Tips to effectively communicate that your dental office is in network or out of network with dental insurances
With dental insurance companies, a lot of patients will call and ask, do you take my insurance?
And this can mean different things.
Can the office file the insurance or is the office in network or out of network?
With dental insurance, there are some offices that may require cash payment for the services and then ask the patients to submit their own claims to insurances.
But this is a rare situation. Most offices will file the insurance for the patient and can accept payment.
So most offices can file the insurance for the patient, especially if the insurance has some type of out-of-network coverage.
The most useful information for the patient may be to know what are the in-network and out of network dental benefits and what percentage does insurance pay for preventative care like exams, x-rays and cleanings.
As long as the dental insurance covers out of network preventative care, this can give the patient a chance to set up an appointment to have an exam, take an X-ray, even have a cleaning and see what the treatment needs are.
The treatment plan can be made, and then an estimate of the insurance benefits and the remaining fees can be determined for those services that are required.
All of this can be explained to the patient before the treatment is done.
Communicating effectively with your patients about networks and insurance
it’s easier to give the patient some information regarding if your office is an out of network provider and if their insurance plan has out of network benefits. That is probably the most useful information for the patient.
It can actually be harder to tell the patient sometimes if the office is in network or out of network. It seems like it would be simple. But the reality is sometimes an office is in one dental network but there is a third-party administrator who also links other insurances to the dental office as well.
To repeat: Sometimes there is a dental office in one dental insurance network, but because of a third-party administrator for that insurance plan, the dental office is also linked to other dental insurances and other networks.
The office may think that they are out of network, but they’re actually an in-network dental office.
Alternatively, a dental office may think they are in-network and yet they have multiple dental providers and multiple dental locations and the insurance company may have failed to credential all the locations or all the dental providers.
In this case if the patient is seen for services and it’s supposed to be in network, but the dental insurance may treat it as an out-of-network claim if it was at one of the locations or one of the providers that wasn’t on the insurance credential list.
Because of these variables, when the patient asks the dental office if it’s in network or out of network, it’s easy for the dental office to give an answer that may not be consistent with how the dental insurance ultimately treats the claim..
It may not be how the insurance company ultimately files the claim. And for this reason, when a patient asks if an office is in network or out of network, it’s recommended to say:
“We will be happy to file your insurance. We are in network with a lot of insurances, but because a lot of these insurances are paid under different plans that may or we may or may not be in network with, we recommend that you please call the toll-free number on the back of your card and inquire directly with your insurance company. Most insurances will cover your preventative care for exams, X-rays and cleanings and we can get your information, schedule and appointment and our benefits specialist can call you prior to the next visit if you do not have coverage at our office for this visit.”
We recommend that the patient call their insurance plan and inquire using the provider’s name and address just to be sure you get the best information from your insurance company regarding if it’s considered in or out of network.
If our office and providers are in network or out of network, this protocol keeps the communication between the insurance and the patient and the office isn’t caught in the middle of the conversation if there’s a miscommunication.
The office can help the patient most by helping them determine if there’s some out of network benefits for preventative care and helping the patient understand these benefits.
Effectively communicate your dental office is in network or out of network with dental insurances
Then if the patient’s covered for an initial visit, whether it’s in network or out of network, then they can come in and any care that’s needed, any treatment that’s needed can be estimated. The fees can be estimated before the subsequent work is performed.