Belle DuCharme

CDPMA, Dental Training Consultant

Show your Patients Love by Getting their Claims Paid

Most dental practices will estimate insurance payments based on the benefits statement and then submit the claim for payment after services are rendered.  The patient is trusting that the business coordinator has the correct information and the insurance will pay as demonstrated on the treatment plan. 

According to the National Center for Health Statistics     , more regular visits are made to the dentist from people with insurance than without insurance. Having dental insurance coverage whether good or bad is a deciding motivator for your patients to show up.

In the business, we all know that “dental insurance” is not insurance but just a limited dollar benefit amount, yet to the patient, it makes a difference in whether they feel they can afford to come to the dentist or not.

Financial agreements in dental offices routinely state that the patient is responsible for payment whether the insurance pays or not.  The patient is focused on the insurance payment coming in so when they receive a statement saying the insurance company denied payment, they are not happy with you, not the insurance company.  Countless patients have terminated their relationship with their dentists due to insurance-related issues.

How can you get the claims paid and keep your patients?

  1. 1. Perform a detailed Insurance Verification prior to patient arrival or before rendering treatment.
  2. Submit the claims correctly the first time including all the patient information, narrative and required documentation for the claim such as x-rays and intra-oral photos and periodontal charting. Confirm the claims are being received by the software compliant Clearinghouse and check the insurance submittal reports daily.
  3. Follow up on all claims that are unpaid in two-three weeks, especially claims without attachments such as preventive or basic services that should pay within a couple of weeks.
  4. If you receive a denial, appeal immediately and let the patient know that you are working on getting it paid now.
  5. Outsource to an industry billing expert, if your front office person doesn’t have the time to sit on the phone investigating unpaid claims and writing narratives and appeal letters. The billing expert(s) can work behind the scenes and get the claims paid in a timely manner while your business team can concentrate on the patient and explaining treatment.

Many dentists and their teams learn that pleasing patients by helping them with their benefits keep them accepting new treatments.  It doesn’t mean that the patient is absolved from any financial responsibility it means that you care about developing a long term solid relationship with your patients.  

Dental Billing Tips and News for Pros; Edition #144


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