In past articles in Dentistry Today I have covered a common sense approach to making financial arrangements with patients. The main thrust of those articles is that all financial arrangements are made prior to the beginning of any treatment, while showing patients how they can afford their dental treatment. What I did not write about previously is how we manage the patient’s dental insurance in relation to the entire financial arrangement scheme. I have received numerous requests from readers to talk about a common sense based approach to handling a patient’s dental insurance, and that will be the topic of this article.
- Subscriber name and social security number.
- Insurance company name, address, and phone number, and the name of the insurance representative to whom you spoke
- Employer name and group number
- Maximum benefits
- Calendar year or benefit year
- How much has been used to date
- Deductible amount, family deductibles, and has deductible been met
- Any waiting periods
- Missing tooth exclusions
- Date of eligibility
- Is reimbursement based on usual, customary and reasonable (UCR) fees, or fee schedule?
- Break down of benefits in percentages:
Class I — Preventative
Class II — Restorative
Class III — Major
- In which class are endodontics, periodontics, and oral surgery?
- Are night guards, occlusal adjustments, frenectomies, bone grafts, and implants covered?
- Frequencies — Are exams, prophys, and bitewings allowed two times per calendar year or 6 months to the date? Is fluoride treatment covered once or twice per year, and is there an age limit?
In our office this checklist has been developed over the years, and we find that this will, in a nutshell, give us some very good ideas as to what the patient’s insurance is going to pay. Generally speaking, once you get through to an insurance representative, you can have all this information in less than five minutes. Unfortunately, occasionally you will get an insurance clerk on the phone who really has no clue as to what they are talking about. Our advice is to politely finish the conversation and call back until you are satisfied that the person on the other end of the phone knows the plan, or ask for a supervisor for clarification. We also make this call even if we know the insurance plan very well. The reason for this is we want to make sure the patient does in fact have this dental insurance. You may also find out from time to time that there may be subtle changes that have been made to the dental insurance plan.
Working with dental insurance can be a challenging experience. Using good common sense and an easy-to-use system can make handling the patient’s insurance predictable and rewarding, both for the patient and for your practice.
Dr. Malcmacher maintains a general and cosmetic private practice in Cleveland, Ohio. He is a researcher and consultant with Dentique, Inc, a dental product and management consulting firm. Dr. Malcmacher is a frequent contributor to the dental literature, an evaluator for Clinical Research Associates, a visiting lecturer at New York University School of Dentistry, and has served as a spokesperson for the Academy of General Dentistry. He is a consultant to the Council on Dental Practice of the American Dental Association. He can be reached at 27239 Wolf Road, Bay Village, OH 44140; (440) 892-1810; or email@example.com.