According to the American Dental Association (ADA), nearly half of adults admit that they haven’t kept up regular trips to the dentist. Why? Because of the cost.It’s true that dental procedures like root canals, cavities, and even simple cleanings aren’t cheap these days, with out-of-pocket costs easily running into the thousands. This is where dental insurance can help. 

This article looks at the steps you should take before selecting a plan and how to get dental insurance. Still unsure? We have answers to some of the most commonly asked questions that will give you the confidence to get and use your insurance like an expert.

What to do before getting a dental insurance plan

Thanks to today’s easy-to-navigate websites, purchasing insurance only takes a few minutes. But before you grab the easiest (and cheapest) plan available, follow the steps below to make sure what you pick will work for you.

Step 1: Who needs coverage?

Are you looking for coverage just for yourself? Or do you have a spouse or kids whose dental costs you’ll also need help covering? If you’re in the latter group, you need to consider your dependents. Determining just who needs dental coverage is step one. Single and loving it? Skip to pre-existing conditions. 

Did you know dentists who treat kids often require training in pediatric dentistry? With its own special training and skill set, this type of dentistry is covered in some packages and not others. Full coverage plans will be your best option if you think your children will need braces. Overall, when purchasing dental insurance for kids you will need an idea of which pediatric dentists are within your coverage networks and what services are included in the plan.

Step 2: Understand pre-existing conditions

The Affordable Care Act made it illegal for health insurers to deny coverage for pre-existing conditions, however, this only applies to health insurance. Dental insurance is, unfortunately, not clearly included under this act.

Pre-existing dental conditions — conditions experienced before you get dental insurance — can sometimes lead to the denial of insurance claims. Pre-existing conditions can include missing teeth or diagnosed gum-disease but can vary by plan. Figuring out if you have a pre-existing condition will help you find insurance that offers you coverage.

Step 3: Budget for out-of-pocket expenses

Budgeting for dental expenses isn’t impossible as long as you read through the insurance plan details and then compare.

Find out the co-pay amount and how much of a deductible you will need to pay before the insurance kicks in. Deductibles can run upwards of $1,000, so it’s important to try to set this money aside ahead of getting dental work done. That’s part one of your budget done. The type of dental insurance that a person has will typically guide how much they pay for services. Insurance plans often follow a 100-80-50 rule. Many plans also have $1,500 maximums that they’ll payout to claimants annually, though there are exceptions. Compare different plan options to see which out of pocket expenses fit within your budget. 

Step 4: Anticipate waiting periods

Anyone looking to get dental insurance can probably go for cleanings or x-rays immediately. But be prepared for waiting periods from six months up to a year for coverage on root canals or gum disease treatment.

Why? Insurance companies are businesses at the end of the day. Without these waiting periods, nothing would prevent people from signing up for coverage only for a month or two to get some badly-needed dental work and then ditching their coverage. 

Waiting periods don’t necessarily mean more in-depth dental work can’t be done right away, people just might have to pay out of pocket. Again, check your plan options for rules on waiting plans. 

If it seems like we’re telling you to do a lot of reading, you got us. We are. But this will save you huge toothaches down the road. 

Step 5: Decide between group or individual coverage

The National Association of Dental Plans noted that as of late 2016, roughly 250 million Americans had dental coverage, falling into two types of plans:

• Public plans like Medicaid, covering approximately 83.9 million people
• Private and group plans, covering approximately 164.2 million people

How do you decide what to choose? Group plans generally are purchased through employers or groups like the AARP. If you’re purchasing insurance all on your own, you’ll likely select individual coverage.

How to Choose a Dental Insurance Plan

After following the steps above, it’s time to select an insurance plan. Here’s what to do at this point to ensure you get the coverage you need.

Get Clear on Your Coverage

Dental insurance generally breaks down into three types of plans. Knowing which one is right for you can help maximize your dollars and ensure you aren’t paying huge amounts for services.

• Dental Health Maintenance Organizations, or DHMOs, have lower premiums, higher deductibles, and restricted provider networks.

• Dental Preferred Provider Organizations, or DPPOs, have higher premiums, higher deductibles, and broader treatment networks.

• Dental Indemnity Insurance, which is becoming less common, has the highest premiums but allows people to go to any dentist they want.

Whichever you choose, you’ll want to be clear what the plan you’ve selected exactly covers and how much of covered expenses are paid out. More information can typically be found online or the literature they send you. 

Yup, that’s right. More reading. Find a comfy spot and dig into those insurance booklets. 

Know which dentists are in your network

Unless you opt for indemnity insurance, you’ll be restricted on which dentists you can see.

While you aren’t outright restricted from going to out-of-network dentists, this can lead to extra charges. If you’re looking at a PPO or DHMO dental insurance plan, consult their online network list. Dental offices will also generally know which insurance plans they can accept. That said, choosing an in-network dentist shouldn’t prevent people from seeking second opinions. 

Select your coverage level

Now you need to take a critical look at how much insurance you need.

A cheap plan of maybe a few hundred dollars a year with a couple of cleanings included will more or less pay for itself. Cleanings aren’t relatively expensive and are even available at dental schools for cheap, so while it can be tempting to forgo dental insurance entirely, we wouldn’t recommend it. For its relatively low cost and availability in times of emergency, dental insurance is worth the $20 or $30 monthly premium.

From there, you will want to decide if a PPO, DHMO, or indemnity plan is right for you and how much of a deductible you’re comfortable paying.

Narrow down your choices

This is the due-diligence stage of getting dental insurance you’ll actually use. Check out reviews online of potential insurers to make sure there’s a good chance they’ll payout on any claims. Also, check out the reviews for dentists in their networks. It might be worth selecting a slightly more expensive plan if it leads to better coverage and a better dentist.

Get dental insurance

When you’re ready to get dental insurance, the process is pretty easy and generally happens one of three ways:

1. Through a job
2. Through an insurance broker
3. On a dental website

Again, it’s the work leading up to this stage that matters much more than the actual, simple transaction.

Five FAQs to consider when you get dental insurance

Confused? Need more information about the benefits of insurance? Here are some answers to a few common questions.

1. Is there a best dental insurance?

Not exactly.

Finding the best dental insurance depends on a range of factors, including a person’s level of need and their economic situation.

For younger people with relatively strong teeth, a high-deductible plan that’s good for occasional cleanings and emergency fillings or root canals might be the best dental insurance. This same plan, however, might cause serious financial hardship for people expecting to get a lot of use out of their dental insurance.

2. How do I get dental insurance?

Dental insurance can usually be purchased a few different ways. Many people become eligible for group dental insurance after an initial waiting period at a job typically after 60 or 90 days. Others decide to purchase private insurance through an insurance broker or by contacting a dental insurance company directly. You can also get dental insurance online straight through providers.

3. Does dental insurance have open enrolment like the ACA?

This depends in part on if a person is looking to purchase dental insurance alongside their ACA plan. If this is the case, the answer is yes, though a person isn’t limited to purchasing dental insurance strictly during open enrolment periods. They can also purchase ACA dental insurance after a qualifying event, like the loss of a job.

Information on open enrolment periods can be found on Healthcare.gov or websites for state-based exchanges, such as Covered California.

4. How much will dental insurance cost me?

It can be difficult to calculate the true cost of insurance. While premiums can run for under $20 a month, that’s only part of the cost.

Many insurance plans have deductibles that need to be met for the year before starting to cover costs. Other plans require certain work, such as root canals or gum-disease treatments, to be paid for partially (but substantially) out of pocket, often needing you to cover at least 50 percent.

Premium expenses can run about $360 a year for individuals and up to $680 annually for families.

5. Can I use a policy tomorrow that I purchase today?

Yes, but avoid the temptation to pull a fast one. The rules of insurance are clear and typically long for a reason.

As noted earlier, many insurance plans have waiting periods on procedures like root canals, to help prevent people from signing up for insurance right before having a bunch of dental work done and then quickly canceling.

Dental insurance isn’t a video streaming service or gym membership. Attempting to treat it like one is likely to fail — don’t try it. 

Article updated as of June 2021

The post How to get dental insurance appeared first on The Floss By Opencare.

Running a dental office requires multi-tasking. From acquiring new patients to negotiating an office lease and managing your employees – there are a myriad of challenges involved. Effective management of these activities can put your practice on the road to success, but how do you do that? These aren’t typically skills taught in dental school, and they can feel overwhelming at times.

How do you effectively manage it all and provide excellent dental care? 

You’re not alone in feeling the sense of challenge here. Rare is the business that can do all these things well. That’s why practices will sometimes choose to outsource certain activities they don’t have the time or expertise to do. It’s costly, but it does free up your time to focus on patient care. So how do you weigh the costs and benefits to determine what and if outsourcing is a good option for you?

