Dental Insurance and Benefits Verification on the Phone
The dental clinics’ staff must avoid spending a long time on the phone with insurance companies for verifying their patients’ insurance and benefits. Employees must attend to other matters in the clinics, like their patients and appealing claims (Kassab 2016; Schultz 2016). Offices must develop an efficient process to verify insurance and benefits over the phone.
The clinics’ staff spends much time verifying their patients’ insurance and benefits. According to Dr. Dorothy Kassab, president of Dental Claims Cleanup, “On average, there are 6 new full benefits verifications (new patients, emergency patients, existing patients with new insurance) that need to be obtained with an average 15 minute call time. That is 1.5 hrs [sic] on the phone” (2016). She also mentions, “many insurance reps do not give the correct information causing estimation errors or wrong plan setup,” causing employees to call the insurance companies again for the correct information (2016). Additionally, offices must call insurance companies many times “to obtain full benefits breakdowns due to more frequent insurance plan changes by employers” (Kassab 2016). They also must call insurance companies annually to receive new information about the insurances companies’ fee schedules (Kassab 2016).
Clinics should make their verification process more efficient over the phone by revising their forms and verifying insurance and benefits sooner. Jennifer Schultz, “founder of Virtual Dental Office and Dental Insurance Navigator,” claims, “To gather all of this information [such as individual codes, coverage percentages, deductible, history, remaining benefits, etc. on their benefit sheets] and enter it into your software can take as long as 30 minutes per patient” (2016). Helen B. Funk, “office manager of Cosmopolitan Dental,” recommends “[creating] an insurance verification form with the most frequently used procedure codes and other necessary details pertaining to your office” (2016). Schultz also recommends deleting uncommon treatments from the form since “[getting] code information for procedures that are completed only a few times a year is a waste of time. You can give estimates for those procedures (based on coverage percentages), schedule the patient, and send a preauthorization. Or you can call about that single procedure without taking the time to get the information every time” (2016). With a revised form, staff members could then verify their patients’ insurance and benefits more quickly. Offices could also verify insurance and benefits before the days of their patients’ appointments (Funk 2016). In addition to that, at the beginning of every year, “when most policies renew,” they should verify their patients’ benefits with their insurance companies (Schultz 2016). Afterwards, for regular patients, since the clinics’ staff knows their “history and remaining benefits if insurance payments are entered correctly into [the] software,” the staff does not have to call their insurance companies (Schultz 2016). For new patients “with a plan that has been checked,” the staff “[needs] only verify eligibility, history, and remaining benefits for that specific patient” (Schultz 2016).
With a more efficient verification process, staff members could have more time to address other needs in their dental office.