To Post at Full Fee vs Insurance Fee – That Is the Question

There is a question many offices face and it can be a difficult one to answer. Is it better to post at insurance plan fees that are in-network, enter all those fee schedules and update them each year, or is it better to post at full fee and adjust off the insurance write-off once the Explanation of Benefits is received?

Is that a loaded question, or what?! Unfortunately the answer is not a simple one and there are several things that must be considered. Insurance management never seems to be simple, does it? As with treatment, it boils down to benefits and detriments in your personal situation.

1. Determine your standard procedure

It starts with the practice’s goals for the practice and for being in-network with dental insurance plans. There are several factors that can make a difference in what decision would best fit. Some examples of goals might be:

  • The practice wants to remain in-network with as many plans as possible and has no desire to get off any plans
  • The practice would like to know which plans are no longer a benefit to the practice
  • The practice would like to wean off some of the harsher plans
  • The practice would like to not be in-network with any insurance plans and still retain their patients who are on those plans

2. Compare and contrast

What would give the most benefit to the practice would be to post at your full fee and adjust off the difference to individual insurance adjustment accounts (even if there are 30). This gives the practice the following benefits:

  • The practice can track how much would have been produced, if you were able to collect full fee
  • The practice can track how much each individual plan adjusts off your regular fee
  • The patient can see the full fee value of the procedure that was delivered and how much their dentist had to write off, so if the plan becomes too harsh in adjustments they will better understand why you can no longer be in-network
  • Claims are filed at full fee so if an insurance company decides to pay $17 more on a crown, you will get the benefit of that increase
  • You are influencing the insurance company to raise their benefits payable in your region

Having said that, it can also depend on what dental software is in the practice and what its capabilities are.

3. Track it

If you determine you want to be able to track more accurately what is going on in your practice, you do need to have a plan in place on how you will accurately calculate the patient’s portion. A Jameson Advisor or other professional coaches can help you to set up such a plan of action.

There are three things every in-network practice needs to know about each insurance plan they are in-network with:

  1. How much did each insurance plan produce in the last 12 months?
  2. How much was written off for each insurance plan for which the practice is in-network?
  3. What percentage of the active patients in the last 2 years is on each plan for which the practice is in-network?

Do you know the answers to these three questions for the insurance plans for which your practice is in-network?

Knowing these three things allows the practice to make educated decisions about what is the best way to handle being in-network with any insurance plan.

Insurance management is its own system that needs to be taken seriously and requires someone on the team investing time and energy to maximize. Be “insurance aware,” rather than “insurance driven,” and you can make the system a productive ally instead of a menacing foe.

2 thoughts on “To Post at Full Fee vs Insurance Fee – That Is the Question

  1. What great, practical information about submitting treatment fees to insurance plans and benefits to tracking this information

  2. My sister wants to have full dental braces, however, she’s not sure if her insurance will be able to cover all the expenses. It was mentioned here that she should properly evaluate what services should cut off and use. Moreover, for better guidance on insurance adjustments, it’s advisable to go to insurance experts.

Comments are closed.