Take, for instance, insurance verification (IV). When it comes to IV, there’s a range of options: from having your front office staff do 100% of it to outsourcing to a partner like Opencare. And there’s quality to consider; how much more valuable is IV done right in spite of higher costs? There are real tradeoffs to this decision.

Why is insurance verification Important?

Insurance verification is an essential aspect of revenue cycle management that helps avoid claim denials, reduces patient ineligibility-based rejections, and speeds up the billing cycle. This improves office processes, optimizes patient retention strategies, and goes a long way towards optimizing profitability. In short, IV saves your practice time and money.

Don’t forget about accuracy

There are generally two parts of the equation to optimizing your practice performance: generate more revenue or decrease costs. 

Often, when we speak with dentists, they consider insurance verification a cost center – something they need to pay someone to do to run their practice. However, at Opencare, we think of it as a revenue enhancer, where high quality, even at a higher cost, can be MORE valuable.

Let’s run through an example: let’s say your office manager is completing IVs and paid $20 per hour. You have the opportunity to switch this to a service that can complete the same IVs/hr but it costs $30 per hour. Most of us would do the quick mental math and keep it in house, it’s $10 cheaper.  

But consider accuracy – what is the accuracy rate of your office manager vs. that of the service provider?  Remember, there are already fixed costs like hygienist salary, rent, etc. you’re paying, so wasting an appointment slot or not being paid by insurance on the back end because of an incorrect IV is quite expensive!  

Going back to our example, let’s say the difference in accuracy is 10% between your office manager and service provider.  And each can do 3 IVs per hour, so it costs $67 for your office manager and $100 for your service provider to do 10 IVs each.  That’s a difference of $33 – which is easily covered by having 1 more appointment or being able to collect the fee from insurance for that appointment.  So in many instances, even paying more, your practice is realizing more value from improved accuracy.

The benefits of in-house IV

First and foremost, doing IV in-house is beneficial because you have more control of the entire billing process. This allows you maximum customization of the process to your schedule, needs, and systems.  In addition, employees can address any issues right away. 

Second, an in-house IV expert can help resolve a patient’s queries before their dentist appointment. In-house experts are often intimately familiar with each patient and their individual history, needs, and circumstances.

Finally, doing so in-house is generally cheaper – especially if you have front office staff who have some free time. Going back to the example above, even the cheapest outsourced options will cost a bit more than you’re paying your staff.  

How much does in-house IV typically cost?

When Opencare has asked our dental practices how they evaluate this, dentists often will cite salary against the cost of the outsourced option. That’s a good starting point, but there are numerous hidden costs associated with in-house IV that are harder to discern. Make sure you’re factoring these in, as it may very well affect your decision.

Let’s look at these hidden costs:

Recruiting

How much time does a dental practice spend hiring a qualified front office person? Consider time spent on advertising, reviewing resumes, completing background checks, pre-employment assessment tests, and other recruiting activities. Do you want to spend the time and energy to do this not only upfront, but if your staff leaves?

Training

What training and skill development does the employee need to manage this position on an ongoing basis? On-the-job training and continuing education requirements can add significantly to cost and reduce available hours to work on IV.

Benefits

The obvious cost of taking on a new employee is their salary. However, there are numerous other employment costs to think about as well. Standard employee taxes and benefits like insurance add ~20% in salary, which doesn’t include additional perks that you may wish to provide.

The indirect costs of in-house IV

Besides the direct costs, there are also some additional factors to consider:  

Management time

Ever have to fire an employee? Or have to go through an uncomfortable compensation discussion? People management can be tricky, time consuming, and just plain stressful, which is why there are professionals who specialize in this. If this comes natural to you, great. But is it something you want to carve out the headspace for? 

Opportunity cost

Insurance verification processes take away a valuable asset from your front office staff: time. Your front office staff could be doing more efficient and valuable tasks, like talking about treatment plans or spending time helping patients understand their treatment plans. This is known as opportunity cost.

You always want to take into consideration the potential value you are losing when you have missed opportunities in your office.

What can you gain from outsourcing IV?

Once you’ve adjusted for all these factors, you can begin to understand the true cost of the in-house option. Compare that to a fully outsourced managed service can provide:

• High quality insurance verifications with accuracy of, maximizing the number of patients you can see 
• Limits incremental staff time, which can reduce compensation cost and/or free staff to do other activities
• Eliminates need and time for upfront and on-going training
• Reduces management time

Furthermore, insurance verification outsourcers like Opencare have the knowledge and experience to help you collect payments more quickly and reduce claim denials. And by reducing time spent on IV, it can enable you to focus on offering exceptional patient care and building stronger relationships with your patients.

What’s the right choice: in-house or outsource?

There are times when it makes sense for you to do tasks in-house, and there are advantages to doing so with IV. It gives you more control and options to customize the process and can be cheaper. 

However, there are real costs as well which we often see dentists ignore. Some things may not be so obvious at first like accuracy, management overhead, and additional costs – to the detriment of their practice.

Ultimately, every dental practice has unique needs, and you need to decide what’s best for you. To get the most benefits of IV for your dental practice, conduct a thorough cost analysis and weigh the factors we’ve discussed here.

If you have questions, reach out to us. We’d be happy to help you evaluate your options.

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Dental insurance can be confusing. We know you’ve got questions. We’ve got answers. Let’s break it down for you.

Insurance basics: Common questions 

How does dental insurance work?

Like any other insurance, you have to pay monthly premiums based on the company, your area of residence and your insurance plan. Public health insurance usually doesn’t cover much (if any) dental work, so the majority is covered by private insurance. 

Dental insurance often depends on the dentists you want and how much you can pay. If you’ve got a dentist already and they’re part of an insurance network, then you can go for one of their plans. When your dentist is not in-network, you’ll still be covered by the insurance, although you’ll pay more out of pocket. If you don’t have a dentist, you can visit any of the dentists in the network and still be covered. 

Most dental insurance providers have a waiting period before any dental work can be done, typically between six months and a year. Most policies do not cover cosmetic care procedures since they aren’t a medical necessity. 

Need more answers? Check out our full guide here.

How much does dental insurance cost?

For many people, dental insurance costs about $50 per month, though it can cost as low as $15 per month. The cost usually depends on the level of coverage you need and the state you live in. 

Most plans have an annual limit of coverage you can get. For most dental insurance plans, the limit is usually between $1000 and $2000. Once you reach your maximum yearly limit, dental insurance cuts all coverage. You’ll have to pay for any other dental work out of pocket. 

Unless you’ve got major procedures scheduled like a root canal or a crown, you’re unlikely to use all your annual coverage. In fact, only about 4% of Americans use up their maximum benefits. 

Why should I buy dental insurance? 

Dental care can be pretty expensive, especially when paid out of pocket. But dental care is absolutely essential to your health, so you can’t skip out on it. 

Most dental insurance plans will cover a big part of your procedures, making dental care affordable for both individuals and families. Your bi-annual visit to the dentist will be paid for in full by your provider – a benefit you can enjoy right away. 

Having insurance is also an excellent incentive to make more preventive-care visits even if you have healthy teeth. Less money is spent on preventive care and saves a lot of money that would be spent on costlier procedures in the future. 

Who needs dental insurance?

Dental insurance is for everyone unless you can afford to pay a hefty bill when you need to get dental care. Even though you may not exhaust your annual limit, you’re better off with insurance. If you’re elderly or you feel like you’re at a greater risk of getting dental problems, then insurance is something for you. 

What is dental indemnity insurance?

Dental indemnity insurance is a type of insurance that pays for your care after you’ve seen the dentist and paid upfront. In this case, you visit the dentist first, pay the cost, and then submit your claim to your provider. Your insurer will then reimburse you for part of the fee. 

This plan is best if you have a preferred dentist or you want a wide variety of providers. The annual coverage limit may be higher, but the monthly premiums also tend to be higher than other plans. 

What is a fee schedule plan?

A fee schedule is a list of prices that every dentist has that shows how much they charge for all procedures they offer. The list also includes how much your dental insurance will pay. The schedule varies depending on what the insurance provider considers allowable and the dentist’s rates. 

The fee schedule plan is often controlled by the “usual, customary and reasonable” (UCR) price that insurance companies wish to set for a procedure. UCR is usually around the average of what other providers charge within the area. 

Types of Coverage

What is covered by Medicaid?

