Collecting from insurance requires skill. Even though insurance could be considered more regularly reliable than individual patients as far as payments go, they aren’t perfect — and sometimes, you’ll have to deal with collecting unpaid balances from insurance as well.
Preventing Unpaid Insurance Balances
One of the more common issues you might deal with would-be claim denials from a patient’s insurance provider. Some of the most common reasons for claim denials include:
- The procedure was not covered under the patient’s plan.
- The patient has reached their annual maximum benefit amount.
- The patient had not yet met their deductible.
- The procedure was deemed medically unnecessary.
- The procedure was not coded correctly.
If a claim is denied, the patient or dental office may be able to appeal the decision or resubmit the claim with additional documentation or information.
Ensuring Collection From Insurance
Your practice should generate insurance “aging reports” every two weeks, marking the outstanding insurance claims that have existed for more than 60 days. Some insurances have a “timely filing limit”, and won’t pay claims after a certain number of days. For example, Ameritas won’t pay on claims after 90 days if it was never received, or if the CoB needs to be updated, etc.
KPIs for Collecting From Insurance