Dental insurance confuses patients, and as dental practitioners, it is their responsibility to have a well-informed team who knows the insurance company rules and can address related questions.
By incorporating a streamlined verification process, the dental practice can avoid unnecessary claim denials and rejections by upgrading themselves with the patient’s eligibility, payer rules, predetermination status, and other mandatory claim details.
Here are a few reasons why insurance verification can save dental practice time and positively impact the practice’s revenue cycle health.
It is the amount that beneficiaries pay before the insurance company pitch in. Some dental procedures are expensive, and some are not subject to deductibles. Therefore, the insurer will not pay until the beneficiary pays for the dental care on applicable services. Implementing dental insurance verification as a part of the practice’s standard procedure can help set up the dental practice in boosting the collections.
Some insurance companies only pay once and if the patient covers a certain amount of time in the plan. The waiting period applies to specific services or fillings. Dental insurance verification saves practices hours that would go into fixing the claims if performed correctly.
There are services that most dental plans do not cover, like cosmetic services. The type of dental insurance plan determines the exclusions. Verifying the dental coverage of the patient saves both time and money before providing any treatment.
Frequency and limitations:
The dental insurances have restrictions or limitations on the services each year, like cleanings per year and dental examinations per year. For instance, if the dental insurance has a frequency limitation of 2 dental exams per year, the insurer will not pay for the third examination.
The insurance plan clearly says about the details that sometimes get overlooked. Dental insurance verification reduces the pain of difficult financial conversations after the treatment.
Dental procedures are expensive. Many insurers put a number on the amount they will pay in a year towards dental care. Once the predetermined amount gets covered, the insurer will not pay until the upcoming year begins. After the maxed-out amount, it is the patient’s responsibility to bear the cost.
Here are the steps involved in the verification process provided by the billing companies that can help you prevent claim denials and save dental offices time and money.
Timely verification of patient eligibility and benefits improves claim accuracy and patient satisfaction by informing the payment responsibilities. Sometimes the patients need to be notified about the changes in the insurance benefits. Verifying both new and existing patients before submitting claims avoid hassles.
It is one of the grounding reasons for denials. Some carriers cover cleanings and exams twice a year. If the office verifies the eligibility of the returning or recalled patients a week before their appointment, the chances of getting a clean claim will be higher.
Reliable billing companies make use of this knowledge for submitting clean claims by either calling the company or check at the carrier’s website. If any patient information is missing or not updated, the practice will get the complete breakdown of the patient’s eligibility from the insurance company.
Checklist of the eligibility items before submission:
Neglecting dental insurance verification can ruin the practice’s reputation and lead to many issues, such as dissatisfied patients, inconsistent cash flow, claim denials, unexpected patient balances, and debt write-offs.