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Dental Insurance Verification: How to verify your patients are covered

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Dental insurance verification plays a significant role in the successful running of a dental practice. It allows dental professionals to provide necessary treatment to the patients, receive maximum allowable reimbursement from the insurance company, and helps them build a positive rapport with patients by avoiding any unexpected bills . This article will talk about how to verify the insurance coverage of your patients and a checklist for dental insurance verification.

What is Dental Insurance?

Dental insurance pays entire or a portion of costs associated with preventive, minor, and some major dental care depending upon the plan type. With dental insurance, the patient can get the necessary treatment without worrying much about the costs. Patients have the option to choose a dental insurance plan as per their requirement as there are several plans available.

Each dental care plan includes three basic services including preventive dental care services, basic dental care services as well as major dental care services. Generally, every dental insurance policy covers most of the preventive services, fewer basic services and the least amount of major services.This is why the kind of dental care service that you are opting for in your plan is crucial as you need one that provides you the best value for your money and at the same time takes care of your oral health.

Patient verification for Insurance Coverage

Dental insurance verification is essential before starting the treatment if the patients wish to use their dental insurance during the billing. You need to make sure that the records of your patients are updated. You can do this by simply collecting the required data for Insurance Verification from the patient and verifying it with various means available before the appointment time. Make sure you ask for this information every time they book an appointment with you as there is a good possibility that patient’s coverage or other details might have been updated in the course of the last and upcoming appointment .

Patient verification could be done with help of one of the following modes.

  • Insurance Portal.
  • Interactive Voice Response System of Insurance.
  • Faxback.
  • Call to Insurance on Provider helpline.
  • Follow the steps below to verify your patient’s dental insurance coverage:

    Verify Eligibility: You can verify the insurance coverage of your patient with the help of one of the modes mentioned above.. It will allow you to verify if the patient is actually covered under any plan or not.

    Patient/Policy Information: Confirming Patient/Policy information is just as important as verifying eligibility, because it doesn’t matter if the patient has any active policy or not if we can’t submit a claim to Insurance after the services are rendered.

    Check Coverage,Maximums, Deductible & Service History: Check the insurance plan benefits, Maximums & Deductibles and inform your patients about them so that they know how much their insurance company will pay and how much they are liable for. Collecting service history of the patient is must as a service performed in the past might impact reimbursement of a service in treatment plan.

    Keep Patients Apprised of:

    Treatment Plan: Patients need to have a clear idea of their plan coverage and limitations. So, it’s your responsibility to make them aware before starting the treatment. It will allow you to get paid on time from the patients and insurance company.

    Claim Processing Guidelines: Let your patients know about the claim proceeding guidelines in advance. Simply use an information sheet explaining the claiming process and other instructions and have it signed by the patient.

    Checklist for Dental Insurance Verification

    Having a dental insurance verification checklist can speed up the process and spare you necessary time which you can utilize in the treatment process. To make it easier, here are the primary things that you must check during dental insurance verification:

    • Insurance coverage dates
    • Type of dental insurance plan and its fee structure
    • Deductibles and Maximums
    • Essential documents
    • Patient’s information while submitting a claim
    • Category-wise coverage percentage
    • Tooth implant coverage
    • Tooth grafting coverage
    • Insurance coverage for cleanings, crowns, full mouth x-rays, and build-ups
    • Entire Service history of patient that might impact service in treatment plan