As per the American Dental Association (ADA), nearly 65% of Americans have dental coverage. This is why it is vital to educate dental offices and dental practitioners to handle specific scenarios and respond accordingly. Expensive treatment like dental care can have a significant impact on the practitioner's financial health. Through the Dental Insurance Verification process, chances become substantial that you will be able to collect what you are owed, as it verifies the patient's active benefits, coverage with the insurer, and eligibility before the rendered treatment. Here are a few common denial scenarios and some ways to prevent them.
Lack of information on the claim:
Approximately half of the denial claims for pivotal and crucial services have insufficient information on the insurance claim. The pending status for the claims needs well written narratives. For instance, they should include answers to all the W’s like why, where, what, who, and when of the claim. Additionally, they must also have a written explanation of the procedures performed and their medical necessity. One of the several reasons for denying dental claims is missing information like incorrect diagnostic or CDT codes, missing narratives, radiographs, and policy limitations on the plan. As per Dental Economics, for claim processing, send a recent periodontal charting or full-mouth series for the last six months, encompasses orthodontic, periodontal, endodontic, and other necessary services.
Insurance Coverage Limit:
The dental plans vary based on what an individual's employer is providing. It comes with several limitations, exclusions, and frequencies. Hence handling varies from plan to plan. A limit in a dental plan refers to the individual's lifetime or annual pay for treatment. All dental plans have frequency limitations meaning definite procedures will be covered in a couple of years or from time to time. Exclusions for costly treatments like an implant, oral surgeries result in lower reimbursement from the plan. This is why dental practitioners need to submit a predetermination before performing any treatment to understand what the patient will be paying.
Deadlines non-adherence:
Dental claims submitted untimely are not processed by the payer. Every health insurance company offers a deadline, and failing to submit on time is an easy excuse to deny the claim. This is why it is advisable to submit as early as the completion of the treatment. Some health insurance companies have shorter filing periods, 180 days or even 90 days. Furthermore, most PPO plans have a filing period of one year from the date of service.
Wrong data information:
There are a lot of reasons that take time and training. For instance, an error in patient information on the submitted claim can reject the payment claim with a remark of incorrect beneficiary identification. It implies that either an incorrect enrollee's ID or name on the form. Learning how to file clean claims, your staff team should be vigilant to facilitate claims processing.
Difficulties in Coordination of Benefits (COB):
Coordination of benefits applies to a person with more than one dental plan to cover their dental procedures. Delays in claims processing in understanding COB regulations can occur because of insufficient or wrong information on the file or negligence with the Explanation of Benefits (EOB) from the primary payer when submitting the claim to secondary. Most dental offices should confirm the primary and secondary insurance information during the official visit. Many times claims get rejected, and to prevent COB issues practitioners, should know about the plan and the primary and secondary payers. To pay claims, first, it is sent to the primary payer and later to the secondary payer with an attached EOB.
Obsolete Insurance Information:
It is one of the most common reasons for denial. For instance, if the patient has changed his/her employer, coverage benefits are outdated, the policy has modified or terminated, and updates in the insurance card could get the claim denied. Dental insurance eligibility verification ensures that the records are correct and updated regularly.
Outsourcing the verification and authorization services can help patients with their plans and support dental practices with uninterrupted cash flow. These experts carefully look for errors and correct them before the claim submission to maximize the reimbursement.
Maximum contract allowance, also known as maximum plan allowance is the amount that is reimbursed for each dental service by the dental insurance companies. These amounts are pre-decided by the payers, for each dental service, and are dependent upon the enrollee’s dental insurance plan. It helps to calculate how much the insurance pays and the total patient liabilities for a particular treatment.
How are Maximum Contract Allowances Determined?
Deductibles, maximums, co-payment, and co-insurance amounts are decided based on the maximum contract allowance of a dental insurance plan. The in-network and participating dental practitioners are dental service providers who accept maximum contract allowance as full payment for the services rendered. However, non-network and non-participating dental practitioners have the authority to charge more than the maximum contract allowance. It is then the responsibility of the patient to pay the difference in the amount (balance bill) charged and maximum contract allowance. This additional amount cannot be added to co-payment, co-insurance, or deductibles.
