How to Make Insurance and Benefits Verification a Better Experience for Clinics and their Patients
The dental clinic’s employees must deal with many tasks, such as communicating with dentists and verifying their patients’ insurance and benefits. With so much going on, mistakes happen (“How to Avoid Delays and Denials”). Insurance and benefits verification must proceed smoothly and quickly without frustrating patients.
Staff should verify them as soon as possible to expedite the medical billing process. Helen B. Funk, “the office manager of Cosmopolitan Dental,” says that by verifying them before they see their patients, the employees can then tell them an approximation of their coverage on their appointment days (2016). Consequently, their patients could be in the clinic for a shorter amount of time and would only worry about their dental treatment. Regarding “Returning Patients,” the staff should record any alterations to their insurance or to its policies as they verify their insurance and benefits again (Swanson). New and old patients want to receive treatment without being bogged down by insurance details.
When mistakes in claims occur, clinics deal with unsatisfied patients. Sometimes, “[an] insurance company might reject a claim because a medical billing specialist incorrectly input patient or insurance information” (“Course 8: Medical Billing Errors”). It can deny claims “because of common billing errors or missing information, but can also [deny them] based on patient coverage” (“Course 8: Medical Billing Errors”). Patients may lose not only time by dealing with these mistakes, but also money based on the content of the claim (AIMS 2015). For example, according to Dental Support Essentials website’s article, “Common Dental Insurance Pitfalls – Part 1,” based on “preliminary information” regarding coverage for “restorative work,” employees thought that their patient would only pay half of their crowns treatment (2017). After the treatment, the insurance company denied their claim because it “considered crowns in their ‘major services’ category [instead of the restorative work category] and the patient did not have coverage for ‘major services’. Ultimately, the patient ended up having to pay 100 percent of the procedure…” (“Common Dental Insurance Pitfalls – Part 1” 2017). The staff must review claims again and research more thoroughly in order “to fully understand the treatment coverage and payment implications” (“Common Dental Insurance Pitfalls – Part 1” 2017; “Course 8: Medical Billing Errors”). According to Dr. Dorothy Kassab, President of Dental Claims Cleanup, problems regarding payment may lead the “angry” and disappointed patient to leave for another clinic and cause him or her “to refuse to pay for something they are not pleased with” (2016).
Although dentists must address their patients’ needs, in Dr. Mustafa Shah Khan’s article, “Starting a dental practice – How can you afford it?”, he says, “Unfortunately, the clinical side of dentistry is only half of what we do. Dentists and dental practices are small corporations. To be successful, we must not only have great clinical skills, but we must also understand the business side of dentistry” (2014). Part of running a business also involves creating a good experience for their patients by thoroughly verifying insurance and benefits early in order to increase retention rates.