A smooth patient visit starts long before the patient arrives. From the first phone call to the moment they sit in the chair, proper pre-appointment readiness protects both the patient experience and your practice’s revenue — and it starts with a clear, consistent process.
Step 1: Confirming the Appointment
Pre-appointment readiness begins when you receive the first phone call from the patient. A warm, professional conversation sets the right tone from the start.
Appointment confirmation is key to getting patients in the chair as scheduled:
- Schedule the patient with the correct provider — one who aligns with their specific needs and insurance coverage
- Two weeks before the appointment, call or text to confirm
- Follow up again two days prior
- When confirming, make sure the patient knows the exact treatment being completed and the exact date and time
- If they need to cancel, have available dates ready for rescheduling
Step 2: Collecting Insurance Information
Once the appointment is scheduled, immediately obtain the patient’s insurance information. Here’s what you’ll need:
- Insurance carrier and plan name
- Patient’s legal name, address, date of birth, insurance group number, and insurance ID — always collect the legal name, not a preferred name or nickname, as insurance companies require exact identification
- Subscriber information — if the subscriber is different from the patient, also collect the subscriber’s name, address, and date of birth
- Whether the patient has dual coverage — many patients have a secondary carrier
- Medical insurance information — medical plans are increasingly covering dental treatment
It’s essential that the information received is correct, so repeat back everything the patient provides to confirm accuracy.
Step 3: Verifying Insurance Coverage
Once insurance information is collected, it’s time to verify it with the carrier. Insurance verification is more than confirming coverage is valid on the date of service — it’s a multi-step process that requires several questions to be asked for dental claims to be billed correctly.
Key items to verify:
- Whether the plan has a deductible and if it has been met
- Annual maximum and how much has been used
- Whether pre-authorization is required for the planned treatment
- Whether the plan has a waiting period
- Age limits, frequency limits, or alternative benefit downgrades for specific treatments
- Coverage percentage for all planned treatments
Insurance verification can take up a large portion of the workday. For more on how outsourcing can help, see our guide: Dental Insurance Verification Outsourcing: A Complete Guide.
Step 4: Obtaining Pre-Authorization
When verifying insurance, always confirm whether the planned treatment requires pre-authorization. If it does:
- Submit the proposed treatment plan to the insurance carrier before the appointment
- Obtain their written approval — the carrier will respond with a pre-authorization form detailing which treatments are approved and which are not
- Communicate any unapproved treatments to the patient before their appointment so they are not met with unexpected charges
Note: If the plan requires pre-authorization, treatment should never begin before it is received. If treatment is not pre-authorized, the insurance carrier will not pay for it.
For a deeper look at the difference between insurance verification and pre-authorization, see: What Is the Difference Between Insurance Verification and Prior Authorization?
Pre-Appointment Readiness Checklist
Use this checklist to verify your practice is ready before every patient visit:
At scheduling:
- Patient scheduled with correct provider
- Appointment date, time, and treatment confirmed with patient
- Patient’s legal name and insurance details collected
- Subscriber information collected (if different from patient)
- Dual coverage confirmed or ruled out
- Medical insurance information obtained if applicable
Two weeks before:
- Appointment confirmation sent (call or text)
2-3 days before:
- Second appointment confirmation sent
- Insurance verified with carrier
- Deductible, annual maximum, and coverage percentage confirmed
- Pre-authorization submitted and received (if required)
- Patient notified of any unapproved treatments
Frequently Asked Questions
A solid pre-appointment process protects both the patient experience and your practice’s revenue. When insurance is verified and pre-authorization is obtained before the visit, patients arrive knowing what to expect financially, claims go out correctly, and post-treatment billing runs more smoothly.
Insurance should be verified 2-3 days before the appointment. This gives your team enough time to confirm coverage, identify any issues, and communicate with the patient before they arrive.
If a treatment requires pre-authorization and it is not obtained before the appointment, the insurance carrier will not pay for it. There is generally no opportunity to backdate pre-authorization once treatment has been completed, so it’s critical to confirm whether it’s required during the verification process.
To verify a patient’s insurance, you’ll need the insurance carrier and plan name, the patient’s name, address, date of birth, group number, and insurance ID, and subscriber information if the subscriber is different from the patient. Due to HIPAA requirements, insurance companies can only verify coverage when all identifying information matches exactly — any discrepancy can prevent verification.
Is Insurance Verification Slowing Your Team Down?
Insurance verification is one of the most time-consuming steps in the pre-appointment process — and one of the most consequential for your revenue. If your team is struggling to keep up, consider outsourcing it to eAssist. Our dental insurance verification professionals work to get your benefits confirmed accurately before every appointment, so your team can focus on the patient. To learn more, schedule a free consultation.
