Key Terminology in Dental Insurance Verification

00:01 Introduction – Dental insurance Verification  

Hi, this is Amber Darst, Solutions Manager for MOS and today I’ll be touching on a crucial topic that forms the foundation of the dental billing process – dental insurance verification. Whether you’re a dentist or part of the back office staff, understanding the ins and outs of dental insurance verification is paramount to a smooth dental billing process as well as patient care.

00:26 Importance of Dental Insurance Verification –

Dental insurance verification is like the first brick in the intricate structure of dental billing. It’s the process that determines whether a patient’s dental treatment is covered by their insurance or not. But why is this so important, you might ask? Well, verification errors can lead to claim delays or even denials, which can be frustrating for both the patients and the dental practice. To help you navigate this crucial aspect of dental billing, let’s explore some key dental insurance terms and their definitions.

01:00 Annual Maximum 

First, we have annual maximum. This is the maximum amount of money that a dental insurance company will pay for dental services and treatments within a single benefit plan year. Once this amount is reached, the patient becomes responsible for any additional expenses.

01:19 Assignment of Benefits 

Next, we have Assignment of Benefits or AOB. An AOB is an agreement where patients transfer their insurance claim rights to a third party, usually the dental office. This allows the dental office to bill the insurance carrier directly, eliminating the need for patients to pay upfront.

01:41 Appeal

Now we have appeal. When a claim or procedure is denied by the insurance provider, a dental office can request an appeal asking the provider to reconsider their decision.

01:53 Coinsurance 

Then we have coinsurance. This refers to the percentage of the dental treatment cost that the patient is responsible for paying, calculated after any deductibles are met.

02:06 Co-payment or co-pay

Then we have copayment or copay. This is a fixed dollar amount that patients pay at the time of their dental visit for their covered services.

02:17 Coordination of Benefits or COB 

Coordination of Benefits or COB comes into play when a patient has coverage from multiple dental plans, allowing them to use both plans to cover their treatment cost.

02:29 EOB or Explanation of Benefits

Then we have EOB or Explanation of Benefits – a statement provided by the insurance company detailing the treatments received, insurance payments, the dentist fees and the patient’s potential out of pocket cost.

02:45 Out of pocket cost

That brings us to out of pocket cost. This is the expense for dental care that’s not covered by the insurance, including deductibles, coinsurance, co-payments and uncovered services.

02:58 Waiting period

And then last, we have waiting period. This is the duration during which patients may have to wait before being eligible to claim specific dental treatments, often for costly services such as dentures or crowns.

03:13 Conclusion 

Now that we’ve covered a few of the essential dental insurance terms, remember that having a thorough understanding of them can make a significant difference in ensuring a smooth billing process and patient satisfaction. With the complexity of insurance systems and the importance of accuracy, many dental practices and professionals turn to experienced dental insurance verification companies.

MOS is an experienced dental billing company that is committed to assisting dental practices with completing their insurance verifications ahead of the patient’s appointments, ensuring seamless patient experiences and efficient billing processes. If you’re in need of professional support with insurance verification, don’t hesitate to reach out to our team by calling 1-800-670-2809. For a full list of the dental terms associated with this podcast, please refer to the attached article. And that’s all on this. Thanks for listening in.