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Benefit checks for out of network insurances

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Benefit checks for out of network insurances

Most important for patients who have their initial visit in the dental office and want to know fees is to be sure that their insurance has a benefit for preventative care coverage.

Is this preventative care coverage available to the patient both in network and out of network?

Trying to figure this out is important.

Many policies will cover most of the expenses for the initial exam, x-rays and cleaning at most of the dental offices. And if there is a small balance remaining, the dental office may even choose to discount the preventative care to make this initial visit easier for the patient.

It’s a great opportunity for the patient to get to know the office and for the staff to get to know the patient and communicate what they see are the patient’s needs and to help determine the fees and the next steps for treatment. 

Initial exams and out of network benefits for preventative dental care

The initial visit is key for the doctors to help patients know what needs to be done and then they can estimate the fees and the benefits for the services.

Most insurances will pay for preventative care in and out of network.

There are a few dental insurances that only have in network benefits for preventative care.

This may be like a government run insurance, for example.

These government run plans may not pay for benefits for a cleaning or an initial exam or Xrays out of network. They may only allow the patient to go to an in-network provider, but most insurances will have an in and out of network benefit. 

The key is checking to make sure that insurances have some out of network coverage and then it’s clear that the initial visit will be covered, whether it’s in or out of network at the office. 

The first step is getting the insurance information from the patient, setting them up a time to come in. This is more efficient than trying to call the patient again to schedule. Then before the appointment time, doing a benefits check prior to that initial visit just to make sure there are benefits to visit your office for that initial visit. 

And then following up with the patient so that they know their benefits, especially if there is no insurance coverage. 

Especially if there’s any concern about that initial visit not being covered, then it’s good to follow up with the patient, and also to record that information in the practice management system for future reference.. 

Benefits for initial visit

As far as the benefits for that initial visit, you may put that into the practice management software so that if future patients have that group insurance number, that same plan, then that information will be in there.

If there is no out of network coverage and the office is expected to be out of network, then it’s important to let the patient know and especially because many dental patients will expect this initial visit to be at no cost or minimal cost if they think their insurance is going to cover the exams cleanings and x-rays.

So find out if there’s no out of network coverage and if the office is considered out of network and call and let the patient know.

Helping patients when there are no benefits for out of network insurances

If there are no benefits at the office, what are the other ways that we could help the patient?

Are there dental membership plans or other ideas that the office can do to help?

A good initial workflow is to try to help the patient get the information about their dental insurance.

Help them get scheduled, and then do a benefits check to see what their benefits are and make sure that whether they’re in network or out of network, there is out of network coverage for preventative care.

If there is only in-network coverage for preventative care, make sure your office is in network.

If your office is out of network and they only have in-network benefits for care, then make sure that you’re giving them some alternate ideas or some advanced notice so they won’t be surprised when they come in.

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