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Dental insurance being intimidating makes an impact on patients. Dental practices ensure that their patients get high-quality treatment along with the verification process that often determines whether the patient can afford treatment or not and eventually the experience.
Importance of Dental Insurance Verification Process
- Getting the dental insurance verification process done beforehand helps the practitioner to educate their patients about the coverage their plan offers. The limits and terms are likely different for each insurance plan. The patients are less likely to know what their policy covers, for which areas a co-pay would be required, and how much the out-of-pocket expense is to avoid surprises.
- Through dental insurance verification, the dental practice can analyze the benefits information of the patient before the treatment to prevent the chances of last-minute cancellations, co-pay rejections, claim denials, and delays.
- Insurance verification for your dental practice can make your dental clinic proactive, which results in a central component of patient support. The patients need to be equipped to navigate insurance jargon and have time to talk to insurance representatives about active coverage. Verifying them proactively on your end determines the patient’s share and the insurer’s share.
- Insurance verification is a daily task similar to claim filings and submissions that help the practitioner to understand if a patient gets covered before the service. Otherwise, the patient will have to cover the cost of the service even if they have insurance. It is crucial to determine the patient’s eligibility for the treatment cost for an impending dental service.
- The dental practice later discovers that the procedure is not covered, and the patient gets forced to cover the cost of the expensive dental procedure. It will negatively impact the relationship and potentially affect the later clients.
- Also, dental practice awareness makes their patients aware of the costs and other necessary details about the policy that help patients choose the best course of action at their discretion.
- Patients rely on the dental practices staff to complete the dental insurance verification, and when the dental practice slips something through the cracks. They have to pay out-of-pocket, which reflects poorly on the practitioner.
Dental insurance verification protects the practice from errors and fraud in their employment situations. Here are a few pointers on how eligibility verification is crucial and affects the RCM.
- Retroactive changes to eligibility put the participating provider in a recoupment situation when treating a patient who has lost the benefit coverage. That results in the claim getting paid incorrectly and the out-of-network provider having to return payments. In both ways, the payers withhold funds for the individual provider’s future insurance payments.
- It is possible that the patient’s dental plan did not receive the updated notification from the employer informing that the insurance plan gets terminated. And as verified by the office staff through the payer’s online portal or toll-free number is not accurate, documenting the interactions with the payer can assist in any future dispute resolution. The payers might say reimbursement has already been paid or refuse to reimburse. In both ways, it affects the consistent cash flow of the office.
- There should be some sample questions to ask to get some information from the patient at the time of the office visit. Are there any changes in your dental coverage since the last time? If yes, share the details of the new dental plan, such as the name of the dental benefits carrier, individual or member identification number, and group number. These questions will help the office understand the new plan and the preferred collection method.
Has there been any recent changes in the employment (loss of job, laid off, leave of absence, no longer working with that employer, shift to part-time work) for yourself or the policyholder? In case of yes, it is better to ask for the paperwork from the employer stating the active dental plan coverage. These changes affect the dental coverage and the patient’s share.
How to verify?
The process starts before the patient visit and performs every time a patient visits the clinic. Initially, it seems like a time-taking task, but it improves efficiency.
Checklist to verify
- Active coverage dates
- Type of dental plan and the fee structure
- Maximums and deductibles
- Mandatory documents
- Patient’s details
- Category-wise coverage percentage.