For instance, if a patient chooses to see an in-network (or participating) dental practitioner and the max contract allowance for the services rendered is $100, they will accept $100 as full payment for their service. As per policy, if the insurance covers 80% i.e. $80, of the maximum contract allowance, the remaining 20% i.e. $20, will be the co-payment amount. This will be the patient’s responsibility to settle.
On the other hand, if a patient chooses to visit an out of network (or non-participating) dental practitioner, and they charge $120 for the same service; while the maximum contract allowance is $100, the insurance company will only reimburse 80% of the maximum contract allowance i.e. $80. The remaining $40, where $20 is the co-payment amount and $20 is the balance bill, will then be the responsibility of the patient to settle.
Considering all the intricacies involved, it becomes highly important for a dental practitioner to be well versed with all their patient’s policies and insurance protocols. If not, it can lead to revenue loss and claim denials. In the modern world, where there are multiple variants of policies, it has become strenuous for dental practitioners to be up to date with every detail.
Therefore, most dental practitioners’ opt. for dental billing companies like Capline dental to handle all the necessary steps of the revenue management cycle. Such companies serve as a reliable source to bolster the dental billing cycle and help practitioners grow.
People often enrol for dental insurance coverage when they are in need of a costly dental procedure. However, they are surprised to learn that they don’t necessarily have access to all the benefits associated with their insurance plan right from day one when the coverage starts.
The full benefits of a plan are usually available after a certain period of time which may vary from a few months to a full calendar year depending on the type of insurance plan. This period is called dental insurance waiting period and it helps to keep the insurance costs low in the long run for all the parties involved.
Why are dental insurance waiting periods needed?
Dental insurance waiting periods help to encourage people to remain enrolled with the insurance plans for longer periods and to seek regular treatments rather than enrolling last- minute whenever there is a need for any major dental procedure. This is a major concern for insurance companies since most people seek to enrol for insurance plans only as a one-time benefits usage option and opt out of the plan right after the procedure is completed and fully paid for by the plan. This leads to long term losses for the insurance companies and hence the dental insurance waiting period serves as kind of an insurance for the insurances.
With the concept of waiting period with insurance plans, more and more people carry dental insurance even when there isn’t the requirement of any costly procedure and their teeth are happy. This helps to keep the insurance premiums low for the public and the coverage costs manageable for the insurance companies. Waiting period helps to keep insurance premiums affordable for the people.
Can you visit a dentist during the waiting period?
If your insurance plan has an associated waiting period, it doesn’t mean that you necessarily can’t visit your dentist at all and get the cost of your visit covered by your plan. Dental insurance waiting periods commonly apply to basic and major dental procedures like crown, bridges & dentures, fillings and non-surgical extractions. Most of the preventive care services are covered from day one.
The procedures having waiting period under your insurance plan would be clearly listed in your benefits summary document. For the procedures listed in this category you’ll have to bear the full cost until the dental insurance waiting period lasts and you can start availing full coverage benefits of your plan. However, the waiting period doesn’t mean that you will have to bear full costs of even the preventive dental care services. In most of the cases, routine care services like cleanings, x-rays and dental check-ups are covered right from the beginning of the plan as these are necessary routine services to prevent the requirement of costly procedures in the long run.
This being said, after the waiting period you have access to full coverage benefits of the insurance plan and don’t have to even pay for the basic and major dental procedures depending on the type of plan you have enrolled for.
Are there any plans with no waiting periods?
Since dental insurance waiting periods are just to encourage people to carry insurance plans for longer durations and not just one-time benefits, it is very much possible for you to avoid the waiting period if you are insured with certain types of insurances over a period of time. These instances are:
Waiting Periods Help you lower the Dental insurance costs in the long run. Though at the outset, the waiting period might seem as an unnecessary hassle for the public and as a means to delay the benefit coverage, however, in the long run it helps to keep dental insurance costs in check and curb the insurance premiums considerably. The longer the waiting period, the lower is the insurance premium.
