Common Challenges in Dental Insurance Claims and How to Overcome Them

Common Challenges in Dental Insurance Claims and How to Overcome Them

Dental insurance claims for any dental practice can be quite a challenge. While it can time to acquire operational mastery of the process, a practice can recognize bottlenecks and switch to automation over manual tasks. It can outsource these tasks to a dental billing and collection company to lower costs and ensure successful claims submissions.

Typical challenges in the dental insurance claims process

Selecting an out-of-network dentist

A regular cause for dental claim denials is receiving treatment from a practice that is out of the network. Generally, insurance plans outline practices that render services at predetermined rates. These practices provide the best value for insurance benefits while also offering a reduced out-of-pocket expenditure for a patient.

Selecting services from the list of in-network providers can help to maximize dental insurance benefits. A patient must confirm if a dentist chosen is part of the new network before making the switch. A patient can seek services from an out-of-network dentist but there can be a possible increase in out-of-pocket costs.

Forms with errors or incomplete

Insurance claims can be denied due to input errors or if forms do not have complete or accurate information.

Errors can happen while completing the paperwork, both by the patient and the dental team. A patient might erroneously share incorrect information while the dental team can enter incorrect data into the system or may not incorporate all information on the form.

A practice must commit an adequate amount of time and effort to precisely fill and submit claims. Data entered including patient information, treatment codes, or insurance coverage details must be accurate and verified.

Exceeding annual maximum limits

All insurance plans have an annual maximum amount that the insurance organization will reimburse. Basic services can be covered but expensive procedures like crowns or root canals can exceed the maximum.

A patient needs a plan that can cover anticipated treatment requirements without crossing the annual limit. A patient who needs extensive services and procedures must select plans that have a higher maximum so out-of-pocket expenses get minimized.

Deviation in estimated cost or coverage

A patient can be in for an unpleasant shock if the insurance coverage and patient liability are different than expected. A pre-determination of benefits from the insurance company helps in claim denial or a misunderstanding of the coverage.

Tips for Successful Dental Insurance Claims

A denied dental claim is frustrating for a patient and a dental practice. Applying a few best practices can considerably enhance the chances of a successful claim reimbursement. Here are ways to overcome the chances of denials and maximize successful dental insurance claims:

Choosing from a set of in-network dental practices

A patient must select a dental practice from the list of in-network providers available to benefit from reduced out-of-pocket expenses. The network status of the dentist must be verified before changing an insurance provider or a plan.

Claim forms need to be double-checked

The claim forms need to have accurate and complete information to get passed by the insurance company. One must dedicate adequate time for claim preparation and double-check all treatment codes, patient information, and other relevant documentation.

A dental billing and collection company can add value

There are challenges and complexities in dental billing and this can place a burden on the dental team. Outsourcing such a critical service can ensure timely and comprehensive billing services and accurate claim submission while also maximizing reimbursement for a dental practice.

These specialists stay updated on the latest coding and claim submission guidelines. In addition, they can handle the entire billing process including follow-up on unpaid claims.

Timing Dental Treatment

A patient needs to consider the annual maximum limit of the plan. A patient can deliberately select the time for treatment based on the annual maximum. If the maximum limit towards the end of the year has been reached, a patient can delay procedures that are not urgent until the new year of the policy begins.

Pre-Determination of benefits

A patient must always ask for a pre-determination of benefits to clearly understand the coverage and costs that need to be borne by the patient. This can help the patient in managing expenses and avoiding any shocks during the claims process.

A dental team needs to streamline the claims submission process so that reimbursements are quick and accurate. Automation of routine tasks or outsourcing the billing and claims submission process can improve billing efficiency and customer satisfaction while considerably lowering claim denials.

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