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Monique Long

Monique Long

Chief Sales Officer

Top insurance insights everyone should know

Dealing with dental insurance takes up a major part of a dental administrator’s day. For many offices, it is factored into everything from scheduling to treatment planning to the dental billing processes. The constant changes from insurance carriers are a lot to keep up with for dental professionals, so it is no wonder that many patients are not as knowledgeable about their dental benefits. We compiled the top insurance insights from our dental billing experts within eAssist to help you navigate insurance conversations with your patients. But first, let’s start at the beginning.

When did dental insurance start?

Have you ever thought how simpler your life in your dental office might be if there was no dental insurance? What if every patient was self-pay and insurance conversations regarding benefits were unnecessary? Before dental insurance was established in the 1950s, this was the reality. 

In 1954, the International Longshoremen’s and Warehousemen’s Union and the Pacific Maritime Association (ILWU-PMA), presented the idea for dental insurance to the dental associations in California, Oregon, and Washington. The idea was originally for dental coverage for their employees’ children. ILWU-PMA funded the plan, and the idea caught on quickly. The original three dental associations eventually evolved into an insurance carrier we are all familiar with — Delta Dental of California

Want to know more? There are a lot more details about the history of dental insurance and how CDT codes were created in the May/June edition of the Insurance Solutions Newsletter.

Top insights from dental billing experts
As a dental office administrator, you may find yourself regularly having difficult conversations with patients regarding their dental benefits. We understand and have been there. We compiled some top insurance insights from a few of our incredible dental, orthodontic, and patient billing experts. These tips will help you avoid some of these difficult conversations by knowing what to address upfront.

  • May I see your medical card? — Kristina M., Success Consultant

Some patients have a dental rider on their medical policy, meaning the medical insurance needs to be billed before sending to the dental insurance. By getting their dental and medical information at the first appointment, you can avoid 

  • Consider using the terms “policy” or “benefit” — Lisa H., Orthodontic Success Consultant

Dental insurance is vastly different from medical insurance, but patients may not be aware of that fact. If you find that your patients are regularly misunderstanding, using different terms can help patients recognize this difference and not have the same expectations as their medical insurance coverage.

  • Include routine cleanings in their treatment plan — Briana H., Success Consultant

Have you ever heard, “My benefits have maxed out, but I still get two free cleanings a year”? This is a common misconception because patients don’t always realize that their preventative care is included in their yearly allowable. Avoid this confusion, and be completely transparent, by including the patient’s routine visits on their treatment plan.

  • Dental insurance has its limits — Dr. Roy Shelburne, Director of Insurance Administration & Compliance

Patients may think that their yearly general dental maximum means a full dollar amount that will be paid towards their treatment in one large chunk, leaving them with the remainder to pay (e.g. total treatment $2000 – insurance benefits of $1500 = $500 patient payment). Having a detailed treatment plan that shows the estimated covered percentage can be helpful when you are explaining these details to patients. 

  • Use words that stick with patients — Lily W., Success Consultant

Using different wording like “guesstimate” instead of “estimate” brings awareness to the fact that you are not guaranteeing the estimated coverage shown on the treatment plan because the insurance has the ultimate say. 

  • Pre-authorizations are not always set in stone — Jeri P., Success Consultant

Pre-authorizations are a great tool to use to give the patient a more accurate estimate of their copayment. But even with a pre-authorization from the insurance carrier, there is no guarantee. Make sure you have a financial form for the patient to sign that states they understand they are responsible for what the dental insurance plan does not pay. 

  • Dispell dual insurance myths — Sonya P., Success Consultant

Patients with dual insurance may be under the assumption that they won’t ever have to pay a patient copayment. In some cases this may be accurate, depending on the treatment, but always confirm this very important detail with the secondary insurance: coordination of benefits. If secondary insurance does not coordinate benefits with primary, reflect that on the treatment plan upfront to avoid a difficult conversation after the claim has paid.

Insurance overload

The insurance carrier landscape is always evolving, and it can be hard to keep up. Just take a look at what dental administrators have to stay up-to-date on every year:

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Feeling overwhelmed? Don’t worry, we are here to help. At eAssist, our Success Consultants have over 10,000 years of combined dental billing and insurance experience. We can help you navigate the insurance carrier breakdowns, outstanding claim follow-up, and so much more! Every service is designed specifically to give you the peace of mind that you deserve and allow you to focus on what really matters: your patients.

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