Steps to Ease the Dental Insurance Verification Process

Hi, this is Amber Darst, Dental Coordinator for Managed Outsource Solutions.

I’ll be talking with you a bit today on the Steps to Ease the Dental Eligibility Verification Process. The office staff at dental practices can get spread pretty thin at times. Patients are coming in, patients are leaving, the phone’s ringing, someone needs to pay their bill. There can be a lot to handle all at once. Then, there is the task of handling the dental insurance verifications. Obtaining these verifications prior to the patient’s appointments are crucial when you are looking to keep a steady, problem-free cash flow. But making sure that these are completed for every insured patient can be quite the headache and very time consuming with all of those other tasks taking up the greater portion of your day.

Here are just a few issues that a dental practice’s front office has to deal with when it comes to verifying benefits.

• The length of time involved in making calls to the insurance companies for benefit verifications for both new and existing patients. Sometimes you can get stuck on hold for long periods of times just trying to verify one patient’s coverage and that can be very frustrating.
• Also, frequent insurance plan changes by employers. These changes happen often and when it does, it leads to an increased number of phone calls that need to be made to obtain all the new coverage details
• Another issue is the risk of insurance misinformation by the insurance rep. You only know what they tell you and sometimes they are not accurate and that’s also very frustrating. You have to be very thorough with the questions that you are asking them to make sure that what you are getting is precise information and up to date information.
• Then there is the amount of time involved in updating the insurance information and possibly even a new fee schedule in the system. So you are now having to take all of this new information and plug it into all the proper places, and that’s for each and every time that an insurance plan changes.So, verifying coverage and benefits is not only important for the practice but it’s also important for the patients as well. They are relying on their insurance plans to help pay for their treatment and they like to know what to expect, what would be their portion of payment before the time they need to come in for the treatment. Here are some tips to help practices streamline their eligibility verification process.

• Set up an insurance file for each patient:Each patient should have their own insurance file with all of the relevant details entered into it. The insurance information should be obtained during the initial call or most definitely before the point of service. Returning patients should be asked if their insurance has changed, and if it has, new coverage and benefits should be verified. Verifying dental eligibility in advance saves time and allows the practitioner to provide the patient with a cost estimate before they visit.

• Calling the insurance company: When you call them directly, it gives you a window of opportunities to ask more questions and obtain accurate and up-to-date information on patient’s benefits. Like I was saying earlier, you really need to be thorough with these questions that you ask to ensure that the information you are being given is precise.
• Document all coverage details: All aspects should be verified and documented such as: the patient’s name, the policy holder’s name and Social Security number, as well as insurance information that you would find on the insurance card. A few coverage aspects to verify include: the percentage by category, frequencies and limitations.
• Communicate to the patients in advance about what’s covered:
  Most patients don’t understand their coverage and benefits. Educate them and inform them about the details of the dental service that will be provided during their visit, what the insurance will cover, and what their portion will be as far as payment goes.  This helps to avoid the problem of surprise bills. Nobody likes that.

• Also, inform the patient about the claim processing guidelines: Let them know you will be following the service with their insurance, but there is no guarantee of payment. Ensure them that you will be submitting everything to support payment, but it is ultimately up to the insurance carrier to approve the service and pay towards it. So, managing insurance benefits and patient expectations is not easy. Practices have to deal with a large number of insurance plans that are constantly changing. Following the above-mentioned steps can help practitioners effectively manage the insurance process, improve cash flow, and grow patient satisfaction. Outsourcing the patient eligibility verification task to a reliable company can help alleviate the stress and time it takes to get this process accomplished.

I hope this helps, but always remember that documentation and a thorough knowledge of pay regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thanks for listening in!