For many dental offices, insurance related issues can be complicated; staff members may not fully grasp all the intricacies of the industry to begin with, much less feel confident enough to answer insurance related questions patients might have concerning their plan.

For most offices the thought of “insurance made easy” evokes mixed emotions. When I worked in a dental office, not only did I have questions concerning dental insurance, but also questions about how to use the software created to make processing insurance more efficient. It was a full-time job and most practices don’t have the luxury of an in-house insurance coordinator.

Here are a few tips I learned not only from my experience as an office manager, but also as a liaison for an insurance company.

Tip #1 – Insurance questions regarding percentages, deductibles, co-pay and maximum allowable should be addressed by the Human Resources department for the patient’s specific employer. This is because each specific company purchases the plan they desire for their employees. Each HR department explains the plan details and extent of coverage to eligible employees during enrollment. As a dental staff member, attempting to explain specific coverage related details to a patient concerning his or her plan can be frustrating. Therefore, if a patient has questions like these, kindly suggest that they consult the human resources department of their place of employment.

Tip #2 – When using a software program to process claims, make sure you have completely linked all information about the insurance to the patient. It is important that you don’t skip any steps. Software is only able to generate estimated benefits depending on the totality of information in the system. Ensuring that adequate information is in the system may require some time and effort on the outset, but pays huge dividends in the long run.

Tips #3 – Make sure the information provided on claim forms is only that which is necessary.Know which number insurance companies use for processing claims and make that the designated number. If there is more than one number, the claim will be rejected. The massive machines used to read claims are calibrated to read only certain fields based on their protocols. In this case more is not better.

Tip #4 – All fields on the claim form must be generated with key strokes. Handwriting on claims will cause the claim to be rejected during the machine processing.

Tip #5 – We all wish insurance allowable fees were higher, and in order to ensure that the insurance company has a pulse on what standard fees are based on geographical location, it is necessary to make sure you are filing your standard fees on claim forms. Actuarial departments use this data in different geographical areas to evaluate the need to raise their allowable amounts. Help yourself and those in your area by showing insurance companies your current standard fees for dental procedures.

Tip #6 – Be patient. If you have to phone the insurance company for clarification on a claim, don’t be shy in asking to speak with a supervisor if your questions are not being answered. It’s okay. No one knows it all. Patience and persistence are key.

Tip #7 – Attend seminars sponsored by insurance companies when they are available, query insurance staff at booths during conventions, visit a dental insurance processing center. Knowledge makes for a deeper understanding in regards to a product or organization.

One comment on “Insurance Made Easy

  1. Tip # 7 is the best! I try to make it to every local dental insurance seminar or webinar for out-of-state carriers. They provide the best clarification of policies and give a lot of help with claims processing issues. It really does take the guess work out of submitting for difficult to bill/code procedures. Great Post!

Leave a Reply

Your email address will not be published. Required fields are marked *