Dental Insurance Verification: In-House vs. Outsourced

Insurance verification is a tedious and time-consuming task that requires concentration and patience to complete. Verifying patient’s coverage is the first step in the dental billing process and doing it right improves cash flow and patient satisfaction. There are two options when it comes to verifying insurance – perform the task in-house or outsource it to a dental insurance verification company. When you look at the pros and cons of these choices in terms of cost, accuracy, expertise and patient satisfaction, outsourcing has a definite edge over in-house insurance verification.

• Cost: Verifying a patient’s insurance eligibility and benefits is critical before submitting an insurance claim to a clearinghouse or dental insurance plan. Getting the work done in the most cost-effective way is necessary, but hiring additional staff to do it in-house can be an expensive proposition.

Outsourcing dental verification

The costs of outsourced dental verification will depend on various factors such as:

• Whether a standard form or detailed form is used
• Data entry requirements
• Charges for emergency patients

In-house dental insurance verification

Cost of in-house dental insurance verification would depend on whether you hire a full-time insurance verification specialist or a part-time employee. Other factors to consider when determining the feasibility of employing an in-house insurance verification specialist include:

• the number of patients with a big employer in the area (which will reduce the time spent on verifications as patients with this employer will have same benefits depending on the plan they have)
• the number of patients the practice sees per month along with emergency visits
• the number of hygienists employed by the practice

Based on these considerations, it has been found that the costs of in-house insurance verification are much higher than outsourcing. Reliable insurance verification companies have experts on the job and you can expect big savings when you partner with the right company.

• Scalability: Time spent on verification and calling the insurance company would be less for:
  • family accounts as all members are in the same plan and a full breakdown would not be necessary for each member; however, a child may be in a separate plan from the parents and so this does not apply for all cases;
  • if many patients are working for the same employer, as they may have the same benefits for their plan.

  Outsourcing has a definite advantage when it comes to business scalability. An experienced insurance verification service provider will be well-positioned to scale to meet your growing patient volume by hiring additional staff, without any additional costs for your practice.

  With in-house insurance verification, you would have to hire more staff to handle high volume work, which will increase the amount you spend on salaries and benefits.

• Accuracy: Accuracy is paramount when it comes to insurance eligibility verification. Getting an accurate breakdown of benefits including effective date, plan maximum, co-pay, coverage period, deductibles, in-network and out-of-network benefits, and other information such as maximum limitations, is necessary for both the practice and the patient. Insurance providers update their plans frequently and not checking the details will lead to insurance claim denials. A large number of claims have been found to be denied for data related errors. Outsourcing companies have a dedicated and knowledgeable team on the job, which ensures that claims go out accurately and practices get paid in a timely manner, which will reduce the length of the medical billing cycle.

• Expertise: Knowledge and expertise are crucial to complete insurance verification before a patient receives dental services. For instance, both the dentist and the patient should know how the plan will cover a planned procedure. Coverages may differ such as 100%, 80%, or 50% depending on the type of procedure being done. There may be limitations on the number of times a dental insurance plan will pay for a certain treatment. For instance, the plan might cover only two cleanings a year. If the patient has completed these two cleanings and comes in for another, you must inform the patient that their insurance plan will not cover it.If you outsource dental verification to experts, they will provide you with the correct information on plan benefits in a timely manner so that you can discuss the coverage details with the patients. This will improve the patient experience and satisfaction. With their vast expertise in the field and knowledge of the coverages provided by different insurance plans, an experienced dental verification company will ensure your staff has more time to focus on care rather than spending hours on the phone verifying patient eligibility for services. Nevertheless, to make the outsourcing decision, weigh the pros and cons carefully by breaking down the costs while factoring in the availability of expertise to perform the task successfully.

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Amber Darst

Amber Darst is our Solutions Manager in the Healthcare Division, Practice and RCM. She is CPC certified by the American Academy of Professional Coders (AAPC). With a rich background in dental services, her expertise ranges from insurance coordination to office management.

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