Cusptips

Do you take my insurance?

21,002 Comments / practice Management / By

Do you take my insurance?

Patients want to know their costs for treatment and what benefits their insurance can offer at your office.

They may call your office and ask, do you take my insurance?

The reality is most dental offices can file most all insurances. But the patient also really wants to know not only does the office take their insurance, they want to know what kind of benefits their insurance will pay at your office and if there are any negotiated in-network rates to help save costs.

They want to know whether the office is in network or out of network. So you really need to know more about the types of insurance and what type of insurance this patient has.

6 types of insurance

There are many types of insurance, here are 6:

1. Open panel freedom of choice

The open panel freedom of choice insurances. With these plans, a person can choose any
dentist and any dentist can choose to participate.

2. Closed panel insurance

These plans allow the patient to only be seen by a dentist who has a signed contract with
insurance.

3. PPO (preferred provider organizations)

PPOs are preferred provider organizations and this may be a patient who has in-network
coverage, where this may with an in-network provider who has signed a contract with the
insurance carrier to charge a reduced fee for the patients.

These patients may still have the option to see an out-of-network provider, but they may pay a greater share of the full fee.

4. EPOs

EPO is an exclusive provider organization and these patients can only see an in-network dentist and there are no out-of-network benefits.

5.Capitation plans

There are also capitation plans, which could be a DHMO – A dental health maintenance organization.

Dentists in these plans are paid a monthly fee to care for the patients, but the patient has to go to a contracted dentist.

6.Medicaid

There are also plans like Medicaid that are state run plans and the benefits are paid by the state.

The insurance coverage for these has to be verified for the date of service to be sure that the patient has eligible coverage and the patient has to go to an in-network provider.

So you can see there are a lot of complexities to this question. Do you take my insurance?

And the best thing a dental office can do is to help the patient get some answers about the benefits and help them to get the care they need.

That’s what the patient wants. They want answers about their benefits and they want to get the care they need.

Understanding insurance benefits

So try to help them understand their benefits in the most transparent way and recognize that it’s not only confusing for the patient, but it can also be confusing for the office sometimes.

For example, sometimes you may hear a patient has insurance X and you don’t recognize the
name of this insurance.

You may have never heard of insurance X before, but when you call the provider relations number on the back of the insurance card, you learn this insurance X uses the insurance Y fee schedule and your office is already a participating provider for insurance Y.

This could be a third-party administrator acting on behalf of insurance X so the patient can get in-network rates with the insurance Y provider.

Even though they have insurance X, they have in network coverage at your office with insurance Y networks, it’s very complex.

So sometimes the answer of whether the office is in network with a company is way more complicated than just looking at your list of insurance participation and knowing which insurances you’re in-network with at your office.

To know which patients get in-network rates at your office, you really have to dig a little deeper and be able to explain in-network and out of network benefits for the patient.

It’s important to them. They want to understand their insurance.

Most of the out-of-network providers can file the benefits for the patient to be seen out of network. The insurance may pay the same fee, but the patient is paying possibly a greater share of the fee, especially if they’re not getting the same reduced fee schedule.

This may happen if they’re not getting the reduced fee schedule or there could be a different percentage paid to out of network providers by the insurance.

Some out-of-network insurance coverage like Medicaid won’t pay a benefit if the patient goes out of network.

So you really need to know if the plan for the patient is a PPO or an EPO and many are PPOs
but some are EPOs and so we need to check the details.

If you’re certain that they’re in-network providers, you can just let the patient know yes and we can file this insurance.

But if you’re not sure if it’s an in-network provider, don’t just send the patient away struggling to find the care they need and not learning anything about their insurance.

Help the patient, help them understand their benefits.

Helping patients understand their benefits

Offer to do a benefits check.

Set up the patient in the computer with their contact information and their insurance group
information.

Get the provider relations number for the insurance and then create a system in your office to do these benefit checks.

Maybe you put their name on a clipboard, maybe you keep their names on a list on a spreadsheet.

You could even have an online form that you can enter the patient in and the staff member can track the patients who need a benefits check.

This form could even be made into a portal on your website to offer to do benefits checks for patients.

And then your staff member can look at the collected info to check benefits- always make sure after you do the benefits check that the patient gets a follow-up call and that the information is saved in the practice management software for reference.

What to do for the benefits check first?

