Insurance Verification & Estimates
February 2024
Our billing blogs often talk about the foundational workflows that set billing management up for success –insurance verification is no exception! Understanding a patient’s insurance coverage and benefits sets the stage for accurate treatment estimates and claim submissions. We assure you that prioritizing your insurance verification process will be time well spent. So, what is a good insurance verification?
Insurance Verification
There are 3 key components to a comprehensive dental or medical insurance verification:
(1) Benefit Coverage and Eligibility
This is the easiest information to gather. You can usually find information such as coverage percentages, eligibly status, effective date, maximum, deductible, and waiting period data on payer and/or network portals – many even offering direct data bridges to your practice management software.
(2) Guidelines, Limitations, etc.
Specific coverage information by procedure, including limitations, are often only available by calling a payer representative. Calling to obtain insurance verification information for every patient may seem daunting but, again, we assure you that prioritizing this level of detail will be time well spent. In fact, the ADA still strongly recommends verifying coverage by calling insurance customer service.
(3) Coordination of Benefits
Much like guidelines and limitations, specific details regarding a patient’s coordination of benefits from coverage through multiple policies (dental and medical) can often only be obtained during an insurance verification call with a payer representative. Read our billing blog on “Coordination of Benefits: Oral Surgery” for more information.
P.S. You can only verify insurance credentials that have been accurately obtained from the patient. Read our billing blog on “Maximizing Data: Data Entry” for more information.
Fee Schedules
Once you have comprehensive insurance verification information, your treatment estimates can be accurately determined – but only if you have up-to-date fee schedule information for your in-network payers! Having a current fee schedule for each payer you participate with is an essential tool for your practice. Read our billing blog on “Fee Schedules & Contracts” for more information.
Treatment Estimates
It’s pretty simple. A comprehensive insurance verification + fee schedules = accurate treatment estimate. And if you setup a workflow that prioritizing verification as soon as a patient’s first appointment is scheduled, then providing an accurate treatment estimate at the time of their consultation is easy!
Dental Billing & Consulting Professionals is always available to be a resource to you as you assess and prioritize this workflow in your practice. Our services are customized to your specific needs and goals. Call or text us at (860) 435-7344 any time to learn how we can support you in optimizing your billing management.