However, to be able to make the most of such a benefit you need a regular enrolment with any relevant dental insurance plan and to maintain a healthy oral routine so that any requirement of complicated dental procedures never comes unplanned.
Having coverage under a dental insurance plan is something that keeps you relieved all the time and is a reason for your everlasting smile for a multitude of reasons, having not to worry about costly dental procedures being one. You are always up-to-date with your dentist visits since most of the costs are covered by your dental insurance plan. You have the necessary financial protection and all the more reasons to maintain a healthy oral routine.
However, what happens when you have coverage under more than one dental insurance plan? In this case your reasons for a healthy smile are literally doubled since you are fortunate to have what is called dual coverage. Though, this doesn’t mean that you enjoy the double benefits under both the plans. Your out of pocket expenses are drastically reduced since the combined benefits of both the plans work out in such a way that the combined amounts paid by insurances cover almost the entire amount charged by the dentist for any procedure. Though, the combined benefits are calculated in such a way that it never exceeds the actual amount charged by the dentist.
What is coordination of benefits in dental insurance coverage?
Coordination of benefits takes place when a patient has coverage under more than one dental insurance plans and both the plans have COB provisions. In such cases, both the insurance carriers (or the same insurance carrier, if both the insurance plans are of the same insurer) work out the benefits together by coordinating about the percentage of coverage each plan has to bear as per the policy terms and the coverage details of each plan. The out-of-pocket expense for the patients is almost taken care of by the combined coverage benefits of both the plans since the primary insurance covers a part of the cost and the remaining cost is covered by the secondary plan.
For example, if a particular dental procedure is covered with 80 percent coverage under both the insurance plans that a patient has enrolled with, the primary plan covers the 80 percent costs and the remaining 20 percent is covered by the secondary plan. So, the out-of-pocket expense for the dental procedure is almost nullified by the combined coverage of both the plans.
Who is the primary carrier and the secondary carrier when both the plans have COB provisions?
The first payer or the primary carrier is the plan in which the patient is enrolled as an employee or the main policyholder. The secondary plan is the one in which the patient is enrolled as a dependent. For example, if you are enrolled in a plan with your employer and in a second plan with your spouse’s employer then the former one is the primary carrier for you and the latter one is the secondary carrier. Depending on the plan type, primary and secondary plans are decided as per the rules set by the particular state or could fall under federal guidelines.
How does coordination of benefits work out for children’s coverage?
When children are covered under dental insurance plans of both the parents, the primary plan is determined by the “birthday rule”. The enrolled insurance plan of the parent whose birthday comes first in the year is considered the primary plan for the children’s insurance coverage. However, this birthday rule is liable to be superseded by any court ruling or a decree.
When does the secondary policy pay?
The secondary plan supplements the primary plan in a way that it takes care of the balance cost after the primary plan has paid its share of the coverage. The secondary acts as a second level payer in this regard and accepts the claim only after receiving a copy of information of payment made by the primary plan called the explanation of benefits, or EOB.
Coordination of benefits between the insurances helps to bring down the overall insurance costs for the patients. However, it is important to note that there would never be doubling of benefits but a calculated sharing of the coverage costs between both the insurance carriers involved. The patients are advised to check their plan details COB clause and the available procedure that each plan covers to avail the maximum from coordination of benefits.
Dental insurance plans are generally designed to provide dental coverage from a specific network of providers. Although patients can always visit an out-of-network dental provider, going for a treatment from an in-network provider usually costs much less than going to an out-of-network provider. Now, the question here is whether an insurance plan pays for an out-of-network treatment or not. Does an insurance plan allow patients to visit an out-of-network provider and pay for the treatment they receive? Does it pay partially or fully or pay nothing? The article will address all these questions in detail.
