Dealing with Dental Patients' Insurance

Every dental provider spends time and/or money focusing on marketing their practice. This means they need to be paid for the services they render, and most often, this means going through a patient's insurance company.  In this post, we will discuss some of the basics involved with handling your patients' insurance. 

Decide if You Are Going to Operate In-Network

Your customers' insurance policies are going to have rules regarding dentists who are in or out-of-network. You will need to decide if you want to become a part of those networks or if you want to remain outside of them. More patients will likely come to your establishment when you are in-network, but you will face restrictions as well. Insurance companies may not wish to cover procedures that you deem medically necessary, and this may result in more out-of-pocket expenses for your patients.

You can intervene by communicating with the insurance company, but the extent to which you can actually sway them will be limited. You will often need to explain to your patients what their insurance company's parameters are so that they will be fully aware of costs, co-pays and remaining balances due, as insurance policies may not provide 100% coverage for even routine services. 

Obtain Patients' Insurance Information

You will need to create an insurance file for the patient, and you'll want to have a detailed list of questions for the patient to fill out so that nothing is forgotten. This should generally include information, such as the patient's name, address, policyholder name, employer name and contact information, social security number, policy and group number, and their employer's name, address, and telephone number. Make sure to duplicate this paperwork in the patient's medical records and to keep a digital copy in your computer.

Inform Patients of Your Procedure

Your patients are actually able to file insurance claims on their own, but it is likely you would lose business if clients were expected to do this. That said, you will need to decide how much of this process you will want to take on, as you can take care of it fully or even partially. The best way to communicate your protocol to patients is to mail them a copy of your procedures prior to their first visit so that they will have a chance to look this document over in its entirety.  Ask for your patient's signature, and be sure to keep a copy of this in your patient's file. 

Filing Claims

It is best to file claims electronically and to keep paper records of each filing. You will need to develop an office procedure for how many times you will refile a claim before it becomes the patient's responsibility for working things out with their insurance company. Typically, you can refile a claim after 30 days and then again after 60. 

If 80 days have passed with no payment from the insurance company, you need to send your patient a statement with an explanation that their insurance has been billed with a request for the remaining amount due. You can include the patient's signed admission that they are liable for work done regardless of insurance coverage, and your staff should encourage the patient to contact his or her insurance company to ask them to pay.