In a previous blog entry on October 15th, I mentioned a checklist of questions we ask the first time we call an insurance company. Many dental insurance companies now have benefits available by fax or online, but often this benefit information may just be an overview. While it seems time consuming to get all of this information ahead of time, it frequently pays off when a new patient is in the dental chair wanting to know about coverage for a treatment like full mouth debridement or sealants. Since my office manager has checked with the dental insurance company ahead of time, the answer is immediate. This avoids delays for the patient and staff which results in the treatment being performed that day rather than having to be re-scheduled.

My office utilizes a dental insurance checklist to fill in the basic insurance information given by the patient and the insurance benefits given by the insurance company representative. On this checklist, we record the date insurance was verified, the insurance representative’s name and answers to the following questions solicited from the insurance company representative:

– deductible and maximum amounts, as well as how much of the deductible and maximum have been met thus far that year,
–  percentage breakdown for each level of treatment,
– whether the benefits are on a calendar year/benefit year/contract year,
–  frequency allowance and last date of cleaning, exam, x-rays, sealants and fluoride,
–  if periodontal and endodontic treatment are considered basic or major,

–  if there are any waiting periods,

–  replacement frequency for prosthodontics,
–  if night guards are covered,

–  if full mouth debridement is covered and when, and
–  if composite fillings are downgraded to amalgam fees.

Our Dental Practice Management Tools CD includes an “Insurance Benefit Verification Form,” along with many other useful dental practice management forms.