Remote Dental Billing and Patient A/R

What do Insurance Breakdowns have to do with Collections?

What is usually the first task that we give to our untrained or new-to-the-dental-field employees? 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.

But why are insurance breakdowns so important? Let’s look at an example on how an accurate insurance breakdown could save your office from sending a patient to collections or possibly losing them:

Scenario 1: Susie calls the office as a new patient. She has Metlife insurance and wants to come in for a new patient exam. You get Susie scheduled and then quickly get a faxback of her insurance breakdown. You are ecstatic that she has 100% coverage for preventative and diagnostic and scan her breakdown into her document center without second guessing a thing. Susie comes in for her comprehensive oral examination and a full-set of x-rays (FMS) and is on her way after scheduling her cleaning. About twenty days later you get Susie’s insurance payment back and realize they did not cover her FMS. It appears she was not eligible. Now Susie surprisingly owes your practice over $100 without even getting her cleaning or consultation yet.

What could you have done?

Scenario 2: 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 a FMS because she had a Panoramic X-ray done 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 in order to properly diagnose her, your office typically does a full-set of x-rays upon her first appointment with them. You continue to 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 to us and let her know that if they are of diagnostic quality then you will not have to retake them. If they are not of diagnostic quality, then you can let Susie know what her estimated portion will be when she comes in for her visit. You are able to explain to her that your office strives on getting your patients the best estimates possible to prevent any surprise bills as best as you can.

Keep in mind, you need to always make the patient aware that insurance is always an estimation and ultimately they need to know the design of their plan, as it may jeopardize their benefits. However, it is my belief that we are to give our patients the most accurate estimation we can. One thing I like to say when it comes to insurance breakdowns and collections is:

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 perio surgery only? Make sure your estimation matches their breakdowns. Accurate, detailed breakdowns lead to collecting what is 100% rightfully yours.

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