Medicaid covers dental services for all individuals under 21 years enrolled in the program. This is part of a set of benefits referred to as the “early and periodic screening, diagnostic and treatment” (EPSDT) benefit. The dental services covered include preventive care as well as diagnosis and treatment of dental conditions.

The states determine the dental benefits that adults get under Medicaid. Most states only provide minimal emergency dental care, with very few offering comprehensive coverage. 

What is covered by medicare?

Like Medicaid, Medicare does not cover dental procedures. However, it offers limited care required to maintain general health, or is a part of another medical care regimen under Medicare. For example, Medicare may cover the additional dental care after you undergo jaw surgery. 

The insurance does not cover any follow-up dental care after the initial treatment has been done. 

What’s the best dental insurance in the United States? 

There are plenty of dental insurance providers in the country, and what may be good for you doesn’t necessarily work for everyone else. Some of the dental insurance providers include:

• Cigna
• UnitedHealthOne
• Humana
• Delta Dental
• Ameritas

Before choosing a dental insurance provider, it’s best to compare different insurance plans to choose the one best suited for your needs and budget. 

What procedures are usually covered by dental insurance?

Most insurance plans include some preventive care coverage in the form of two checkups and cleaning in a year. Other dental procedures that may be covered under insurance include:

• Fillings
• Crowns, implants and bridges
• Root canals
• Emergency procedures, eg oral surgery
• X-rays
• Tooth extractions

The level to which these services are offered will depend on your plan. Preventive care is often fully covered, while other major procedures like fillings may require additional out-of-pocket funds. 

What does “in-network” mean?

In-network dentists are part of a pool of providers who work with insurance companies to offer dental services at discounted prices. Choosing an in-network dentist ensures that your insurance always covers you and that you’re always paying less for your services.

You’ll also benefit from more coverage and fewer out-of-pocket fees every time you get dental care. 

You’ll have to contend with fewer dentists available for your choosing, though. The dentists in the network may not be perfect for your needs sometimes as well. 

What is PPO? What is DHMO?

A preferred provider organization (PPO) is a type of dental care plan whereby customers choose a dentist from a network of preferred dental providers. 

These providers usually offer their prices at reduced rates within a maximum annual limit. Some PPOs allow you to choose a dentist out-of-network and may even offer you lower rates when you’ve exhausted your yearly coverage. 

Dental HMO is exactly like PPO insurance, only that the dentists offer their services at pre-determined prices. The participating dentists are paid a fixed monthly fee. DHMO is often used by businesses to cover its employees but can be used for individuals as well. An advantage of DHMOs is they often have lower premiums compared to other dental insurance plans. 

How do I get the most out of my benefits?

To get the most out of your insurance, you need to determine which plan is the right one for your needs. Once you have a plan that suits you, you’ll get the best coverage when you remain in-network, whether it’s an HMO or a PPO. If you go out of network, you’ll have to pay more out-of-pocket. You can also work with your dentist to schedule your dental procedures so that your visits do not exceed the annual limit. 

Will all providers accept my insurance? 

Dentists within your insurance network will accept the coverage if the services offered are included in the plan. However, if the dentist is not in-network, they may or may not accept your insurance cover. If they do, they will be listed as out-of-network to your insurer, and you will have to top up the bill in most cases. 

How do I find a dentist who takes my insurance plan? 

Your insurance provider will typically have a list of dentists within their network that you can check out. You can also call the dental office to find out which insurance companies they work with, or you can use Opencare to find a dentist who takes your insurance.

What is covered by dental insurance?

How do I know how much dental treatments will cost me?

When setting up your dental appointment, you can ask your dentist for an estimate of how much the procedures will cost. Some insurers will encourage you to send a treatment proposal before beginning the dental treatments. This proposal will help your insurer determine whether the services are covered, the maximum coverage you can get and whether you’ll need to top up out of pocket. 

How do I know what my dental insurance covers? 

Your office can send your insurance a pre-estimate/predetermination request to find out what the insurance will cover and what it will not. The pre-estimate will also let you know how much they’ll cover so you can plan the dental visit. If you have anything other than major, always recommend getting a pre-estimate. To do that, call the office or send the insurance company a pre-estimate or predetermination after you book your dentist appointment. However, a pre-estimate is not a guarantee that the insurance will pay for everything in the pre-estimate.

The office took my insurance; why do I still have an amount to pay?

A number of reasons may be responsible for this. First, you may have exhausted your annual limit. You may have also selected a dentist that’s out of network, or the services may have been denied(insurance determines the service not necessary).If your treatment has been denied, you can follow up with the insurance company yourself and dispute the treatment that was not covered. 

Why didn’t I get my free cleaning? 

When we say insurance covers two cleanings a year, it’s not totally free. You have an annual maximum (average $1000-1500 USD per year), but once you’ve used that maximum, your insurance will not pay for any other services even if you’re eligible for them. However, some plans will specifically say diagnostic and preventive care aren’t calculated as part of the maximum. In these cases, you would still have those two free cleanings. 

How do I check the balance of my annual dental insurance maximum?

Do you know how much your maximum annual insurance is? If you do, you can calculate the difference between what you’ve already spent and that annual limit. To get accurate figures though, you can always reach out to your insurance provider to check how much you’ve used up and how much you’re left with for the year. 

What if my dentist referred me to a specialist; is that covered?

Some specialist services may be included in your plan. Whether you’ll be covered or not depends on your insurer, your dental care plan and the circumstances of referral. If you’ve exceeded your annual limits, however, you may not be covered by your insurance. You might also have to pay more if the specialist is not in-network. You can use Opencare to find plenty of dentists and specialists near you that are covered by insurance.

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In America and Canada, dental insurance coverage is quite pervasive. In fact, about 80% of Americans have either private insurance (172 million) or enjoy publicly funded dental benefits (87.6 million). 

But how many people actually understand how insurance works? Have you ever asked yourself “what is covered by my dental insurance?” Are you taking full advantage of your benefits to keep your pearly whites healthy? Read on to learn about how dental benefits work and what dental procedures are covered by insurance. 

How does dental insurance usually work?

When you sign up for dental insurance, you’ll pay a monthly premium, just like health insurance. Many plans also use a co-insurance structure. This means the insurance company will pay part of the cost of the procedure and you’ll be responsible for the remaining amount. 

For example, PPO plans (we’ll explain more about this common type of dental plan later), use a 100/80/50 co-insurance structure. This means they’ll pay 100% of preventative care costs, 80% of the cost of basic procedures (such as a dental filling), and 50% of major procedures. 

Many plans will have a deductible, which means you’ll have to pay for a certain amount before your insurance kicks in. Annual maximums are also common, which means they will only pay up to a certain amount within a one-year period. 

You can buy stand-alone dental insurance. However, many people have dental benefits attached to their medical insurance. A stand-alone plan tends to be more flexible and offers more benefits overall. They also are not likely to have a waiting period which means you can get the care you need faster. 

Dental benefits as part of your medical plan are more convenient. However, there are typically more limitations on the benefits such as when and how they can be used. 

Basic dental plans vs full coverage plans

Before deciding on a plan, it’s important to be aware of what it covers. Dental insurance plans can be divided into two groups – basic and full coverage. 

Basic dental plans cover preventative care costs. This includes coverage for routine dental visits, professional cleanings, and dental x-rays. Some plans will also offer partial coverage for basic procedures like fillings. However, your insurance co-pay will generally be higher.

Full-coverage plans generally cover the same things as basic plans. You can expect preventative care coverage and basic procedures. However, they offer coverage for a wider range of procedures, as well as the percentage that is covered is higher. 

With a full-coverage plan, procedures like crowns, root canals, and extractions may be covered. Plus, more advanced procedures like dentures, dental implants, braces, Invisalign, and other orthodontic procedures may also be included. 

The name full-coverage is slightly misleading because they still won’t cover 100% of your dental costs. Plus, each plan has its own list of covered treatments. Be sure to read the fine print carefully before undergoing dental treatment. 

Types of coverage: 

Now let’s talk about the various places you can get your insurance coverage. 

Employer coverage

Most people with private insurance get it through their employer or some other kind of a group insurance plan. This is typically a less expensive way to get coverage, but not always so do your homework. It depends on the type of plan your employer offers. 

Large employers are more likely to offer dental benefits, but some smaller companies also offer coverage. 

Individual plans

If you don’t have access to dental coverage through your employer, you can get an individual or family plan. Most preventative care costs will be 100% covered, however always read carefully to understand your whole coverage package.

Medicare

The government program for patients 65 and over doesn’t cover most dental care. There is one exception, however. Medicare Part A, which is hospital insurance, will cover certain dental services if the patient receives them while they are in the hospital. 

