Common Mistakes in Dental Insurance Verification and How to Avoid Them

Common Mistakes in Dental Insurance Verification and How to Avoid Them

When done correctly, dental insurance verification can save a significant amount of time and prevent unpleasant surprises for patients due to unexpected bills. Outsourcing these services can also help accelerate your insurance verification process while enhancing its accuracy. A few mistakes to avoid while verifying the insurance details of patients are as below:

Using outdated patient coverage information

Even for regular or existing customers, the dental team must verify patient benefits to ensure that the system has captured the current coverage. Although a dental practice might utilize outsourced insurance verification services, the team must still update the PMS (practice management system) when necessary.

One needs to ask patients about changes that could indicate new insurance coverage, such as retirement, changes in marital status, or sometimes a new employer.

Many patients might change their insurance annually, and some might not realize they have new benefits even if they still have the same provider but with a new policy. If coverage has changed, the team must verify all the new benefits just as one would for a new patient.

A dependence on predeterminations for estimating out-of-pocket expenses

A predetermination is an estimate of insurance coverage and the patient’s responsibility before dental treatment. A predetermination is like verification, to a large extent.

The insurance company reviews the request and notifies the dentist and patient of one or more of the following areas:

  • Patient’s eligibility
  • Covered services
  • Amounts payable
  • Co-payment and deductibles
  • Plan maximums

However, a dependence on predeterminations instead of performing verification is not advisable. Predetermination and insurance verification are not the same things as predetermination is not a guarantee of payment and is not always reliable. It is only good as of the date it is processed. Insurance verification allows you to interpret the information and plan service schedules accordingly.

The dental team needs to wait for the insurance company to process the predetermination and send the results. This could cause a delay in treatment. Insurance verification puts the practice in control of interpreting the information and speeds up the treatment schedules with patients.

Verifying insurance details on the day of treatment

The dental team must make it a point to verify the insurance coverage of any patient at least 3 working days before the appointment. This ensures a smoother check-in and check-out process.

Delaying until the day of the appointment increases the likelihood of an error, particularly when discussing important factors such as:

  • Effective coverage dates
  • Reached benefit maximums
  • Remaining waiting periods
  • Deductibles, if any

These issues could lead to invoice amounts being considerably higher than expected by the patient. Providing incorrect information can cause a dent in reputation as well as a delay in payment from patients who were not given adequate time to make alternative arrangements.

Hurrying through the process and losing vital data

For a single patient, insurance verification may not take a lot of time. However, when verifying multiple patients at a time, the process can become challenging and tedious. It is crucial not to rush or skip checking each patient's insurance coverage, as overlooking key information could impact the out-of-pocket expenses of a patient. This could also increase claim denials.

This indicates that your team may not have the capacity to handle insurance verification internally. In such cases, a dental practice can opt to outsource insurance verification to specialists and save employee costs and time.

Utilizing professional support for insurance verification leads to more accurate cost estimates. By reviewing the latest data before patients' visits, the practice can provide them with correct information, leading to a better understanding of coverage, benefits, and financial responsibility. This then increases the likelihood of faster payment.

Error in deciphering COB rules

During insurance verification, if a patient has coverage under multiple insurance plans, the dental team needs to determine the coverage hierarchy, identifying primary, secondary, and sometimes tertiary insurance.

The process of determining the order of patient coverage is known as Coordination of Benefits (COB). This can be challenging for dental teams to comprehend because it is specific to each patient's circumstances.

Incorrectly sequencing a patient's insurance coverage can result in immediate claim denials. Having a solid understanding of these rules and feeling confident in applying
them to patients with multiple insurance plans can enhance your ability to collect more from insurance companies.
Staying updated on COB rules, insurance regulations, and patient coverage guidelines can facilitate smoother insurance verification processes for your team.

Managing the demands of insurance companies calls for careful attention to the administration of processes that govern billing and claims. Precise dental insurance verification can help a practice receive prompt reimbursements and maintain profitability. The dental team must stay vigilant and updated on all aspects of these processes.

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