
Managing insurance benefits and patient expectations is not easy. Practices have to deal with a large number of insurance plans that are constantly changing and dental eligibility. Following the above-mentioned steps can help practitioners effectively manage the insurance process, improve cash flow, and grow patient satisfaction. Outsourcing the patient eligibility verification task to a reliable company is a feasible option to achieve these goals. Experienced companies have efficient systems in place to help dental practitioners submit error-free claims, prevent denials, and ensure smooth cash flow.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.