As you’re fully aware by this point, dentistry is one of the many specialties of healthcare. Routine dental care is not only essential to our oral health but also our overall health too. Unfortunately, insurance treats dental care differently than it does other forms of healthcare. Dental insurance plans work a bit differently than other kinds of health insurance, and often, they do not cover the entire cost of a patient’s treatment. This can be a tricky issue to navigate. It causes stress for both the patient and the dental clinic team, especially when it is not properly handled or communicated.
Dental insurance typically covers preventative care (like cleanings and checkups), basic procedures (fillings and extractions), as well some portion of major procedures (like root canals and crowns). However, the specifics of what is and what is not covered can vary widely depending on the insurance plan that the individual patient has.
As business coordinator, your duties will certainly include the handling of insurance claims. You will face both the patients who are seeking to cover the costs of their treatment with insurance, as well as the insurance companies themselves. This makes developing a strong understanding of the ins and outs of dental insurance especially vital to your success.
Different Types of Dental Insurance
In-Network Dentists vs. Out-of-Network Dentists
In-network dentists have a contract with a specific dental insurance provider to provide dental services to their policyholders at a discounted rate. This means that the dentist has agreed to accept the insurance provider’s payment as payment in full for the services that they provide.
Out-of-network dentists do not have a contract with the insurance provider and are therefore not obligated to provide services at a discounted rate. This means that the patient may be responsible for paying the difference between the dentist’s fee and the amount that the insurance provider is willing to cover.
Always keep in mind that every dental insurance plan is different, so it is crucial to review the specific details of a patient’s plan before providing any estimates or discussing finances at all. By understanding the anatomy of a dental insurance plan, you will be well-equipped to help your patients to maximize their benefits and make informed decisions about their dental care.
Anatomy of a Dental Insurance Plan
Explanation of Benefits (EOBs)
Oftentimes, while working with dental insurance companies you will encounter an Explanation of Benefits (EOB). An EOB is a document that details the insurance company’s payment or denial of a dental claim. It will provide helpful information about the patient’s specific benefits, how much the insurance company paid, and also how much the patient still owes, if anything.
Your dental practice will have its own unique way of storing and handling patient EOBs. These methods are often determined by state or local dental association requirements, so as to better protect patient confidentiality.
There are five things that you will find in a patient’s EOB:
- Claim information, or what was submitted by the dental office.
- Service and coverage information, or in other words, the details of the patient’s dental insurance plans and the benefits that they are owed by it.
- Explanation of whether the claim was paid, or whether it was denied.
- Patient identifiable information such as policy number, group number, date of birth, and more.
- Details on resubmissions needed, if applicable.
Some items might look confusing at first for those who are newer to dental terminology. Here’s a breakdown of common terms you might see on an EOB, and what they mean:
EOBs are an important factor to understand when learning how to work with dental insurance companies. By working to understand EOBs properly, you will be able to ensure that your practice receives the payment that it is due and that the patients better understand their benefits and the limitations of their insurance, as well as the balances they may owe. This will work wonders in preventing financial surprises and keeping patients well-informed, and therefore less upset or stressed about the financial aspects of their treatment.