Understanding In-network and Out-of-network
As per the conditions of the plan that they have enrolled, patients pay a certain amount for the treatment they receive and the rest, the plan covers. This is typically the process when they visit an in-network provider. It keeps their dental treatment costs at bay and this is precisely the purpose of taking a health insurance plan.
Availing out-of-network benefits
A lot of patients are unaware of the benefits their dental insurance plan has to offer even after taking one. Awareness about the type of plan is important to avail the benefits. Let’s take a look at some of the points worth knowing when it comes to out-of-network coverage.
When do patients need an out-of-network provider?
Let’s take a look at some instances when a patient may need to see an out-of-network healthcare provider.
So, a dental insurance plan can pay for out-of-network care. However, the cost of the treatment may either go up or similar to in-network rates, depending on the terms & conditions of the plan. Patients need to consider learning all about their plan and maintain regular communication with their insurer to understand all the charges in case of out-of-network care.
You are likely to consider cost comparison and different premium options while taking dental insurance. The one thing you may not be aware of is the dental insurance deductible, the minimum amount paid to a dentist to get insurance benefits. You need not worry as deductibles are probably one of the simplest and direct aspects of dental insurance.
Dental Insurance Deductibles - Individual and Family
Talking about the individual deductible, it’s the ‘minimum’ amount you need to pay out-of-pocket to your dentist before you start getting your dental insurance benefits. In simple words, whatever amount you directly pay to your dentist before your insurance plan starts paying for the dental services you receive is called a dental insurance deductible.
A family dental insurance plan typically has an individual deductible as well as a family deductible. However, an individual deductible can be used per person until it reaches the limit of the family deductible.
Let’s assume that as per your family insurance plan, your family deductible is $100 and the individual deductible is $50. If two family members use their individual deductible, the limit of the family deductible is reached. So, other family members covered in the insurance plan who need dental treatment would not have any deductible for that calendar year.
You are most likely to have a deductible if you have taken dental insurance. However, it’s advisable to check whether the amount you need to pay as deductible fits your pocket or not.
Note: If your insurance plan has a deductible, paying it will allow you to avail the benefits of your insurance plan.
How Dental Insurance Deductible works?
Generally, a deductible is a specific amount and works the same way for all types of insurance. If, as per your insurance, the amount for the deductible is $100, you need to pay it to make an insurance claim.
A generally asked question is that do all dental services have a deductible? It entirely depends on your dental insurance plan. Some dental plans have deductibles for all dental treatments and procedures, while some plans do not have deductibles for preventive care like cleanings, fluoride treatment, and diagnostic services. So, if you do not require any of these dental services for one year, you would not need to pay anything toward your deductible. You can check with your dental insurance provider as well to know about deductibles.
How are dentists affected by deductible?
People are generally hesitant to pay any out-of-pocket cost, especially when they have taken dental insurance to take care of any required dental treatment. That’s the reason a lot of people try searching for an insurance plan that has no or minimum deductible without thinking that it’s vital to get all the benefits of their insurance plan. It directly affects the dental practitioners in terms of revenue and the number of patients.
How to guide patients to collect deductibles?
Dentists need to guide their patients about the importance of paying deductibles. They can make the patients aware of the following points:
How insurance verification can help to maximize deductible collection?
A proper insurance verification verifies a lot of things before approving a patient’s claim. Beyond verifying patient information & policy status, copays, coinsurances, and coverage, it also verifies deductibles.
Dentists are required to ask their in-house insurance team to perform a thorough insurance verification for all the patients to maximize deductible collection. If you have outsourced dental insurance services for your patients to a reliable dental services partner such as CAPLINE, you can stay assured of all the necessary steps required for insurance verification.
FAQs
There are some general questions asked by patients as far as deductibles are concerned. Here are some popular ones:
1. Does a personal dental preventive plan have a deductible?
Ans. No. Deductibles are not applied to any preventive dental treatment. There are no deductibles for the Personal Dental Preventive Plan.
