Denials, Appeals, & Outstanding Claims

While the process of dealing with insurance seems like an arduous task, you should never use this to justify skipping the step of verifying a patient’s insurance benefits. Verifying a patient’s insurance is when you confirm the patient’s coverage before the treatment, to ensure that all payments and treatment information are clear before the expenses are charged. It is absolutely essential to verify a patient’s insurance information before treatment. 

 

 

The last thing that you want is an angry patient that is spreading the word that your practice did not inform them properly of their required payments before charging them for a service. Avoid frustrated customers and negative reviews by communicating clearly with patients, and avoiding financial surprises. 

 

Providing Insurance Estimates to Patients

By verifying the insurance coverage, you will be able to understand how the patient’s coverage might be limited. It is essential to make sure that you explain to the patient what the limitations of their benefits are before their treatment is finished and they are charged. This is especially true in the cases of some patients who may need more extensive treatment, which is essential to their health, but too costly to be entirely covered by their insurance plan. Even if it doesn’t cover everything, dental insurance DOES limit how much they will pay. 

 

Dental coverage, unfortunately, is not based on what the specific dental needs of the patient are, or what the dentist recommends they do to treat their oral health concerns. It is based entirely on how much the patient’s employer pays into the plan. 

 

Be sure to review all of the necessary factors, such as deductibles, limitations, waiting periods, coverage percentages as well as any non-covered procedures if applicable to the patient. When providing the final estimate including the patient’s co-pay or out-of-pocket expense, be sure to ALWAYS provide it in the following specific formula: 

 

 

Best ways to verify insurance coverage:

 

A, Login to the insurance portal to ensure the patient has insurance coverage and gets the benefits. Some insurances do not have an online portal or they have a limited information 

B. Call if needed to get the breakdown of insurance benefits 

 

Here is an example of the breakdown you need to have for each patient so that you can correctly present the limitations of their insurance plan, give them the benefit breakdown, and collect the correct amount of copays