If you were to survey most any dental office staff, they would likely admit that dealing with dental insurance is one of the most frustrating parts of their job. For your average small-business dental office, filing and accepting insurance benefits is akin to playing a game against a bigger, faster, stronger opponent who gets to change their rules between every play. Also, there is still no central database to easily confirm and explain the tens of thousands of dental plans on the market. With all the technology we possess, we still have to estimate to patients what their plans might or might not pay. It’s confusing to patients, doctors, and dental teams.
Let’s peek behind the scenes and see what your dental team might do on your behalf.
Despite current technology, figuring out dental benefits often starts with a long, drawn out phone call to an insurance call center so that your team can tell you what procedures are covered, what percentage they might be paid at, and how much your plan covers per year. This can sometimes be done on the internet. Unfortunately, the information gleaned at this stage is often out-of-date or incorrect. This is because many dental benefit plans are filled with clauses, provisions, and exceptions to the “standard” coverage. At best, dental offices learn what might or should be covered under a plan, plus a yearly coverage limit.
Once a procedure is performed, a claim can be electronically filed to the dental insurance company on your behalf. Sometimes, a claim is paid promptly. Other times, the insurance company will request more information. Your team will then send x-rays or charting or photos or explanations on your behalf. Sometimes, a claim will be flatly denied because of some obscure clause or plan waiting period. And sometimes, get this, we will receive a letter stating that the claim has shown up at the insurance company. Why would they do that? They send a useless letter because claims are supposed to be resolved in thirty or sixty days. A letter to your dentist at day twenty-nine or fifty-nine buys allows them to keep your money that much longer. That is one of the many tricks that they play.
Despite all the hassle, dental insurance is often a great benefit that allows millions of people access to dental care they might not get otherwise. Every little bit helps and some insurance to help pay for care is better than no help at all.
Until next week, keep smiling.
-Please send questions to Drs. Parrish at www.ParrishDental.com.