2. Should I get an individual dental plan or a family dental plan?
Ans. It entirely depends on your requirements. If you are a single parent with a child on Medicaid or CHIP plan, an individual dental plan will probably suit your pocket and requirements. A family dental plan should be your first choice if more than one member of your family is not on a Medicaid or CHIP plan.
3. Can I go to any dentist for treatment?
Ans. Yes, you can! However, if you go to an out-of-network dentist, your out-of-pocket cost will increase as you may not get discounts or complete coverage which you get with an in-network dentist.
The total amount paid by a dental benefits provider as per your dental plan within a period of 12-months for your dental care is termed as Dental Insurance Annual Maximum. In simple words, it’s the maximum amount that your dental plan pays for your dental care in a plan year. The one year period is called a benefit period.
The annual limit is not just placed on the dollar amount. Sometimes, it may be placed on particular services such as prescriptions or hospitalization. So, it may be a cap on the dollar amount of covered services or the number of visits for a particular service covered in the insurance plan. Once the annual limit is reached, you would need to pay for the dental services you take for the rest of the year.
Sometimes, Dental Insurance Annual Maximum is also called plan maximum or annual benefit maximum. The 12-month benefit period can start at any point in a year. Generally, a dental insurance annual maximum can range from $750 to $1500 or $1000 to $2000.
Let’s understand the concept of the annual maximum with an example. Assume that your dental plan’s annual maximum is $1000. Your plan will pay for the dental services you receive in the benefit period until it reaches its maximum limit i.e. $1000. Once it reaches its maximum limit, the dental plan resets back to the maximum amount at the beginning of the next benefit period.
An interesting fact about the annual maximum is that most people never reach their dental insurance annual maximum in the benefit period. As per the National Association of Dental Plans, more than 97% of people on a PPO or DPPO plan (Dental Preferred Provider Organization plan) do not reach their dental insurance annual maximum.
Note: The annual maximum is usually confused with the term “out-of-pocket maximum” which means the maximum amount paid by you, the dental services receiver, in a benefit period or plan year.
How Dental Insurance Annual Maximum works?
Before understanding how annual maximum works, you should know the following points:
Now, let’s take a look at the following example to understand how the annual maximum works.
Good to Know points:
You can either take coverage from your employer or purchase a dental plan as per your budget and requirement. However, if you are someone who wants to avoid the headache of annual maximums, you are most likely to settle for a DHMO plan or a discount dental plan as you would have limited choices.
You should also be aware of the fact that, in most cases, the annual maximum is often sufficient to cover the dental care you need in a year. However, it’s a good idea to talk to your dentist if you are worried about your annual maximums. Get an idea about the costs when scheduling for dental treatment and make your dentist aware of your annual maximum. Your dentist is likely to come up with a treatment plan that fits comfortably in your annual maximum without compromising on your dental care.
Dental Insurance Verification standardizes claim submissions to improve patient flow to a large extent. Understanding insurance eligibility and the active coverage would help the dental practitioners to get paid for the treatment rendered. If the patient fails to receive the authorization and approval from the insurance company, then the dental treatments can result in an unpaid claim or a lengthy denial rectification.
To keep up pace with the changing industry, you need to verify the eligibility, payment terms, Co-insurance coverage, and deductibles to keep improving your accounts receivable process. This step is highly prone to errors and can lead to inconsistencies between the treatment and your explanation to the patients why the out-of-the-pocket expense is not estimated correctly.
The problem is tangible as this happens with nearly 75% of submitted claims, it also affects your RCM if not done right the first time. In this article, we discuss the process of dental insurance verification that will help you improve the RCM and avoid recoupment requests.
1) Get Patient Insurance Details:
Dental offices should ask the right set of questions to understand all the intricacies of the policies; like, “Has your dental insurance plan changed from last time?”, “Have there been any employment updates for the payer?”
Even trivial mistakes in dental insurance verification can lead to claim rejections. It is not a simple eligibility check. Thus, it is essential that dental offices verify recall/ new patient information benefits through insurance policy details, phone calls with the insurer, or a real-time eligibility system beforehand to expedite the dental billing process.