VA benefits

Eligible individuals can buy discounted dental insurance through the VA. Coverage is offered through Delta Dental and MetLife. The patient is responsible for paying premiums as well as the full cost of copays. 

Medicaid

Medicaid is another publicly-funded source of dental benefits used for people who can’t afford dental care. Eligibility is based on income and coverage tends to be very limited. 

All states are required to offer dental benefits to children, but each state can decide what they want to offer for adults. Most states offer at least emergency dental care coverage but fewer than half of the states offer comprehensive dental coverage for adults. 

What procedures are typically covered?

Are dental cleanings covered by insurance? Preventative care is typically cheaper than dealing with the ravages of periodontal disease or other dental issues. To that end, most dental plans offer coverage for the following:

• Twice-yearly dental exams (may require a co-pay)
• Dental x-rays, commonly offered once every two years
• Dental fillings
• Root canals
• Tooth extractions
• Bridges, crowns, implants
• Emergency dental care
• Dental appliances

Keep in mind not all of these procedures are covered fully. Dental procedures are divided into four categories, preventative, diagnostic, major, and basic. 

Preventative and diagnostic procedures are often covered at 100%. This includes regular dental exams, professional cleanings, and dental x-rays. 

Basic procedures are covered at 80% and major procedures at 50%. Major procedures include crowns, bridges, dentures, and other similar procedures. 

Basic procedures include fillings, root canals, oral surgery, and periodontal care. All of these except fillings can be considered major procedures as well. It depends on the severity of your situation. 

Dental bonding is also typically covered. However, if the tooth needs bonding as a result of an accident, you’ll be encouraged to use your medical insurance first. 

What procedures typically aren’t covered?

There is also a list of dental procedures that insurance typically doesn’t cover. Much of the determination is based on medical necessity. 

For example, you may need a crown to hold together a broken tooth and help to prevent further damage and that would be covered. However, a veneer over a chipped tooth serves a primarily cosmetic purpose. For this reason, veneers are almost never covered.

Another good example is that dental plans will cover silver-colored amalgam fillings based on medical need. However, if you want more expensive tooth-colored composite fillings, you’re going to have to pay the extra cost for those. 

Nitrous oxide (laughing gas) is used sometimes to help nervous patients relax. Unfortunately, dental insurance doesn’t cover it. If you really can’t handle visiting the dentist, you can opt for sedation which is usually covered.

However, this won’t usually apply to regular checkups. Most insurances will add the caveat that you need to be having two extractions or some other type of major work for sedation to be covered. Alternatively, your dentist can write a prescription for something to calm your anxiety and insurance will typically cover that. 

Dental appliances such as mouthguards for bruxism (teeth grinding) are usually not covered. In some situations, such as for gum surgery, some insurances may cover mouthguards.

How much does dental insurance cost?

Dental insurance is relatively affordable, on average costing Americans between $15 and $50 a month. To determine if dental insurance is worth it for you, you’ll need to pay attention to your dental habits as well as the type of plan you purchase. 

Don’t forget to factor in other dental costs like co-pays, co-insurance, deductibles, and annual maximums. 

You also need to carefully weigh your likelihood of needing major dental work done as the cost can quickly add up. For people with healthy teeth, it can be cheaper to pay for the cost of routine dental care out of pocket.

Types of dental insurance networks

Insurance providers typically work with a network of dental professionals. To get the most benefit from your plan, you’ll want to choose in-network providers. Let’s look at the most common types of dental networks you might encounter.

PPO

A preferred provider organization (PPO) has a list of preferred dentists in their network. You’re not completely restricted to using a dentist from their list, so if you find a dentist outside their network that you like, you can go to them, but you’ll pay more to do so.

DHMO

A dental health maintenance organization (DHMO) is similar to PPOs in that they provide a list of preferred dentists. This arrangement takes all the guesswork out of knowing how much your dentist appointment will cost. All the dentists in the network have agreed to a set price for their services. 

There is no annual maximum or deductible, but you are required to use in-network providers.

Fee-for-service dental plans

These types of dental plans offer the most flexibility with a very large network of providers. However, the price you pay for services can vary significantly. You are required to pay a percentage (which varies according to procedure) and your insurance covers the rest.

Choosing your dental insurance plan

We hope this article has given you some guidance when it comes to dental insurance and dental procedures covered by medical insurance. The most important thing is to stay up-to-date with your dental checkups. Regular exams and cleanings are the best way to avoid expensive dental problems in the first place.

Find a dentist near you and level up your oral wellness today!

The post What dental procedures are typically covered by insurance? Let’s break it down appeared first on The Floss By Opencare.

Dental work can be expensive. And what makes it more expensive, is when you put off seeing your dentist, or even performing good, basic dental hygiene. But when you don’t even do the basics, dental procedures can get expensive real quick. For example, a simple amalgam filling can cost around $300 and one dental implant can cost up to $4,500!

Prices like those will leave you wondering how on Earth you’re going to pay for the procedures you need. Thankfully, we’ve got some suggestions. Let’s discuss!

Can dental work be covered by medical insurance?

What’s our big trick for saving money on dental costs? It isn’t anything that crazy. We simply recommend your dentist bill your medical insurance instead of your dental plan because some dental procedures can be covered by medical.

You might assume the only insurance covering you when you visit the dentist is your dental plan. However, medical insurance will cover some procedures, even though a dentist performs them and they are mostly dental in nature. After all, dentists are doctors too that have spent years refining medical experience in their chosen specialty.

There are specific rules about what is covered and what will be denied. If your dental work is needed because of a medical reason, it’s more likely your medical insurance will cover it.

For example, if you need to fix some teeth because you were banged in the face, your medical insurance may cover it since the work is needed as a result of an injury. Another common reason is when you need dental appliances or services to treat medical conditions, such as sleep apnea.

What’s the difference between dental insurance plans and medical insurance plans?

Understanding the difference between dental and medical insurance can be difficult. Knowing where one begins and the other end is confusing, to say the least. It might be simpler to say that any work that happens in a dental office should be covered by your dental benefits, but it doesn’t work that way. However, that’s a good thing for you.

Dental benefits and medical insurance are not the same thing and don’t quite work the same way. Dental benefits primarily cover preventative care, often up to 100%. They often come with a rather high deductible and there is usually a limit on annual spending. 

Thus, if you want any work done that isn’t included in the preventative care package, you’ll need to fulfill your deductible first. If your deductible is $1,000, you’ll have to pay the first $1,000 for a procedure out-of-pocket. After that, your insurance will kick in. Keep in mind that basic dentist appointment costs such as copays usually help to fulfill this deductible as well.

Learn more about what procedures dental insurance covers with our Ultimate Guide to Dental Insurance

On the other end of things, dental insurance will often only pay up to a certain amount. For example, you might have a $3,000 yearly limit. 

Medical insurance, on the other hand, is more useful as a safety net. There isn’t as much emphasis on preventive care, but rather it’s there to cover unexpected expenses from injuries and emergencies. You’re probably already aware that without insurance, most people wouldn’t be able to cover the high cost of medical help on the spot. 

Though your specific plan may have a deductible (and sometimes a high one) the spending limits are usually much higher than a dental plan. In most cases, there is plenty of room to cover the cost of your dental procedure. 

Can I be reimbursed from medical insurance on dental work?

The short answer? Yes, your medical insurance may reimburse you for dental work. The hard part is knowing if they will in your specific situation or not. Even if the procedure you’re applying for might be covered for someone else, there’s no guarantee your medical insurance will pay your claim.

For example, if you lose or break a tooth because of an injury, it’s possible your medical insurance will cover it because it is a medical cause. However, if your troubles are purely dental in nature (such as losing a tooth because you didn’t care for your teeth well), the claim may be denied. 

It also depends on the insurance plan you have. Insurance with better coverage will be more likely to pay your claim. Plus, remember that if your medical insurance has a high deductible, you’ll be responsible for that first. 

In other words, while you can hope your medical insurance will cover a procedure, there is no guarantee and you may want to have a backup plan for those bills.

12 procedures medical insurance might cover:

By now you should have a basic understanding of the difference between dental benefits and medical insurance. Let’s look at some common dental procedures that can be billed to medical insurance companies. 

1. Sleep apnea appliances

Sleep apnea is a medical condition characterized by the patient not being able to breathe properly at night, usually because the airway is being blocked off. This medical condition can often be treated by using an oral appliance to bring the jaw forward and maintain the airway open. 

2. Surgical extractions

In some cases, tooth extractions will be covered. This is more likely if you are having multiple teeth removed at once and almost assured if the extractions are necessary because of an injury.

