Cusptips

Do you take my insurance?

13,221 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.

13,221 thoughts on “Do you take my insurance?”

  1. Treflri

    [b]Всем привет[/b])
    Будучи студентом, я наслаждался учебой до тех пор, пока не пришло время писать диплом. Но паниковать не стоило, ведь существуют компании, которые помогают с написанием и защитой диплома на отличные оценки!
    Изначально я искал информацию по теме: купить диплом в соликамске, купить диплом в невинномысске, купить диплом ссср, купить диплом в минусинске, купить диплом техникума, затем наткнулся на http://pokupki.bestforums.org/viewtopic.php?f=30&t=17800, где все мои учебные вопросы были решены!
    Удачи!

    Reply
  21. DavidNew

    Turn the cream of the crop when it comes to OnlyFans accounts. Get the most beneficent OF models for 2024 who resonate with your preferences and interests — engage yourself in the search.

    The essence of OnlyFans [url=https://medium.com/@onlyfans-free-trials/the-best-free-trial-and-free-onlyfans-for-2024-22421b5ed81d]https://medium.com/@onlyfans-free-trials/the-best-free-trial-and-free-onlyfans-for-2024-22421b5ed81d[/url] lies in that it is a subscription-based social media dais where creators are masterly to monetize their content by requesting monthly payments. Despite being introduced in 2016, OnlyFans has gained brobdingnagian approval, especially within the grown up show realm. Later its allure doesn’t solely zero in on nudity or porn as numerous genres find portrayal on the rostrum: suitableness, knowledge, music and more to indicate but a few.

    The manifestness of mature information on OnlyFans is totally clear. A kismet of creators charge of the plot as a solicitous way to earn loaded by means of posting pictures and videos with an definite focus. Nevertheless, in counting up to this weight on grown-up content, OnlyFans also backs creators from other divers fields. The tenets has enabled cosplayers, gamers, and storytellers in creativity to find their own game plan toward achievement alongside standing minus with innovation in their interactions with their fans on the platform.

    Let us opt for a closer look at some of the finest and most lucrative OnlyFans accounts representing the year 2024. Every account showcases distinct strategies in purport oeuvre and interaction.

    Reply
  22. Vernonjusia

    Пункт технического осмотра (просто техосмотр) является принципиальной частью организации защиты на дорогах. В кое-каких странах он является обязательным для всех автомобилей, чтобы гарантировать их соответствие эталонам безопасности и экологической приемлемости.

    Основная цель пт техосмотра – проверка технического состояния транспортного средства, также его экологической безопасности. В ходе осмотра могут проверяться такие характеристики, как тормоза, освещение, выхлопные газы, состояние шин и другие важные элементы.

    Результаты техосмотра определяют, можно ли продолжать использовать средство передвижения на дорогах либо требуется проведение ремонта. Отсутствие либо нарушение прохождения техосмотра может привести к штрафам или временному запрещению эксплуатации автомобиля.

    [url=https://yandex.ru/maps/org/tekhosmotr/11324347330/?ll=30.350471%2C59.827026&z=16]Пункт техосмотра[/url] является неотъемлемой долею заботы о безопасности на дорогах и помогает понизить вероятность аварий из-за технических неисправностей.

    Reply
  23. generalnay_uborka_njon

    Услуги генеральной уборки в Санкт-Петербурге: Экологичные чистящие средства
    генеральная уборка квартир в спб недорого [url=https://genuborka1.ru]https://genuborka1.ru[/url] .

    Reply
  26. dea1Hot

    Компания «КИП72» специализируется на производстве и поставке контрольно-измерительных приборов и оборудования для множества отраслей промышленности. Мы предлагаем широкий выбор продукции, включая датчики, анализаторы, измерители. Мы стремимся обеспечить клиентов высококачественными и надёжными приборами для контроля производственных процессов и управления технологическими операциями.
    Мы стремимся к постоянному развитию и совершенствованию нашей продукции, а также к расширению партнёрских связей с ведущими производителями и поставщиками оборудования. Мы – магазин, готовый предложить индивидуальные решения для любого клиента.
    «КИП72» активно участвует в жизни общества, поддерживая различные социальные и экологические проекты. Если вас интересует наша продукция или услуги, пожалуйста, свяжитесь с нами по контактам, указанным на официальном сайте фирмы https://www.kip72.ru/, мы будем рады ответить на все ваши вопросы и предложить взаимовыгодное сотрудничество.

    Reply
  36. posle_remonta_uborka_ifSi

    Профессиональные услуги клининга – уборка после ремонта
    стоимость уборки квартиры после ремонта [url=https://www.remontuborka1.ru/]https://www.remontuborka1.ru/[/url] .

    Reply
  37. RobertFub

    [url=https://mounjaro-kupit.su]mounjaro купить цена[/url] – мунжаро +для похудения, тирзепатид инструкция купить

    Reply
  39. MichaelFus

    [url=https://mounjaro-5mg.ru/mundzharo]мочегонные препараты +для похудения безопасные +для женщин[/url] – тирзепатид купить, тирзепатид купить

    Reply
  44. RonnieCak

    Хотите научиться готовить самые изысканные и сложные торты? В этом https://v1.skladchik.org/tags/tort/ разделе вы найдете множество подробных пошаговых рецептов самых трендовых и известных тортов с возможностью получить их за сущие копейки благодаря складчине. Готовьте с удовольствием и открывайте для себя новые рецепты вместе с Skladchik.org

    Reply
  45. Olywkah

    [url=http://sale-cloned-cards.net]http://sale-cloned-cards.net[/url]

    Item 1 Card Total Balance: $3100 – Price $ 110.00
    Item 3 Cards Total Balance $9600 – Price $ 180.00
    Item PayPal Transfers $ 500 – Price $ 49.00
    Item PayPal Transfers $ 2000 – Price $ 149.00
    Item Western Union Transfers $ 1000 – Price $ 99.00
    Item Western Union Transfers $ 300 – Price $ 249.00

    *Prices on the website may vary slightly

    [url=http://sale-cloned-cards.link]http://sale-cloned-cards.link[/url]

    Reply
  46. prays-list_klining_ofki

    Прайс-лист на клининговые услуги: узнайте расценки на уборку
    клиринг в спб цены [url=https://www.uborka-chistota.ru/]https://www.uborka-chistota.ru/[/url] .

    Reply

Leave a Comment

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