For all of you who verify insurance coverage on every patient coming in the next day, for all of you who verify insurance coverage on every procedure, for all of you who enjoy watching yellow stone set, for all of you who truly utilize about 30% of your practice management software system, for all of you who enjoy children screaming in your ear while doing a prophy, this article is for you!
The question is: when should you verify insurance coverage, and when should you not? Or I should ask: when is it valuable to verify insurance coverage and when should you not waste your time?
If it’s a new patient, then yes! When you ask your patient if they have changed insurance plans, and they have one you’ve never seen before, then yes! If you profile your patient and do not trust they have dental insurance because they give you an insurance card with the name “Goofy” on it, then yes! Or if you’re a specialist where you have no relationship with the patient, then yes! (or just call the referring GP office and get their insurance info from them)
What could possibly go wrong if you don’t verify insurance coverage on a long term existing patient, or a short-term one for that matter, and they have an insurance change? Will the earth stop rotating? Will Care Credit go bankrupt? (I hope not, we use them all the time for our patient financing)
The last 3 out of 10 offices we’ve been consulting with have had one full-time person who did nothing but verify insurance coverage on every patient who had a scheduled appointment the next day. In my private practice we have ANY team member do the following:
- Ask our existing patients if their insurance has had any changes.
- If yes, and we already have their new insurance in our system from our existing patients, then we enter their new information, hook them to the existing insurance, and do nothing else.
- If no, we do NOTHING!
- New patients we verify only if it’s an insurance we have never seen before, which happens about 2% of the time is all.
- We allow Dentrix (or any practice management system) to do the work it was programmed to do!
We actually had one of our patients this past week forget to tell us of his change in dental insurance. When we got the EOB back from his cleaning, and it read he wasn’t covered, we called him and got his updated insurance information. We then re-billed it using eClaims which is super-fast. Time spent? UNDER FIVE MINUTES!
Please tell me you’re seeing the business side of this. Wouldn’t you rather have that person whose job it is to verify insurance on recall, social media, and anything else that brings in bigger returns on time invested? Or do you suffer from status-quo-itis still? Or maybe you were just never told about this information before. You can no longer claim ignorance now!
What is the first thing you hear when you call an insurance company? Let me remind you: “anything we might say in our conversation with you is not a guarantee of benefits, payments, policies, promises, pinky swears, etc.”.
When we did our investigation of 26 dental insurance companies, with my colleagues at Panther Security and Investigations, and asked the question, “is it necessary to verify insurance coverage on every patient?”, here are some of the responses we received:
- Recommended, but not necessary. Meaning, we recommend it for our job security. If you don’t call us, we have nothing to do. We could lose our job…
- Doesn’t your practice management system already have the primary coverage tables built into their systems? Just follow those and you’ll be as close as we can get.
- Isn’t there better use of your time?
- They can call today, but it could easily change tomorrow. And we have so many different policies that you’ll want to know exactly which policy they have.
Let’s address point #4. When you signed your contract with the dental insurance company to become that illustrious coveted provider, you contracted with one set of contracted fees. So that’s not changing. It’s their “down-grading”, deductibles, and weird policies that they may have which may leave a balance owing. Guess what the simple solution is? Simply lower the coverage tables! That’s right, you lower the coverage tables and you’ll get closer than wasting time calling the insurance reps. That’s just one of many simplified business skills we teach at My Practice My Business Clinical Business of Dentistry Training. Making the jobs of our front office team members simpler is what we do.
Again, think about all the time it takes to contact dental insurance companies versus just dealing with the one or two who slip through the cracks. Our clients, when they can let go of “the way it’s always been”, or the “status-quo-itis” they experience what we have taught for years, more productive time for that team member!
DOCS, if you would like to send your office manager to our two-day course where they learn the above, AND WAY MORE, go to our website and get them signed up! It’s called: The Clinical Business of Dentistry: Front Office Training. This training is only for existing My Practice My Business clients. Not an MPMB client? Go through one of our amazing trainings. No fluff, just solid business training with guaranteed results. Visit www.mypracticemybusiness.com for more information.
Rob Thorup, DDS
Director of Clinical Development
And the Team at My Practice My Business