Dental Insurance Verification: Check On the Alternate Benefit Clause

Hi, this is Amber Darst, Solutions Manager for Managed Outsourced Solutions, and for this podcast, I’ll be discussing the importance of verifying dental coverage and checking on the alternate benefit clause with each carrier and policy.

An alternate benefit provision in a dental plan contract allows the third party payer or the insurance carrier to determine the benefit based on an alternative procedure that is generally less expensive than the one provided or proposed by the servicing provider. An example of this would be a patient has an implant placed to replace a missing tooth, but their policy has an alternate benefit clause stating they will only pay the amount of what they would pay toward a partial, since that procedure would be the cheaper option that the patient could have chosen to replace that missing tooth.

00:58 Importance of Insurance Verification

Completing both an insurance verification along with submitting a pre determination for costly procedures will give you a better understanding of what to expect for coverage and potential payment from the carrier.

01:12 Choose a Reliable Dental Billing and Insurance Verification Company      

Working with an experienced dental billing and insurance verification company what ensure these tasks are completed in a timely manner for each of your patients before their date of service. This will give you a good idea of what to expect for payment from the insurance carrier and also gives you the opportunity to discuss the patient’s financial obligation with them, so that they can secure their finances for the procedure and avoid any future unexpected bills.

And that’s all on this. Thanks for listening in.