When it comes to running your dental practice smoothly, it’s important to verify and keep on top of your patients’ dental insurance. It can feel monumental sometimes, but general maintenance in verifying your patients’ insurance will help you avoid bigger headaches later. 

Too many patients, insurance plans can be confusing; lots don’t even know the specifics of their insurance plans. 

Because many patients are unaware of their insurance benefits and can’t answer questions about them, it becomes essential to understand how to verify dental insurance before their appointment.

One advantage of dental insurance verification is that you’ll better understand the patient’s benefits and you’ll be able to educate them about their coverage during their dentist appointment. Also, knowing patients’ eligibility information helps you to inform them of their eligibility for a dental procedure. 

Let’s discuss the benefits of verifying dental insurance. 

The importance of verifying dental insurance benefits

Insurance verification is essential when it comes to dental care. If you fail to verify patients’ insurance benefits, you won’t know if a deductible applies to a new patient’s first visit — and the practice may lose money later. You’ll also prevent getting less than expected payment from insurance. 

Often, we find many patients are ignorant about the four insurance payment concepts. They include:

• Deductible
• Co-insurance
• Co-pay
• Out-of-pocket maximum

However, you can only explain these payment concepts to your patients if you know their insurance benefits. Here are some things you stand to gain from patients’ insurance verification:

• Prevention of a denial of payment from patients’ insurance providers for root planing and scaling
• Prevention of a denial of payment for an emergency appointment and limited exam for existing patients
• Prevention of reduced payment for cleaning and examination visit
• Prevention of a denial of payment from insurance for a new patient’s preventive visit

How do I verify dental insurance benefits?

You can use fax, in-house, automated services, or an online portal. Furthermore, consistently ask your patients if there are any changes in their information. Also, verify their insurance plan by getting in touch with the insurance company. Here are some ways to verify patients’ insurance benefits:

Automated services

You can use automated services like DentalXChange.com for insurance verification. All you have to do is log in to your account and check your patients’ eligibility. However, automated services don’t provide stipulations and aren’t detailed enough. 

They aren’t 100% accurate when it comes to waiting periods. Also, automated services require you manually call the insurance company to determine stipulations with some types of procedures. 

Form for in-office dental insurance verification

Your team has to call the insurance company of the patient to fill this form. It’s the best insurance verification method that provides you with all the details you require. However, it takes up considerable time compared to other methods of insurance verification.

IV Services

Insurance verification services allow you spend more time with your patients, and less worrying about insurance. These services call payors on your behalf to get any eligibility information you require. They also call payors on your behalf to get any eligibility information you require.

Online portal

Not many dental insurance providers have a portal online where you can go through patients’ claims. Your office must have online records for the insurance companies you work with. 

It will also help if you didn’t depend on this method to get information. This method isn’t reliable for some stipulations like waiting periods for root planing and scaling.

Fax

Several companies may provide only a certain percentage of information about different procedures via fax. Also, they may not include the history of service prior dates. 

What information do I need when I call the insurance company?

You’ll need the following for proper insurance verification:

• Your office tax ID
• Name of subscriber
• Date of birth of subscriber
• Social security or ID of the subscriber.

Use a printable dental insurance verification form

A printable dental insurance verification form helps you keep a record of patients’ benefits information. It is useful as you can use the same template for all your patients. It will save you time and minimize compliance issues. 

You’ll need:

• Patient’s name
• Appointment date
• Contact info of insurance company
• Social security number, etc.

In addition to the above, the insurance verification form should also include:

• Payor ID
• Claim mailing address
• Tooth implant coverage
• Cleanings, crowns, and build-up coverage

• Frequencies for x-rays and panoramic
• Insurance plan benefits. It includes annual deduction amount in dollars, policy duration, annual maximum, waiting periods, fee schedule.

Without this information, the insurance provider will not give out the patient’s correct benefit information. Therefore, get patients to supply this information when filling their insurance verification form. It all makes the process easier.  This is why most patients in Canada want to find a dentist with experience in insurance verification.

Essential terms regarding insurance verification

Some terms are vital when learning how to verify dental insurance:

Deductible

Ensure you verify from the insurance company whether or not a deductible applies. And ask if it applies to preventative treatments or not. Note some insurance companies even apply a deductible to cleanings or exams for preventative services. You must verify this when calling the insurance company.

Additionally, not all insurance companies cover 100% preventative services and do not apply deductible. Although most do, some only apply deductible to certain preventive services. Some patients assume insurance covers their yearly or twice in a year x-rays and cleaning at 100%. Ensure the insurance company verifies this to prevent any unpleasant surprises on payday.

Dental benefits as-of date

Also, remember to write down the exact date you called the patient’s insurance company. Benefits change from time to time, depending on if the patient changes their insurance plan. Also, insurance companies can decide to change the patient’s benefits. 

Additionally, keep a record of any changes you make to the sheet. If, for instance, the patient decides to change insurance policies, open a fresh template. The new template should include the patient’s benefits on the new insurance plan.

Benefits used to date

This applies to new patients who recently left their old dentist during the benefit period. You’ll need to inquire how much the patient used during the rest of the benefit period. 

Afterward, update this information on your office’s record. It will help you know if the amount for treating the patient is above the maximum their insurance covers.

Secondary or primary insurance

It’s crucial to know if the insurance is the patient’s primary or secondary insurance. Most patients are not sure if their insurance information supplied is the primary or secondary insurance information.

If it’s their secondary insurance, the insurance company will deny your payment. You will have to tender a statement of Estimate of Benefit from the primary insurance.

How long can it take for insurance to approve dental work?

Major procedures may have a waiting period of six months to a year. In contrast, basic procedures have a waiting period within the range of three to six months. For preventive measures, there are no waiting periods.

Final thoughts

Insurance verification is crucial when it comes to preventing payment denial. There are available options to pick from on how to verify insurance. You can decide to use fax, automated services or an in-house insurance verification form. 

When you know your patient’s insurance benefits, you can educate them on their insurance coverage. If their insurance plan doesn’t cover the procedure, you can discuss other payment options with them.

Additionally, one benefit of dental insurance verification is you receiving payment after scaling and root planing. Also, it prevents you from getting less than the expected amount from insurance. The insurance verification process requires that you get the patient’s information.

At Opencare, we can make the dental insurance verification process easier for you. We can help you verify a patient’s dental insurance before they attend their appointment.