3. Wisdom teeth removal

Leaving wisdom teeth in your mouth that should be removed can cause health problems in some cases. On a limited case-by-case basis, medical insurance may cover this procedure.

4. TMJ night guards and appliances

The temporomandibular joint (TMJ) connects the jaw to the temporal bones in the skull. Problems with this joint can cause pain in the surrounding area as well as severe headaches that may be alleviated by TMJ dental devices. 

5. Laser surgery when you have severe periodontal disease

Though not yet well understood, periodontal disease can have a systemic effect on your body and affect issues such as cardiovascular disease. As such, treatments for periodontal diseases, such as laser surgery, can be considered a medical issue.

6. CT scans

CT scans are used as a diagnostic tool for procedures such as implants or cavities. Sometimes, dental x-rays don’t offer the complete picture, and a CT scan can allow your dentist to get a closer look.

7. Dental implants

Missing teeth are more than just a cosmetic issue. Your jaw needs all your teeth to help properly support the structure of your face. There are also other health issues that may arise when you have missing teeth, prompting medical insurance to cover the cost. 

8. Bone grafting

Was your bone loss caused by a medical reason such as trauma or cancer? Bone grafts to correct this are often eligible for coverage. 

9. Frenectomy surgery

Some infants and children need tongue surgery to correct issues in the mouth. This is considered a medical procedure.

10. Congenital defects

If the root cause of your oral health issues is a congenital defect, health insurance may cover treatment.

11. Botox injections

You might be wondering if you read that right, but yes, sometimes Botox injections can be covered. However, they need to be for non-cosmetic reasons such as to treat bruxism and jaw pain.

12. Mucosititis and stomatititis 

The effects of chemotherapy and similar treatments can ravage your entire body. Oral health problems related to these treatments may be covered.

Getting a little help with all this

Wondering how to know if your dental procedure might be covered by medical insurance? Your dentist’s office is an excellent resource. In fact, they’ll be the ones coding the procedure and billing your insurance company and the codes they use can have an impact on whether the claim is approved. Find a dentist who is willing to work with you on billing your medical insurance. It can make all the difference.

However, don’t be upset with the dentist’s office if the claim is denied. After all, they’re doing their best to help you out and ensure your best dental health. They’ll make an educated guess about what your medical insurance is likely to cover, but they won’t always be right. 

If coverage is denied, it’s possible your dental office will offer a payment plan to help you cover the cost of your dental work. They are 100% on your side and will do what they can to help ease the burden.

Save money on dental procedures the easy way

The good news is that you don’t have to learn all the ins and outs of medical billing to ensure you can save money on your dental visit. Your dentist’s office will give you their best guess as to if your procedure will be covered. They’ll also handle all the coding and filing of the paperwork. All you have to do is cross your fingers and hope for the best. 

Again, your dentist’s office can’t assure you that your claim will be paid. However, they’ve already seen many people who needed the same procedures and have an idea of what your insurance will pay. 

Looking for an awesome dentist near you? If you don’t already have one in your area, this is the time to hire one. Don’t shy away too quickly, there’s a great new way to find a perfect fit. Find a dentist through our platform here at Opencare today and level up your oral wellness!

The post How to make your dental work cheaper: 12 dental procedures that might be covered by medical insurance appeared first on The Floss By Opencare.

A business plan. Your practice simply has to have one. It’s going to lay out all the detailed information that helps you set your practice on the road to success. It’ll include market analysis, a marketing plan, competitive analysis, cash flow projections, and more. 

In essence, a business plan allows you to track, monitor, and evaluate the progress of your practice over a period of time. It allows you to gauge how your practice is progressing against your original projections for your business. This, in turn, will make it easier to make an objective evaluation of your practice’s progress. 

And it functions as an essential marketing document. It helps show stakeholders in your business that your practice is sustainable and worth investing in, whether that investment is monetary or time-based. 

Your business plan should be a living document. As you gain experience and achieve goals, the plan should be modified to reflect changing goals and knowledge you have gained during the time the practice has been in operation. 

Business plans provide you with a detailed guideline on what steps you need to follow in order to ensure your practice is a success and that it achieves both your short-term and long-term goals. They are an invaluable strategic tool that every dental plan should carefully consider and craft before opening their business. 

Each individual business plan will be unique to you and your business. However, here are some guidelines you can follow to make the process of creating your business plan easier. Some basic elements any business plan should incorporate include:

Executive summary

The executive summary is perhaps one of the most essential parts of the plan. It’s a short section at the start of the plan that summarizes the plan as a whole. Typically, this section is one to two pages in length.

Some elements that should be summarized as part of the executive summary are:

• Legal structure: Key to establishing your practice, determine what type of business it will be. If you’re setting up a partnership, this section should also include percentage ownership of each partner. Other elements that you should mention include resources like attorneys and accountants who will be part of your support team.
• Services provided: Explain which dental services you will be providing in your practice. This section will also clarify what your practice’s unique value proposition will be — what sets it apart from those of your competitors and other dentists near you.
• Goals: List the overall goals of your practice by priority. You should start with the mission statement and then list out the specific goals.
• Market analysis: An analysis of the dental landscape in your area and your practice’s ability to meet your identified needs.
• Marketing strategy: A quick summary of which strategies you will be employing. This section should be a response to the market analysis, and you should go into more detail in the marketing plan part of the business plan.
• Break-even point: This will also be part of the financial plan and analyses how viable your practice is at the current time.
• Operations plan summary: Summarize what systems you have in place in order to increase the growth of your practice. You will need to go into more detail in the operations plan section.
• Organizational / staffing structure: A summary of how many staff you have, their responsibilities and roles, and a forecast of personnel needs.

This section is key when you approach lenders for loans. It should be enticing to potential lenders and explain how you plan to make your practice a success. Therefore, it should be persuasive and compelling.

While this section goes at the start of your plan, you should write it last. This is because it is a summary of the rest of the plan, and you will need to have a detailed plan completed before you can write it.

Description of products and services

In this section, you should elaborate on the types of services your practice will provide patients. Explain whether specialty services will be performed in-house or will be referred to outside practices and doctors.

If you’re acquiring an existing practice as opposed to opening a new one, clarify any changes you’ll be implementing to the products and services the practice is already offering. 

Operations plan 

This is where you detail the operational systems that will help you run your practice, meet your goals, and measure how effective you are at achieving your aims.

It will describe how you will procure the products needed to keep the business running, what personnel will be part of your business, and how you will manage your inventory. You’ll also detail factors like hours of operation, any licenses and permits you’ll require before opening, dental insurances that your practice will and will not accept, schedule for equipment maintenance, and so on.

One of the most important parts of your operations plan is detailing a one-year action plan. This will serve as a template for you to follow and help you detail what steps you need to take to ensure your plan is a success.

This section is the ‘nuts-and-bolts’ part of your plan and is likely to be the longest section of your business plan. Managing operations efficiently helps increase profitability and decrease stress. Without an efficient operations plan, you will find meeting objectives and goals a challenging task. 

Market analysis and marketing plan

This is where you’ll document data on how your competitors operate. Some parts of your competitors’ practices you may want to look at include their online presence, SEO rankings, how they manage their digital content, and any other marketing efforts you think is relevant.

Once you have conducted a market analysis of your competitors, you’ll also need to document your own marketing plan. Elements you should include as part of your plan include an overview of your intended market and the type of patients you plan to target, their income level, age, and lifestyle.

You should also clearly set out how you plan to set your business apart from competitors and maintain your own customer base. For example, if you operate in close proximity to another dental practice, how will you ensure patients looking to find a dentist visit your practice over that of your competitor?

Make sure to conduct a SWOT analysis. This is an analysis of your practice’s strengths and weaknesses, as well as the market opportunities you can take advantage of and the threats that your practice faces. This will help you better personalize your marketing plan to your goals while also considering outside factors that could hinder those goals and detailing how you will overcome those issues. 

Your marketing strategy should focus on developing awareness of your practice amongst prospective patients. This will include the use of internal marketing (brochures, posters, newsletters, etc.), external marketing (direct mail, email, advertising, online marketing through websites and social media, etc.), and customer service to ensure your patients have a good experience and keep on returning to your practice.

One key element of the marketing plan for modern dental practices is to map out their website design. Having a well-designed website can help you stand out from competitors and can be hugely beneficial in attracting patients. For example, suppose patients are able to make a dentist appointment online quickly. In that case, they are more likely to choose your practice over a competitor that makes it difficult to schedule an appointment. 

If your marketing strategy is going to be significantly different from that of your competitors, you should also explain the rationale behind your choice as part of your strategy.