Knowing the verified information can help dental practitioners in avoiding any financial and administrative errors. Furthermore, it is best to have a template so that no preliminary information regarding coverage is amiss.
The following is a checklist to gather accurate and updated information to avoid the risk of out-of-date, incomplete, and inaccurate information verifying the payers benefit:
Dental insurance verification demands pre-authorization even before dental appointments to avoid high insurance reimbursement turnaround time. Therefore, the person handling all this information should follow the standardized rule approved by the government before the claim is submitted to take care of the inaccuracies.
2) Contact Dental Insurance Companies:
A dental practitioner aims for high accounts receivables, and to do so, provide the proper narrative to staff to handle finances vigilantly. The claims get rejected due to insufficient documentation, inadequate policy awareness, or some periodic changes in the insurance coverage policies. Once the information has been fetched from the form, contact the insurance company directly to ensure eligibility, current benefits, and insurance coverage, which eventually helps in treatment schedules.
Reaching to the insurance companies over the phone can be time-consuming. To make the verification process quick and efficient, dental offices should use the procedure codes and other necessary details on the recall/ new patient into your software. In this way, the staff could verify the insurance & benefits more quickly. Additionally, dental practitioners can manage successful dental insurance billing with a clean claim and low-turnaround time.
3) Follow up and Verify the details:
Usually, a lot of time is wasted in gathering inaccurate data, and a shocking number of practitioners do not check insurance benefits coverage before the treatment. Such scenarios create disagreements and disputes, which can further hinder the verification process. Therefore, it is imperative to conduct a clinical review that confirms that the information shared by the patient is up-to-date and accurate. It is also a good idea to affirm the up-to-date benefits, with the high rates of unemployment, to avoid any such complications.
4) Examine every detail to support the process:
It is not uncommon for a dental office’s employees to make mistakes that later hold funds from future payments. Hence validating it with records save time but also money, based on the content of the claim. A flourishing dental practice relies on satisfied patients without being bogged down by insurance details.
5) Educating the patients proactively:
Dental insurance verification can affect a dentist’s relationship with their patients. To keep the revenue running as well as providing the best treatment, dental practitioners should communicate with the patient as and when needed. It is better to inform the patient about eligibility, copays, out-of-pocket expenses, and other issues before the treatment begins. Consequently, dental practitioners not only increase their chances of collecting funds as well as patients trust them for their oral health.
Let us be your advocate:
Outsourcing the dental insurance verification process can make a considerable difference in the effectiveness of revenue cycle management. In brief, it is the dentist’s responsibility to provide rendered treatment. This process takes a lot of time, and you have to keep up with new terminology and codes for reimbursements to flow into your account. We, at Capline Dental Services, can help you reduce rejection rates by smoothly managing the process, saving your practice time and money without losing focus from your patients.
It is the waiting period that ensures that the patient doesn’t use the full coverage of the insurance for their piled-up treatment requirements and then drops the plan once done. However, certain factors that can affect the status of waiting periods are as follows.
Here is a list of some providers along with their advantages and disadvantages, with respect to the waiting period.
Most of the plans offered by Humana are with zero waiting periods. Not only that, the services offered by Humana are eminent in the market. They have over 270000 in-network dental practitioners with over 6 diverse insurance plans to choose from. It also offers an HMO plan with no waiting period, which gives them an upper hand on its competitors. Additionally, the insurance plans of Humana offer very economical premiums and low deductibles. However, it does have higher coinsurance and certain limitations on preventive treatments than other insurance providers.
Denali dental is another insurance provider that offers zero waiting periods. Furthermore, it offers 4 dental cleaning and two examinations annually in its insurance plans. Even though their insurance premium is expensive when compared to Humana or other providers, their deductibles are substantially low. This factor makes the high premium cost worth in the long run. Additionally, they also increase the annual maxims and reduce the coinsurance payments each year so that their customers stay loyal to the company.
