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Dental Insurance Explanation Brochure for Patients

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As I have stated previously, it is imperative to strive for the collection of accurate co-payments on the date of service.  Many dental offices choose to bill after receiving insurance payment.  Some make an attempt at co-pay collection simply by calculating a percentage of the total fee assessed.  Most patients believe that the estimate they have been given and the co-pay they initially submitted reflect the actual balance that they will owe.  I know how I feel when the auto mechanic provides me an estimate prior to dismantling my vehicle and then surprises me with a much larger bill after the work is completed.  I understood at the time that I was being given only an estimate, but my frustration at receiving such a high bill quickly overwhelmed that understanding.  In order to get my vehicle back, I will need to pay this higher than expected bill.

Patients react in a similar manner when opening the bill from your office reflecting what their insurance did not pay.  They generally believe they have already paid what they owe and that you are now overcharging them.  This belief is further compounded when they receive the estimation of benefits from their insurance company explaining how your fees are remarkably higher than UCR.

Dental insurance benefits are confusing and disappointing to many patients who are accustomed to the more extensive and often clear cut benefits provided by their health insurance company.  The common insurance company practice of downgrading treatment and the incredibly low yearly benefit maximum are two factors that really surprise patients.  In order to lessen the shock our patients might feel from the disparity between the perception of their insurance and the reality of what it does not cover, we designed a dental insurance explanation brochure from questions that we frequently heard our patients ask.  This brochure, entitled Understanding Your Dental Insurance Benefits, has been extremely helpful in conveying some of the limitations of dental insurance plans to our patients.

 The patient dental insurance explanation brochure clarifies in laymen’s terms some of the most misunderstood features of a dental plan.  The veil is lifted from the infamous UCR, or Usual, Customary and Reasonable, which dental insurance companies often employ to depict to patients why a doctor’s fees may be higher than those of the insurance company.   PPOs and in-network versus out-of-network benefits are described. Pre-existing conditions such as the missing tooth clause are discussed.  Frequency limitations, deductibles, percentages covered, yearly maximums, treatment exclusion, wait periods and alternative treatment covered are all addressed as well.  We conclude the brochure with wording indicating how we can help the patient utilize the particular coverage to get the most from the plan, and that the co-payments will be calculated with the greatest degree of certainty that the insurance plan’s available information will allow.  We also invite the patient to feel free to ask us any questions regarding concerns about insurance benefits.  The Understanding Your Dental Insurance Benefits brochure can be found in its entirety on our dental Practice Management CD.

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Jan 12, 2012 | 3 comments | View Post

Dental Insurance Benefit Maximums

As we enter the second half of the dental benefits’ year, it is important to check remaining insurance maximums when calculating patient co-pays.  Many dental insurance companies provide a $1,000 maximum which can be reached quite quickly.  Often, dental patients are not aware of how low this maximum is and will not be keeping track of how much of their benefit maximum has been used.  In order to ensure the proper collection of a patient’s co-pay and maintain goodwill with your patients, a quick check of the patient’s remaining benefits should be conducted prior to presenting the patient with an estimate.  Patients may have received treatment in the office of a dental specialist and used most of their dental benefit amount there.  Some dental insurance companies provide year to date benefit usage information through online benefit systems or faxes, thus facilitating the verification process.

One of the biggest mistakes made in today’s dental practice is that of calculating inaccurate pre-treatment estimates.  Not only is this bad for your production/collections ratio, it can also tend to leave a very bitter taste in the mouth of patients who assumed their bill was paid in full, only to later discover that they are left with a weighty balance after insurance reimbursement.  The best advice I can offer to prevent this practice breaker is to get their bill right the first time!

Aug 10, 2010 | 0 comments | View Post

10 Questions to Ask When Verifying Dental Insurance

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.

Oct 27, 2009 | 1 comment | View Post

The Importance of Collecting Co-Pays at Time of Service

Figuring accurate dental treatment co-pays is particularly tricky due to the complexity of dental insurance industry policies such as UCR and treatment downgrades. When figuring accurate co-pays, the treatment coordinator will need to take into account deductibles, yearly maximums, percentage of coverage, UCR and downgrades. This process can be difficult at first and leads many dental offices to choose to just collect a certain percentage and then bill for the outstanding balance once insurance has paid.

My office attempts to avoid billing patients by figuring accurate treatment co-pays and presenting them to the patient prior to the beginning of treatment. My patients sign a treatment plan estimate acknowledging the estimated amount and the fact that while we have attempted to give them the most accurate estimate possible, they will be responsible for any remaining balance once insurance has paid. We are able to accomplish minimal billing by asking the insurance company a series of questions which I will post in another entry. Often insurance companies will state their UCR for a particular procedure. For those companies that don’t state their UCR, we keep a spreadsheet derived from EOBs to track UCR payments in order to more accurately estimate co-pays for our patients.

Following this protocol has benefited my dental practices in multiple ways:
1) Less unhappy patients who are surprised by a large bill after treatment has been completed,
2) Less work for my staff in terms of billing and re-billing to track down patient payments,
3) Increased revenue as our office ensures payment for the work that is completed by collecting at the time of service and
4) Minimal use of collection agencies.

Oct 15, 2009 | 1 comment | View Post