Financial plan

A financial plan is a key component of the marketing plan and will be the section that’s of most interest to potential lenders. If you’re approaching banks or other individuals for a loan, this section will help them make an informed decision over whether or not to lend to you. Due to its importance, this section should be carefully planned out and meticulously written.

For new practices, the financial plan will be based on 12 and 24-month financial projections, as you won’t already have an existing performance to base it off. Some key elements that you should include in your financial plan include:

• Income projections over a 12 and 24-month period
• Your personal financial statement 
• Collateral you’ll offer in exchange for a loan
• The total amount of funds that will be required by your practice for a 24-month period
• A plan for how the funds will be allocated
• Cash flow forecast
• Historical financial analysis looking into the viability of a dental practice
• Supporting documents that may be required by the lender, including a copy of your credit report, historical financial statements, five-year financial projections, and any other relevant document

Your financial plan should lay out a plan that accounts for the impact of outside financial influences that will affect your finances. These influences include competition, the economy, seasonal variations, and business cycles, as well as any other factors that will impact your practice’s financials. 

Business plan checklist

If you’re just getting started on creating your business plan, there are a variety of templates and checklists that are easily available online. One free downloadable and printable checklist that you can use is this one.

Before you get started on making your business plan, the American Dental Association (ADA) you make sure to ask yourself some important questions, including: 

• Can you describe your potential dental practice in detail?
• Do you have an actionable marketing plan?
• Who is in the market? What are they doing right — or wrong?
• What pricing and payment policies are you considering?
• What’s your growth strategy?

These will help provide you with a guideline you can refer back to when writing your detailed plan.

The ADA also provides a business plan checklist that is tailored to dental practices. You can download the checklist here.

FAQs about dental practice business plans

• How much does it cost to open a dental office?

While start-up costs will differ based on where your practice is located and the types of services you plan on offering, the estimated cost of starting a dental practice can be upwards of $450,000, with up to a third of that being equipment costs.

• How profitable is a dental practice?

On average, dental practices can have about a 25% profit margin. This profit margin can be more, depending on your specialty, location, and overhead costs. It is also possible to increase the profit margin of a dental practice in a variety of ways. For new practices, it your business plan allow you a profit margin of at least 40%.

• How much does a dental office make a year?

The amount you earn is dependent on the type of services your practice offers, including whether or not you offer specialty services. On average, general practices earn around $770,000 a year, while specialty practices can make around $1.1 million annually. 

• How do I write a business plan for a mobile dental clinic?

If you’re planning a mobile dental clinic, the process for writing a business plan is similar to that of writing a plan for a traditional practice. The steps you need to follow will be the same, and any lenders will expect you to present the same information as part of your business plan.

Remember, the executive summary and the financial plan are two key aspects of your business plan when approaching lenders. A well thought-out and well-written business plan does not only make your practice more appealing to lenders but it also provides you with a blueprint to follow in order to achieve personal and business-related goals. So when you’re writing out your business plan, regardless of whether it is for a traditional practice or a mobile clinic, make sure to include all the relevant details.

The post How to write a business plan for your dental practice appeared first on The Floss By Opencare.

Dental health is vital to your overall well-being. However, few people know much about the various types of dental insurance, how they work, or how to leverage them to keep their dental and overall health in good shape.

In fact, about 28 percent of Americans don’t have any dental insurance at all. Among those who do have it, many make costly mistakes with how they use it.

So let us guide you through how dental insurance works, understanding dental insurance billing and plans, and the questions you need to ask yourself to make sure you choose the best option for yourself and/or your loved ones.

How Does Dental Insurance Work: What’s Covered, What’s Not

In America, the Affordable Care Act (ACA) doesn’t provide dental coverage for adults and there are no penalties for not having it. This is because health insurance and dental insurance are entirely separate from each other. In some ways these types of insurance are similar, but there are also distinct differences in how coverage works.

Dental insurance policies can vary widely depending on the provider. You pay a premium based on the type of plan you choose and where you’re located. Many people pay around $50 per month. You may also have a deductible to pay before your insurance pays for any procedures.

In general, dental insurance breaks procedures into three categories: Preventative, basic, and major.

Usually, preventative care—such as twice annual cleanings, checkups, and x-rays—are completely covered with insurance. Sometimes the wording may be explicit about paying for a preventative visit every six months (but not closer together), while other policies may be more lenient within a 12-month period.

Basic procedures like silver fillings, root canals, or dentures are often 80 percent covered. You’re only covered 50 percent for major procedures, which may include crowns (which you typically get after a root canal), implants, and more. You cover the remaining costs out of pocket. The balance you pay is called coinsurance. At the time of the procedure, you may also have a copay. A copay is a set dollar amount you contribute.

However, there’s a bit more to dental insurance than just the 100-80-50 structure and your premiums.

First of all, most dental insurances have a waiting period of six to twelve months (or more) before they will cover anything besides preventative care. Periodontics and prosthodontics might not be available in your first year. If you need a major procedure just a few months after signing up for dental insurance, they likely won’t help with any of the costs. Also note that dental plans may not cover any pre-existing conditions.

A significant way in which dental insurance is different than health insurance is how annual maximums work. Whereas your health insurance might cover all costs after your deductible, dental insurance doesn’t work this way. Dental insurance has an annual maximum of what it will pay, which is typically around $1000-$1500 per year. After that, you pay out of pocket for all costs until the next calendar year. All of the costs mentioned are for during regular business hours. Prices may vary for after-hours visits or urgent care.

Dental insurance will not cover any cosmetic procedures. Cosmetic procedures may include teeth whitening, veneers, tooth shaping, and gum contouring. Some policies cover braces, but others require a rider. A rider doesn’t come with a basic insurance policy, but is instead a provision that adds benefits or amends the terms of the policy.

Different Types of Dental Insurance

Dental insurance prices vary depending on where you live as well as which type of dental insurance you choose. The plan you choose will affect your premiums, which dentists are covered, and the percentage of procedure costs you’ll pay.

Dental Health Maintenance Organization (DHMO)

DHMOs, also referred to as Dental HMOs, work similarly to a health insurance HMO.

This type of plan provides a network of dentists who accept the plan for a set copay or no fee. Members receive discounted rates for services and this type of plan typically has the lowest premiums, no deductibles, and no annual fee. Depending on the plan, your waiting period for major dental work may be short or nonexistent. The most significant downside to a DHMO is you’re unlikely to be allowed to see an out-of-network dentist.

Preferred Provider Organization (PPO)

PPO insurance usually has a broader network of approved dentists than a DHMO plan. You can choose to see a dentist outside the network, but it costs more. In exchange for more dental options, members pay higher premiums and deductibles. PPOs often have a maximum amount they’ll reimburse each year and some have a waiting period before coverage starts.

Point of Service Plans (POS)

A POS plan combines elements of an HMO plan and a PPO plan. The plan allows the use of out-of-network services, but the benefits are much less than if you use an in-network provider. Your benefits are determined at the time of service, depending on whether the dentist is in the network or not.

Dental Indemnity Insurance

Indemnity dental insurance, also referred to as “fee-for-service,” is usually only available to groups of people through workplaces. Your chosen plan reimburses a percentage of the dental provider’s fee. This type of insurance typically covers the broadest range of procedures, but they still have a few exceptions. The good news is that they usually have lower deductibles and higher maximum coverage limits than other plans. However, you have to pay a deductible upfront and your premiums tend to be higher.

Table or Schedule of Allowances Plans

These are indemnity plans that pay a predetermined dollar amount for each of your procedures—no matter what the actual charges are. On your end, you pay the difference between the charged fee and the carrier’s payment. Sometimes your plan is paired with a PPO to limit how much the dentists are allowed to charge.

Direct Reimbursement

Unlike how other plans focus on the type of treatments you receive, this insurance bases your benefits on dollars spent. This self-funded (or employer-funded) plan allows you to choose what dentist you want to see. Depending on the terms of the policy you choose, you either pay the dentist directly or your benefit is assigned to the dental office. You then sometimes submit a paid receipt or other proof of treatment. Finally, you’re reimbursed a percentage of the dental costs.

Dental Discount Plans

Technically, dental discount plans aren’t a type of insurance, but they do save you money on dental care. You pay a fixed annual fee and in return receive a predetermined discount off the standard price of the dental treatment. In most cases, your annual fee covers your preventative cleanings and checkups as well. Dental discount plans have a much simpler structure than insurance plans, so you don’t have a lot of paperwork to complete and instead receive your discount right away. These plans used to be sold only to individuals, but it’s becoming more popular for employers to purchase these plans for company employees as well.