First get a summary of benefits for the insurance, maybe on the phone or on the fax or using the online portals for the insurance. You can request a summary of the benefits that you can scan into your practice management software.

Ask the provider relations representative if your office is in network or are there any thirdparty administrators that cover this plan with your office. And note this information for your patient in the notes section of your practice management software. 

In general, it may help to annually update your insurance coverage for local employers in your practice management system so that it’s stored in your computer and after one call is made to the insurance, the information is saved for not just that patient but for other patients as well. Start with new patients or patients who have large treatment plans and questions about insurance benefits.

You can save this information by group number. Using the group number to name the plan will avoid duplicating plan information with multiple names in your software. Always add the date the information was check as part of the name for future reference. Save this benefit plan on file and to be able to link it to new patients when adding their group number to that same plan. And using the group number to name the insurance plan will help you make sure that you don’t duplicate the different plan names.

You don’t want to have to call the insurance multiple times, so try to have a consistent naming system. Having the information in your software helps so that way you can see the coverage for different categories of insurance benefits.

You can also add notes regarding the in-network coverage for your office and if there’s any third-party administrators that link this plan to your in-network providers. You can add information about frequency of services if helpful.

And now you can let the patient know more about the plan.

If it’s an EPO or a state plan like Medicaid, they may have to see an in-network provider.

If it’s an open panel plan, like many PPOs, they may be able to go to an in-network or an outof-network provider and you can let them know if your office is in-network or if you’re an
out-of-network provider for this plan, you can also let the patient know some estimated cost
ranges for a consult. 

If your office is an out-of-network provider, what percentage does their plan pay for exams and preventative care?

Is it a one hundred percent?

Do you have a copy of the plans fee schedule?

Can you offer to share your consultation price for the patient to first try the office?

You can let the patient know these costs for an initial visit- then once we have a detailed treatment plan based on the comprehensive dental exam – we can give a more accurate picture of costs for treatment based on what needs to be done.

You may want to let the patient know. We have lots of patients with your insurance who come here.

We can do a benefits check and follow up to let you know the benefits of your plan and the cost of your initial visit. And once we have a comprehensive treatment plan to take care of your needs, we can do more specific benefits checks based on what you need.

We can do a benefits check and follow up to let you know the cost of your visit. And then if we’re out of network, if the office is an out of network provider and the insurance will pay out of network, let the patient know what’s the cost for the initial cleaning or the initial consult. Have a set fee you can assure the patient for that first visit- and document it for other staff to know. 

Help patients avoid financial surprises

We don’t want patients to have financial surprises, so let the patient know that if you’re an in-network provider, out-of-network provider.

If you aren’t sure if you’re an in-network provider, offer to do a benefits check to get their information and follow up with an estimate for that first new patient visit.

Let them know this is the cost for the first visit, for the consult for the new patient or maybe a cleaning.

And then once we see you at the office, we can make a dental treatment plan to know what actually needs to be done and we can check benefits again after your first visit.

For the dental treatment, we will create the treatment plan and we may have a policy that if the treatment plan’s over a certain dollar amount, we’ll do a benefits check online or we’ll send the information to the insurance to request a pre-estimate for fees and we can get that information for the patient to avoid surprises.

But our goal is to get the patient the care they need and to help them better understand their benefits. We don’t want them to have any financial surprises.

So let’s try to get them the information they need and get them scheduled and get them a plan for care.

21,002 thoughts on “Do you take my insurance?”

  2. справочник кемерово

    Hi, i read your blog occasionally and i own a similar one and i was just curious if
    you get a lot of spam remarks? If so how do you prevent it, any plugin or
    anything you can recommend? I get so much lately it’s driving
    me crazy so any support is very much appreciated.

    Reply
  4. Raymondnog

    Susan Wojcicki began her career in technology as a marketing executive at Intel. Her significant break came when she joined Google in 1999 as their first marketing manager. At Google, Wojcicki played a crucial role in the company’s growth, overseeing the development of key products like AdSense and Google Video https://susanwojcicki.ru/.

