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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