Why You Should Always Try to Choose an In-Network Dentist

Several types of insurance plans will charge you more money if you use an out-of-network dentist rather than an in-network one. An in-network dentist is one who has an agreement about the terms and provisions with your dental insurance provider.

This agreement means the procedural fees are set and you have a better idea of what you’ll end up paying—which is usually less with an in-network dentist.

The majority of dental offices will accept your insurance even if they aren’t in network. This can result in you paying far more than anticipated. They don’t have any agreements with your insurance on what appropriate prices are for procedures. If they decide to charge more than your insurance expects, you’re the one who has to make up the difference out of pocket.

Questions to Consider When Choosing Dental Insurance

Several factors affect which type of dental insurance is best fitted to your situation.

In most cases, dental benefits from an employer are an affordable, easy choice. However, this isn’t an option for all people. Ask yourself these questions when you need to choose a dental insurance plan on your own:

• Is there a specific dentist or specialist I want to see?

• What is the annual maximum?

• What is the deductible (if any)?

• Is there a waiting period for coverage?

• What is the copay percentage?

• Are there limitations for pre-existing conditions?

• Is there emergency treatment coverage?

If you’re considering investing in dental insurance, it’s essential to understand how it works. Knowing the key differences between types of dental insurance plans, and choosing the best option for you, could end up saving you a significant amount of money.

In some situations, dental insurance may end up not saving you money at all. It’s always worth the time to research which plan would likely benefit you most. No matter which type of dental insurance you choose (if any at all), the best way to save money on dental care is to keep your mouth healthy. Make sure to brush, floss, and visit a dentist regularly.

The post How does dental insurance work? An overview of coverage appeared first on The Floss By Opencare.

Based on reports from the American Dental Association, the average new patient retention is 41%. Overall, dentists keep just 4 out of 10 new patients after their first appointment. Just a 10% improvement in these statistics would add thousands of dollars in revenue every year.

So how do you improve dental patient retention? What kind of strategies and efforts should you implement to get patients to return to your dental office? Let’s look at four things you can do to help create an ongoing engagement with each patient.

1) Treatment planner

Making reminders and appointment scheduling is not enough for successful dental patient retention. You need to hold your team accountable and measure their success. This will help boost your performance and retention.

According to the Dawson Academy, a dental office needs treatment planning protocols. These protocols should feature a practical and easy-to-use checklist. The process can be useful for any patient, regardless of how complex their dental issue might be. 

With an option like this, dentists can get proper quality control throughout the entire process. The planning begins with the dentist completing a two-dimensional functional-esthetic analysis. This checklist helps them address macro and global esthetics. As well as occlusal stability. 

They would then need to add their treatment plan to 3D models. When they stick to this planning process, dentists can provide better patient care and function smoothly. That’s how they build loyal dental patients in the long haul. 

Not sure if you can make the cut? Opencare can provide full insurance verification breakdowns. We can also help you make confident and effective treatment plans for your dental office. The platform can help you grow and manage your business. 

2) Effective patient education

Almost 3.5 billion people around the globe have oral diseases. Experts believe 2.3 billion suffer from dental caries. While 10% of the population has severe periodontal disease. The reason for that is relatively simple. Many people are simply unaware of how bad their teeth diseases can get.

If you want to get patients to return, you need to give them a reason to. It’s up to the dentist to educate patients and inspire them to book a dentist appointment. 

For example, tell your patient if they ignore the cavity, it will continue to expand. If a tooth decays, it will make you vulnerable to brittle teeth. It might cost $200 to get the teeth fixed now. But, if you don’t treat the issue and more oral diseases emerge, then you’ll be spending $2,000 down the road.

Simply put, a dentist needs to build trust and rapport with patients – and master their soft skills.

3) Provide flexible payment options

The cost of regular dental services is usually the main reason people don’t want to find a dentist. Regular dental care is just too expensive. According to a University of Michigan National Poll, 69% of people surveyed said they couldn’t afford regular dental care. It just wasn’t in their budget.

By offering clients flexible payment options, you can overcome these financial pitfalls. For instance, you can give constant patients special discounts, financing, or even a fun points system. With every visit, patients can collect points, which can serve as a discount. 

Another practical idea is to help them understand their insurance coverage. So, the next time a patient needs to book an appointment, they’ll be more inclined to use your affordable services.

By joining our Opencare platform, you can optimize your revenue cycle management. With our services, you can learn useful practices for verifying the patient’s insurance. Our team of experts will guide you every step of the way. We make treatment plans easy with full insurance verification services. 

4) Help patients make the most of the care they pay for

Many insurance plans have high out-of-pocket costs and deductibles. Unfortunately, figuring out the insurance policy can be overwhelming. You can win over patients by helping them get the hang of their expenses. 

Today, dental patients have high expectations. They want their dental practice to take care of their treatment, scheduling, and insurance. If you don’t give them the service they need, some other office will. 

To keep loyal dental patients, start by preparing simple brochures. These brochures should explain everything about copayments, insurance, and coverage. Mix that information with practical examples they can find in real life. This will help orient patients.

Don’t forget to talk about your copayments in detail. Some dental offices require complete up-front payments. Others prefer up-front copayments. Whereas some services don’t even ask for copayment until they have acquired the insurance reimbursement. 

Basically, you should become an advocate for your clients. That’s how you build effective dental patient retention. 

Final thoughts

Working on your patient retention rate is no easy feat. There’s plenty of effort that goes into building a loyal clientele. But, with the right strategies and the proper approach, you can turn the tide. All the options listed here can help you overcome these obstacles. What matters is that you put as much attention into the patient’s financial needs as their dental care. 

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Every dental practice staff member knows the true lynchpin of the operation is the office manager.  This multi-skilled superstar must keep on top of the day-to-day running of the business, manage a team of disparate individuals, keep stock levels up to date, check insurance claims are being pursued in a timely manner and keep an eye on the bottom line.

Combining the job descriptions of logistics expert, sergeant major, accountant and agony aunt takes an incredibly special individual.  If you find a talented office manager, hold onto them with everything you’ve got. If your office manager isn’t properly supported, their effectively spinning plates and it’s only a matter of time before one comes crashing down! 

Three areas for immediate improvement

In what ways can you help this most crucial staff member manage their workload and keep everything running smoothly? It comes down to three things:

1. Time management – allocating their responsibilities effectively
2. Process support – providing software or serviced solutions that make day to day operations simpler
3. Financial management – feeling secure that things are on an even keel

With the above in mind, we’ve put together eight tips to help you support your office manager.

Eight strategies to help your office manager

1) Keep them off the phone

Ideally your office manager should not be covering the phones at all. They need to have an overview of the business. Instead, it’s your receptionist’s responsibility to help patients with booking appointments or spending time on the phone with insurance companies. Remember, it’s more cost-effective to hire extra reception staff than replace a burnt-out OM.

2) Automate or find faster solutions to routine activities

Insurance verification is one of the most mundane and repetitive tasks involved in running a dental practice.  

As the office manager staff at Waterview Dental reports: “One of the key time consumers for receptionists is insurance verification. Freeing up time from the receptionist in verifying insurance may be one of the keys to improving overall office efficiency.”

Your office manager and reception staff should not need to chase after patients’ eligibility. Fortunately, there are solutions that allow you to outsource insurance verification and billing claims. You can pre-verify patients before they turn up for their appointments and keep your office manager off of the phone with insurance companies.

3) Know the bottom line

Regularly check the practice’s financial performance against hard targets. This is perhaps the most important responsibility of a good practice manager. It may seem complex and stressful working out how the business is doing, but in fact it’s straightforward arithmetic. 

There are around 192 working days in the year for the typical dentist. Your practice should have at least an annual target but a monthly target is much more effective (T). Let’s say you have two hygienists pulling in a set amount per day (H). The daily target for your doctors’ daily billings is therefore:

T – (H*192) + 10%) / 192

The 10% is margin for error and allows for contingencies you can’t predict.  

4) Reinvent team roles

 Firstly, look at what aspects of your office manager’s role properly belong to administrators, reception staff or hygienists. It’s all too common for the OM role to become a catch-all for tasks that nobody else wants to do.

Secondly, start to think of your team as sharing in revenue generation. You can use automation and data pushed to desktops and even smartphones to demonstrate to assistants, hygienists, and doctors how they are performing and where they might upsell or prevent that most costly of syndromes – cancellations.

5) Invest in solutions

Proactively research ways to support them with software or outsourced services that optimize day to day efficiency. Whether it’s sending email marketing campaigns to customers, or scheduling appointment reminders or follow-up appointment prompts by text, there are straightforward and effective technological solutions to help generate revenue and keep those bookings rolling in.

