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If you have responsibility for managing dental insurance claims, having treatment and financial discussions with dental patients, and/or you are on the frontline answering patient questions about insurance and treatment scheduling, then, knowledge of these eight best practices will help you optimize both performance and the positive relations you have with your patients.

 

Even if you are not an insurance expert or a dedicated treatment or financial coordinator in your dental practice, group, or dental service organization (DSO), knowledge of these best practices will help you as you serve patients and support coworkers.

 

Step 1: Ensure You Have Latest Insurance Breakdown

Before having a discussion with your dental patient about the treatment fee, the patient’s insurance coverage, and the patient’s estimated out-of-pocket portion, make sure that the insurance breakdown in your computer is as up to date as possible. This allows you to feel confident that you have done as much as is you can to have accurate information.

 

Step 2: Review the Work to Be Done

Begin by reviewing what the doctor and hygienist have recommended for treatment, making sure that the patient is clear about the work to be done and the reason for it. This is done before the financial discussion.

 

Step 3: Show Patient the Full Cost 

The next step is to show the patient the estimate of the full cost of the treatment. Sit next to the patient with the estimation in front of you. Cover up the estimated insurance portion and the patient’s out-of-pocket portion. You can use a blank piece of paper as a cover and slide down the blank piece later in your presentation and conversation. 

 

Step 4: Ask this Question

The best words to use are like these:

“Mrs. Jones, regardless of what your insurance will cover, do you still plan to move forward with this work?” 

The response to this question will help you understand whether the patient is one that only accepts treatment if that treatment is fully covered. If that is the case, keep in mind that your job could be to help the patient figure out how to have the work done over time on an affordable budget. Don’t feel defeated if the answer to that question is no. Use that information to your advantage as you proceed with the financial conversation.

 

Step 5: Review Estimated Insurance and Patient Portion

Slide down the blank piece of paper to expose the additional information on the estimate. Review the estimated amounts that the insurance is expected to pay and that the patient can expect to pay. Use the word “estimated” frequently. Instill that word in the patient’s mind with repetition.

 

Step 6: Assure Patient You Are Doing Your Best

Tell the patient that you have taken the time to look into the insurance and have tried to be as accurate as possible. This provides a level of understanding that you are doing your best to know and understand their insurance, as well as minimizes the possibility that the patient will be upset if their out-of-pocket portion is higher than estimated.

At the bottom of the financial agreement, have a statement that says, “Insurance coverage is only an estimation.  Guarantor is financially responsible for all treatment not covered by insurance.” Review that statement and highlight it in front of the patient to make it clear that you are doing your best to reduce any surprises, and if the cost ends up higher, the patient understands you did your best to make it accurate.

 

Step 7: Have Patient Sign that Review Has Taken Place 

In addition to the signature line that gives consent to treatment, include a signature and date line that that indicates the dental treatment and insurance estimate have been reviewed with the patient.  Ask for this signature even if the patient does not agree to proceed with treatment. 

 

Step 8: Save a Copy

Give the patient the treatment plan insurance estimate and save an exact copy for your records. Keep your copy in scanned digital form for fast look up in your computer system. In digital form, review it over the phone with the patient, you can email it to the patient if the patient needs another copy, or you can print it there in the office to mail it or hand give to the patient.   

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