Some disadvantages of Denali dental is that few of the plans offered by them provide only 80% coverage on the preventive treatments. Furthermore, coverage for orthodontics is not covered in the lower plans.
United Healthcare is known for its insurance plans best suited for basic dental treatment coverage. Most of the insurance plans offered by United Healthcare have a zero waiting period. Their plans offer affordable monthly premiums and low coinsurance fees. However, these benefits are limited to the basic and preventive treatments only. The policies that cover major dental treatments do not offer zero waiting period either.
Unlike United Healthcare, Spirit Dental is known for plans which are best suited for major treatments such as crowns and implants. Major dental treatments are highly expensive, and thus very few insurance providers offer zero waiting periods for the same. Spirit Dental is amongst few providers that provide zero waiting period insurance plans for major treatments. However, the plans only cover 20-25% of major treatment costs in the first year. Similarly, the coverage provided for orthodontics is substantially low. Additionally, the monthly premiums Spirit Dental plans are quite expensive when compared to other providers.
The insurance providers that offer zero waiting period for orthodontics are scarce in the US market. Most of the waiting period for orthodontics extends up to 2 years. Ameritas is one of the very few insurance providers that not only provides zero waiting period for other treatment but also for orthodontics. Even though the plans provide low coverage in the first year, it considerably increases from the second year. The major drawback of Ameritas insurance plans is that very few low-cost plans are available for in-network dental practitioners. Additionally, there is no standardization for the per-policy limit on annual deductibles.
Delta Dental is a well known name in the dental insurance industry. It offers one insurance plan that has zero waiting period with highly affordable monthly premiums. Additionally, there are no deductibles or annual maximums. However, there are some of the services like implants that are not covered in this plan.
Under the Veterans Affairs Dental Insurance Program (VADIP), Metlife offers an excellent insurance plan with zero waiting period for veterans and their dependents. This insurance plan can only be availed by retired service members who are enrolled in the VA healthcare program. There are two insurance policies: basic (Covers preventive and basic dental treatments) and major (covers major dental treatments) with high annual maximums. However, there is a 2 year waiting period for orthodontics.
There are many insurance companies with versatile business plans to assist your patients with the required treatments. The goal is to provide dental coverage that can help patients book appointments in the treatment of choice. However, with so many insurance plans options, it becomes consequential for dental practitioners to have in-depth knowledge of each of them. Being well-versed with insurance policies is a great asset. It ensures clean claims submissions and procures payer eligibility, coverage, and bill for services.
What does Primary and Secondary Dental Insurance Coverage Means?
According to Delta Dental, the plan that covers you as an enrollee is the primary plan. Additionally, the insurance plan that provides coverage for treatment for the dependent enrollee is the secondary plan. Such insurance plans are also known as dual coverage- when patient treatment is secure by two or more than one dental insurance plan. However, having access to two dental insurance plans does not mean that your monetary coverage gets doubled. It has its limitations and unambiguously results that you will enjoy a lower out-of-pocket cost for your dental care. Once the primary plan covers the assigned expenses for the desired dental treatment, the secondary plan must pay an amount by the coordination of benefits provision.
Below are the general guidelines:
How Coordination of Benefits (COB) Work?
When a patient is entitled to dual coverage to fill the gaps, to eschew over-insurance or duplication of benefits on the treatment. Coordination of Benefits (COB) helps to maximize the healthcare coverage for the patients to undergo the necessary or desired treatments. Legally, Coordination of Benefits (COB) has a specific sequence. The claim first goes to the insurer, if the primary plan does not cover the full amount of the treatment, then it is paid by the secondary plan. Below are the types of COB that determine how patient coverage gets settled to avoid dental claim denial.
Therefore, by understanding the coordination of benefits, the health insurance companies plan to avoid errors. At the same time still, the patient holds the coverage that gets sanctioned.
Codes of Filing Claims
Following these steps, dental practitioners can achieve a high clean claim submissions ratio and avoid high claim denial. It will further lower the claim reimbursement turnaround time, and even manage more customers with fewer claims concerns.