6) Develop a claims schedule

Rather than applying an ad hoc approach to revenue protection, set aside a regular time slot each day, or each week, to chase up unreimbursed claims. This will improve cash flow, reducing anxiety. Revenue cycle management is key to a practice’s ongoing performance, and the good news is that much of this can be optimized through software solutions too.

7) Provide continual professional development

Make sure your office manager has protected time to keep up to date with new billing codes, new business practices, and developments within the industry. This ensures they remain integrated in the success of the business, and able to relay news to the team at the regular team meetings we sincerely hope you’re having!

8) Stick to tangible goals

Specified, concrete KPIs that can be measured are infinitely preferable to vague objectives. Make sure your OM buys into this process and that they devise a realistic set of goals against which to measure practice performance.  Reviews should take place at regular intervals. Remember, you are not primarily measuring their performance, but rather the success of the business.

Bonus tip: talk about it

And one more thing… when everyone’s frantically busy it can be hard to find time to take stock. But you need to do this. If it means closing the office for a Team Building Day, so be it.  

Perhaps you can combine a fun morning activity with open and honest conversation in the afternoon. It’s best not to attempt both simultaneously, however – it can be hard to offer meaningful criticism when you’re dodging paintball bullets or riding the rapids!

There should be no hierarchies at play when talking openly – and no consequences (other than business improvement) for anyone speaking their mind. If problems are brought up, make the conversation about ideas and creative solutions, rather than blame allocation.

Once you’ve talked about the practice, what’s working and what’s not, you should see an immediate boost in morale. Now everyone owns the solutions you’ve jointly agreed on.

Follow these tips and your office manager (and the rest of the team) will feel the benefit.

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Is this the year you mean to grow your practice, build accountability, and usher in a transformation? Perhaps you’re focused on attracting new patients, expanding your social media engagement, or improving profitability.

Whatever goals you may have for 2021, it’s wise to ensure they’re SMART. That stands for specific, measurable, achievable, realistic, and time-bound. Setting SMART goals will help you boost dental practice productivity, eliminate inefficiencies and enjoy higher revenues.

Here are seven power-packed strategies to incentivize your staff, innovate your dental practice management and up your productivity. 

1) Discover new ways to motivate your team 

It’s natural for your team’s productivity to fluctuate. But how can you promote a motivated and focused team that firmly believes in your goals for your practice? It starts with finding creative ways to incentivize and motivate team members.

There are no one-size-fits-all solutions when it comes to motivation. While some staff members will be motivated by authority and delegation, others will be by financial rewards or recognition. Employee of the Week and Month awards are age-old and traditional strategies that remain popular today. You can also explore (COVID-protocol-friendly) team-building exercises, luncheons, and activities to create a strong team spirit and a sense of community. 

Several experts believe a daily huddle is an excellent strategy to boost motivation levels and productivity. Before the working day begins, call your team for a quick meeting or a short session. You can revisit the week’s or day’s schedule, suggest changes, and take feedback for improvements. If an early morning huddle isn’t possible, you can schedule one right after lunch or at the end of the day. 

It’s also essential to build one-on-one relationships with employees and help them actualize their true potential. 

2) Master new marketing channels 

Dental practices rely on social media and digital marketing tools to acquire new patients and maintain client loyalty. More importantly, potential patients seek social verification to establish the credibility and credentials of a dentist. For instance, a patient looking to find a dentist will perform a Google search to explore directories, Facebook listings, and more. (Typically, Facebook introduces users to reviews from existing patients and clients.) 

If you’re still struggling to master digital marketing in 2021, you’re putting your dental practice at a significant disadvantage. So, what should you do? Aim to master one social media channel each quarter. It’s a SMART goal, and you can gradually work toward embracing multiple marketing channels over the course of a year.

For instance, start by revamping your Facebook layout and boost engagement on your website. Facebook is an excellent platform to generate leads and uplift your overall SEO game. In the next quarter, embrace email marketing to cement loyalty across new patients you’ve acquired through Facebook.

Mastering new marketing channels and tools will help you increase dental practice productivity by creating a dynamic marketing mix. 

3) Embrace paperless intake and treatment plans 

What’s one of the best ways to make your office more efficient and well-organized? Go paperless and embrace the numerous digital tools available to store and manage patient records. It’s a strategy that offers numerous advantages, such as making dental practice management eco-friendly and well organized.

If you have multiple employees to manage and handle paperwork, you’re wasting resources and resisting innovation. Today, many patients (especially your younger ones) seek digitized and paperless interactions, given the rise of telehealth and e-health records. Some patients may feel more comfortable filling out online forms or using apps to make a dentist appointment. 

Additionally, going paperless eliminates the clutter and promotes a well-organized and healthy workplace. Cloud computing, ehealth records, and digital tools also eliminate the possibilities of human error and boost efficiency. Digital check-ins and records also improve coordination and save loads of resources and time. 

Once you start reducing (and ultimately eliminating)  office stationery, printers, and storage costs, your dental practice can save thousands of dollars annually. You can spend all that money instead toward innovating, embracing new dental technologies, and revamping your practice. Efficient paperless transactions and communication will also help you win over patient trust and confidence. 

4) Promote transparency 

Be up front with your patients. It’s the first step in building their trust and confidence in your practice. Adopt a transparent and upfront method of presenting treatment costs.

You can print out brochures or pricing plans that patients can explore online and in-person while visiting your clinic. Outlining the costs without any hidden charges proves immensely effective at securing patients and increasing revenues. 

Patients fear dental services are likely to cost more than general healthcare services. You can build trust by shattering this belief. Maybe use your first consultation session to discuss treatment costs and insurance coverage. Walking your patient through their insurance coverage is instrumental in acquiring new patients and establishing loyalty. 

5) Use revenue cycle management processes

An efficient revenue cycle management system can help you expand your dental practice’s earning potential. Most dental practices struggle with claims management, EOB reconciliation, aged claims, and verifying insurance. Luckily, today there are numerous management tools and processes that offer superior convenience and ease. Find out more here.

You can explore revenue cycle management to innovate claims submission using your existing management software. You can also hire a trusted third party to verify the benefits and eligibility of payors on your behalf.

Employees often struggle to review and manage aged outstanding receivables and follow-ups. Luckily, you can outsource this sensitive responsibility by engaging a competent third party for an accounts receivable analysis. Essentially, revenue cycle management helps increase dental practice productivity by allowing employees to focus on core operations. 

6) Embrace the power of automation 

In 2021, automation powers some of every industry, be it healthcare, entertainment, tourism, or energy. Automation is the key to enhancing the consumer experience, building a powerful brand identity, and emerging atop the competition. 

As a dentist, you can’t ignore the potential automation offers to reduce expenses and drive dental practice productivity. You can automate numerous processes, such as financial bookkeeping, customer service management, appointments, and much more. There are multiple automation tools and solutions designed to automate marketing, accounting, employee salaries, and other activities.

Embracing these tools will free up your business resources and save up more money for core business innovation. Automation will also help promote efficiency and make dental practice management more effortless and straightforward. For instance, you can automate patient appointments through online forms and maintain an efficient digital schedule. 

These small but meaningful innovations have a far-reaching impact on boosting dental practice productivity. 

7) Revisit goals and progress

Ultimately, you can increase dental practice productivity and stay steadfastly focused on your goals by holding yourself and your team accountable. And doing that doesn’t have to be hard. Start by  organizing weekly and monthly meetings to revisit goals and examine the team’s progress. The key to boosting dental practice productivity is setting achievable milestones, evaluating progress, and celebrating growth. 

These goal evaluation meetings will help you motivate your team and ensure everyone is on the same page. Evaluate the contributions made by each employee, recognize their potential, and underscore their weaknesses. As a leader, you must increase dental practice productivity by identifying outdated practices and ushering in innovation.

It is also essential to get feedback from your team members, value their opinions and incorporate them effectively. If your team members feel unheard, they’re unlikely to align their goals with your ambitions. 

Final thoughts

Besides ensuring patient safety and quality treatments, you must also strategize to ensure profitability and dental practice productivity. This agenda requires you to adopt the mindset of a leader and innovator. In 2021, you can deploy multiple technological tools to boost efficiency, eliminate human errors and improve the patient experience.

If you’re just starting with a private dental practice, these SMART goals will help you create a well-organized foundation. It’s vital to prioritize digital marketing tools because potential patients rely on digital media to find credible dentists. It doesn’t have to be difficult, but with some dedication and energy, you can make your practice everything you want it to be. 

The post 7 tips to increase productivity and efficiency in your dental practice appeared first on The Floss By Opencare.