What do insurance breakdowns have to do with collections?

By Ashley Bond, DrBicuspid.com contributing writer

October 12, 2020 -- What is usually the first task we give to our untrained or new-to-the-dental-field employees? That's right, it's insurance breakdowns. We all have to do them, and to the dental veteran, it seems like it's as easy as 1-2-3 -- but is a breakdown really just a breakdown? Is your office just utilizing faxbacks or generic online portal information?

What if I told you that an insurance breakdown is one of the first steps in collecting 100% of what is rightfully yours? A great insurance breakdown keeps account balances from moving from current to the dreaded aging report.

Ashley Bond
Ashley Bond is the founder of Bond Dental Consultants.

But why are insurance breakdowns so important? Let's look at an example of how an accurate insurance breakdown could save your office from sending a patient to collections or possibly losing him or her.

The scenario

Susie calls the office as a new patient. She has MetLife insurance and wants to come in for a new patient exam.

You schedule Susie, then quickly get a faxback of her insurance breakdown. You are ecstatic that she has 100% coverage for preventative and diagnostic, and you scan her breakdown into her document center without second-guessing a thing.

Susie comes in for her comprehensive oral examination and a full mouth series (FMS) of x-rays and is on her way after scheduling her cleaning. About 20 days later, you get Susie's insurance payment and realize her FMS was not covered. It appears she was not eligible. Now Susie surprisingly owes your practice more than $100 without even getting her cleaning or consultation yet.

What could you have done?

The minute after you get off the phone with Susie, you call and get her insurance breakdown and history. When you follow up on Susie's history, the insurance representative lets you know that she is not eligible for an FMS because she had a panoramic x-ray a year ago at another dental office.

You gather the rest of your information and call Susie back right away. When calling Susie, you let her know that to properly diagnose her, your office typically does a full set of x-rays during her first appointment. You tell her that she is not eligible as her insurance company only pays for those x-rays once every three years.

With plenty of time before Susie's scheduled appointment, you ask her to follow up with her previous dentist to get her x-rays transferred and let her know that if they are of diagnostic quality, you will not have to retake them. If they are not of diagnostic quality, then you will explain her estimated portion when she comes in for her visit. You are able to explain to her that your office strives to get patients the best estimates possible to prevent any surprise bills.

Keep in mind, you need to make the patient aware that insurance is always an estimation, and ultimately, patients need to know the design of their plan as it may jeopardize their benefits. However, it is my belief that we must give our patients the most accurate estimation we can. One thing I like to say when it comes to insurance breakdowns and collections is that, for the most part, patients do not mind paying their dental bills. What they do mind is paying surprise dental bills.

Take the surprise out of it, and give your patients the best and most accurate insurance estimates before they come in. Does their plan downgrade to amalgam for posterior comps? Tell the patient as you schedule their treatment. Do they have a waiting period on crowns for 12 months? Edit their insurance estimation accordingly. Do they cover guards for bruxism or for after periodontal surgery only? Make sure your estimation matches their breakdowns. Accurate, detailed breakdowns lead to collecting what is 100% rightfully yours.

Connect with me for my free detailed insurance breakdown form.

Ashley Bond is the founder of Bond Dental Consultants, a company that specializes in helping practices collect 100% of what is rightfully theirs. She has more than 10 years of experience in the dental field beginning at her father's dental practice, where she saw the ins and outs of everything the business entails.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.


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