    Reply
  11. LelandFip

    Изделия без маркировки изготовителя либо с маркировкой запрещающей аквачистку, принимаются в чистку только с согласия Клиента и обрабатываются по существующим технологиям, без претензий к качеству и товарному виду изделия [url=https://fabrika-himchistki.ru/khimchistka-kovrolina/]чистка ковролина[/url]

    Reply
  18. Dnrtmbt

    [b]Купить документ[/b] о получении высшего образования можно в нашей компании в столице.
    [url=http://meryvnmoraa.com/diplom-253897hyoor/]meryvnmoraa.com/diplom-253897hyoor[/url]
    [url=http://techhansha.com/diplom-kupit-922578vv/]techhansha.com/diplom-kupit-922578vv[/url]
    [url=http://elearning.ims-schulungen.de/blog/index.php?entryid=89480/]elearning.ims-schulungen.de/blog/index.php?entryid=89480[/url]
    [url=http://sbosiamedicolavoro.it/community/profile/ewancarrera2745/]sbosiamedicolavoro.it/community/profile/ewancarrera2745[/url]
    [url=http://userbookmark.com/story17636003/diplom/]userbookmark.com/story17636003/diplom[/url]

    Reply
  24. Trefhjh

    [u][b] Добрый день![/b][/u]
    Покупка диплома о среднем полном образовании: как избежать мошенничества?
    [url=http://lider-school174.com/forum/user/3160/]lider-school174.com/forum/user/3160[/url]
    Рады оказаться полезными!.

    Reply
  25. Michaelmeava

    Предоставляем возможность купить авто от прямого поставщика по достойной цене. Высококвалифицированные специалисты всегда помогут выбрать именно ту модель автомобиля, которая будет идеально отвечать всем вашим требованиям и пожеланиям [url=http://vykup-auto02.ru]китайский авто[/url]

    Reply
  28. Danrmur

    [u][b] Привет![/b][/u]
    Мы изготавливаем дипломы любых профессий.
    [url=http://gtj.kr/board_KtRj53/412098]gtj.kr/board_KtRj53/412098[/url]
    [url=http://itdongnam.com/diplom-147915ybwhw]itdongnam.com/diplom-147915ybwhw[/url]
    [url=http://justbevictorious.com/diplom-kupit-530346ao]justbevictorious.com/diplom-kupit-530346ao[/url]
    [url=http://starryjeju.com/?document_srl=5832414]starryjeju.com/?document_srl=5832414[/url]
    [url=http://ntep2008.com/index.php?name=webboard&file=read&id=33062]ntep2008.com/index.php?name=webboard&file=read&id=33062[/url]

    Reply
  29. LelandFip

    Изделия без маркировки изготовителя либо с маркировкой запрещающей аквачистку, принимаются в чистку только с согласия Клиента и обрабатываются по существующим технологиям, без претензий к качеству и товарному виду изделия [url=https://fabrika-himchistki.ru/khimchistka-kolyasok/]химчистка коляски цена[/url]

    Reply
  30. zapoy_vyvod_ujPr

    Вывод из запоя в наркологическом центре с гарантией результата
    Вывод из запоя в Алматы [url=https://vivodizzapoyavalmaty.kz/]Вывод из запоя в Алматы[/url] .

    Reply
  31. narkologiya_Almaty_xzMa

    Лечение зависимости в Алматы: Обзор ведущих наркологических центров
    Кодирование от алкоголизма в Алматы [url=vivodizzapoyanadomu.kz]vivodizzapoyanadomu.kz[/url] .

    Reply
  33. Michaelmeava

    Предоставляем возможность купить авто от прямого поставщика по достойной цене. Высококвалифицированные специалисты всегда помогут выбрать именно ту модель автомобиля, которая будет идеально отвечать всем вашим требованиям и пожеланиям [url=http://vykup-auto02.ru]lixiang l9 max[/url]

    Reply
  34. MxitZmup

    Если вам нужны атласы, контурные карты, школьные учебники, тогда вам нужно зайти на наш сайт. На geo-gdz.ru вы найдете только полезную информацию. Здесь есть по геометрии Атанасяна для 7 класса решебник задач и другое. Можете контурные карты скачать и распечатать бесплатно. Мы стремимся сделать учебу наиболее интересной. Ищете готовые контурные? Geo-gdz.ru – сайт, который позволяет в прекрасный мир знаний погрузиться. Здесь можете в режиме онлайн изучить атласы и учебники. Абсолютно все картинки высокого качества. Ждем вас на нашем ресурсе!

    Reply
  38. 6isbe_ytpt

    Cummins 6 ISBe: Акции недели – успейте купить по выгодной цене
    двигатель камминз 6isbe [url=https://cummins-6isbe-1.ru/]https://cummins-6isbe-1.ru/[/url] .

