10 Jun Dental Insurance Verification Made Easy — Thanks to Medusind!
Go with a national leader in dental insurance verification!
Why is dental insurance verification the foundation of your dental practice?
- It yields payable claims—because you’ve created an efficient dental billing process.
- Unless your first verify a patient’s insurance, they can’t understand treatment costs and the scope of their financial responsibility.
- If you mess up dental insurance verification, fixing mistakes is going to cost you time and money. You also might end up submitting claims that were unnecessary—because no coverage existed in the first place!
Many dental practices fail to realize that they have to obtain dental insurance verification before a patient’s appointment. Before accepting a new patient, check their eligibility. It’s also wise, each time you see a patient, for your staff to ask the simple question: “Has there been a change in your dental insurance?” Sometimes patients switch jobs, and you have no idea you’re dealing with a completely different insurance carrier.
How do you see if they’re eligible for benefits? When you perform their dental insurance verification, go to their insurance company’s website and check their coverage details.
5 Steps for Effective Dental Insurance Verification
Here is a standard dental insurance verification checklist to run through:
What’s the effective date of their benefits?
Confirm when your patient’s benefits went live. Sometimes if they’ve just signed up for new insurance coverage, their benefits might not have gone into effect yet. Make this the first fact you ascertain during dental insurance verification.
What’s their plan maximum?
Your patient’s dental insurance maximum will tell you how much their insurance company will pay for dental care inside a 12-month period. What if they’re close to reaching their maximum? Confirm this fact right away during dental insurance verification, because if they go over their maximum, we’re talking about out-of-pocket expenses.
What’s their typical coverage percentage?
Before you go ahead with dental work, both you and you patient should know how much of the procedure will be covered by insurance. Insurance companies will often cover 100, 80, or 50%. The patient is responsible for any charges over that. Ascertain this during dental insurance verification.
What’s their deductible?
Your patient’s deductible describes exactly how many dollars they must pay out of pocket for dental expenses before their insurance coverage kicks in. For most plans, there’s usually a yearly deductible per person and a family deductible.
Check Your Patient’s Dental Insurance Exclusions and Clauses
Dental insurance verification might uncover plan exclusions and clauses that further restrict your patient’s coverage.
1. What’s the allowed frequency of treatment?
How many times a year will a patient’s insurance pay for a given treatment? The plan may be limited to two cleanings a year. If your patient schedules a third cleaning, inform them there will be no insurance coverage, so they can decide if they want an out-of-pocket expense.
2. Is there an age limitation?
When children are covered by their parent’s insurance plan, the coverage often stops when they turn 26. Some procedures have age limits: orthodontic benefits might stop at age 18, or fluoride treatments might only apply to patients aged 16 and under.
Is there a replacement clause?
A replacement clause stipulates the plan won’t fund a replacement for given dental procedures such as a lost retainer or a replacement filling for one installed less than 24 months ago. After dental insurance verification, your patient can decide whether to pay for the new work now out of pocket or wait till their insurance covers it.
Is there a missing tooth clause?
Sometimes if your patient loses a tooth before their insurance begins, the plan won’t cover fixing the missing tooth. But if dental insurance verification shows that your patient’s employer has just switched to a new insurance carrier (and your patient was covered under the previous plan), you can appeal the decision.
Is there a waiting period?
Many insurance companies demand that if you just enrolled in a new insurance plan, you must wait for an assigned time period before the plan will cover certain dental procedures. Time periods mostly pertain to restorative or major dentistry, but during dental insurance verification, always check to see if a waiting period is attached to a new procedure under consideration.
Is a downgrade in effect?
Many insurance plans will pay for the least costly procedure if more than one acceptable option exists. Check your patient’s plan during dental insurance verification and let them know there’s a cheaper way to fix the problem. Their plan might possibly also require that they sign a downgrade document.
Medisund is a Recognized National Leader in Dental Insurance Verification
Nationally, Medusind is known as a leader in dental insurance verification. Our experienced staff uses our proprietary QuickVerify™ technology to ensure that timely and accurate eligibility and benefits information gets into your practice management system. Let us handle the time-consuming and difficult process of dental insurance verification so your staff can focus on your patients’ all-important oral health. Contact us so your patients can get into the dentist’s chair knowing there are no surprise bills coming. You can also reach us at dental@medusind.com.