    Reply
  40. dbshop.ru

    В нашем онлайн-магазине dbshop.ru и сервисной мастерской мы предоставляем не только широкий ассортимент автозвукового оборудования, но и обширный перечень профессиональных услуг, основанных на многолетний опыт работы. Наша группа экспертов способна выполнить самые трудные задания, будь то монтаж сигнализации с автозапуском или полная шумоизоляция вашего автомобиля. Если вам требуется [url=https://dbshop.ru/blog/sovety-pokupatelyam/top-5-sabvuferov-dlya-avtomobilya/]сабвуфер под сиденье[/url] наши специалисты помогут вам подобрать и осуществят монтаж идеальное оборудование. У нас вы обнаружите [url=https://dbshop.ru/product/4_kanalnyy_usilitel_pride_quattro/]pride усилитель 4х[/url] которые удовлетворят все ваши запросы. Мы сотрудничаем исключительно с брендами, обеспечивая высочайшее качество и долговечность установленного оборудования.

    Наш длительный опыт дает нам возможность предложить клиентам не просто продукцию, а комплексные решения, которые делают ваш автомобиль удобнее, безопаснее и приятнее в использовании. Мы дорожим доверием наших клиентов и всегда стараемся превзойти их ожидания, предоставляя высокий уровень сервиса и поддержки. Обратитесь к нам, и вы поймете, что профессионализм и качество — это не просто слова.

    Для заказа товаров и услуг свяжитесь с нами: г. Ижевск, ул. Коммунаров, 244, телефон +7 (3412) 91-21-21. Мы всегда готовы помочь вам сделать ваш автомобиль лучше.

    Reply
  41. FilizImani

    Зайдите на сайт https://perune.ru/ и вы сможете найти такие услуги как: трудоустройство за рубежом на круизные лайнеры, услуги по иммиграции в Европу, США, Канаду и другие страны, пройти стажировку в различных странах, а также сопутствующие трудоустройству услуги. Ознакомьтесь на сайте с вакансиями и различными программами. Обеспечим легальное пребывание в странах с высокой заработной платой.

    Reply
  45. dbshop.ru

    В нашем онлайн-магазине dbshop.ru и сервисном центре мы предоставляем не только широкий ассортимент автозвукового оборудования, но и множество профессиональных услуг, основанных на многолетний опыт работы. Наша команда специалистов готова выполнить самые сложные задачи, будь то монтаж сигнализации с автозапуском или комплексная шумоизоляция автомобиля. Если вам требуется [url=https://dbshop.ru/product/podiumy_lada_vesta_20_20_rupor/]штатная акустика веста[/url] наши эксперты помогут вам подобрать и осуществят монтаж идеальное оборудование. У нас вы найдете [url=https://dbshop.ru/product/korob_dlya_sabvufera_15_zya_polutrapetsiya/]закрытый короб 15[/url] которые удовлетворят все ваши потребности. Мы работаем только с проверенными брендами, гарантируя качество и надежность каждой установки.

    Наш многолетний опыт дает нам возможность предложить клиентам не просто продукцию, а комплексные решения, которые делают ваш автомобиль комфортнее, безопаснее и доставляющим удовольствие в эксплуатации. Мы дорожим доверием наших клиентов и всегда стремимся превзойти их ожидания, обеспечивая первоклассный сервис и поддержку. Обратитесь к нам, и вы убедитесь, что профессионализм и качество — это не просто слова.

    Чтобы сделать заказ позвоните нам: г. Ижевск, ул. Коммунаров, 244, телефон +7 (3412) 91-21-21. Мы всегда рады помочь вам сделать ваш автомобиль совершеннее.

    Reply
  47. Yrefeda

    [u][b] Привет![/b][/u]
    [b]Заказать диплом любого университета.[/b]
    [url=http://pirobot.co.uk/doku.php?id=rusddiplomscom/]pirobot.co.uk/doku.php?id=rusddiplomscom[/url]

    Reply
  50. Lazrtxr

    [u][b] Здравствуйте![/b][/u]
    [b]Мы изготавливаем дипломы[/b] любой профессии по приятным тарифам.
    [url=http://telegra.ph/pozdravit-s-postupleniem-v-vuz-08-02/]telegra.ph/pozdravit-s-postupleniem-v-vuz-08-02[/url]

    Reply

Leave a Comment

Your email address will not be published. Required fields are marked *