Monday, August 15, 2022

How Does My Dental Insurance Work

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The Outsourced Biller Has The Same Goal As Your Team: Get Claims Paid

My Insurance Sucks – Dental Insurance Tips and & Lessons

Your team probably dislikes dealing with insurance as much as the next person. The only difference between your team and the biller is the experience and expertise the biller has that comes with dealing with insurance daily.

Plus, the remote biller will have the time to devote to the task of insurance billing. Its like a chess match for the billers, and they always intend to win the appeals game.

While administrative team members are paid by the hour, the remote biller isnt. Your biller gets paid depending on how much money they bring in for you! So they are hyper-motivated to get your insurance claims paid.

Most billers are 1099 contractors. They dont necessarily get the same paycheck every other week as a W-2 worker would. Because of this, their personal income depends on how many claims they close out for each office they work with. Theyre ready to get every single claim paid for you.

And your team is motivated to get claims paid because it will help increase the revenue of the practice. Having this common goal puts everyone on the same team.

Factors That Affect Cost:

1. Insurance revenue. Most outsourced dental billing companies charge based on your insurance collections only. The billing companies will take care of your insurance accounts receivables only for the included fee. Patient AR is an additional service provided by only some dental billing companies. Since its a stand-alone service, it will typically add to your monthly cost.

2. The size of your practice. Some practices have one doctor, while others have multiple providers. The number of providers rendering services dictates the collections. Most dental billing companies charge based on how much you are collecting from insurance on a monthly basis. These are the different tiers of insurance collections that we use to determine the cost of outsourcing:

  • Under $40k
  • Between $150-$200k
  • Over $200k

3. Startup location and new practice cost structure. Without knowing your projected production and collection levels prior to opening, many startups will be considered under a Startup Pricing. Startups require initial setup of the software, which would include setups for the providers, claims, and fees. For a single doctor startup, this may be a flat fee ranging from $750-$1300 per month for a set period of time, typically 3-5 months once patients have been seen and claims have started to be sent.

Additional Fees

2. Stamps costs. Stamp costs range from $0.50-$0.75 per item. Most companies charge a standard rate for each stamp used when mailing claims or sending a statement is necessary.

Tiers Of Dental Insurance Coverage

Now that you understand the varying categories of dental treatment, its important to note that each category falls into a different tier of coverage. Preventative dentistry receives the most coverage, leaving you with little to nothing out of pocket and usually no deductibles. Your insurance plan is naturally encouraging you to take a prevention-based role in your oral health.

Once you do require treatment to repair a tooth, the next tier of coverage is basic, which is your standard restorative fillings and similar work. Depending on your insurance companys specifications, your basic treatment is covered at a lower percentage, like 75-80%. Youll be responsible for paying for the portion that isnt covered by your plan.

Major treatments are covered at an even lower rate. 50% coverage is fairly common. You pay for half, your insurance policy pays for the other half. Sadly by this point, a lot of people try to avoid getting treatment because theyre paying for more than they want to. But delaying care can compound your oral health needs and lead to even more complications in the future.

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Make Communication A Top Priority

Communication is a huge factor in your success with a dental billing company. Especially when you are first onboarding your dental billing company, set a precedent for frequent, easy communication. Learning how to work with each other in the beginning, going through orientation, and getting all of the equipment set up to work with a dental billing company is what sets the foundation of this working relationship.

Your dental office is still going to be responsible for insurance verification and patient billing. Without that information, there is no insurance billing!

Maintain your half of the billing equation while the dental billing company maintains theirs.

Regularly communicating with one another about expectations, denied claims, or questions about the patients information is crucial for you and the billing company to do your jobs well.

Should You Buy Dental Coverage

A Guide to Finding Affordable Dental Care

If yourecurrently without dental coverage, you might be wondering whether or not itsworth buying your own policy. Theres no universal answer here, as everyones financialsituation and oral health needs are different.

Generally, youll want to start by considering the costs of a dental plan versus your typical annual dental care costs. Break down what your dentist charges for twice-a-year cleanings, X-rays, fillings, and other routine care. Then, compare these costs with the dental plan premiums under different plans. Keep in mind that you may be able to deduct your insurance expenses come tax time.

Youll also want to consider your overall dental health when deciding whether to buy a policy of your own. If you have a history of dental problems, it will probably be worth spending the money on coverage to have the additional peace of mind. And if youre on Medicare, remember that Medicare will not cover dental work unless medically necessary.

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Tips To Help You Understand Your Dental Insurance

You may not realize it, but dental insurance is completely different than medical insurance. Because people use their medical insurance more, they may get confused about the differences. We meet with so many patients who are not in touch with what their dental plan actually covers, so we wanted to share some important information and tips to keep you informed about your coverage and its use. Please note that the information were providing does not apply to HMO/DMO plans.

With most medical insurance plans there is no real maximum spend. You may have to pay $4,000 out of pocket to get your deductible met before insurance starts paying, but there most likely will not be a cap on the coverage for the year.

However in dentistry, while the deductibles may be smaller at $50-$100, the maximums are much lower. For care that goes beyond the routine, most plans cap coverage at $1,500 a year, although higher annual limits can be arranged by paying a higher premium.

Because dental insurance coverage differs so greatly from medical insurance, it is more appropriate to call it a dental benefit. Dental insurance acts as more of a gift card to put towards your treatments. Once the dollar amount is reached, the gift card has run out.

Here are 4 tips to help you understand your dental insurance:

Q: Which Plan Pays First

A: The plan that pays first is considered the primary plan. This is determined by COB, which is usually dictated by state and government regulations. Generally, the primary plan is the one in which the patient is the main policyholder. The secondary plan is the plan that the patient is covered as a dependent.

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What Is Not Covered By Dental Insurance

This depends on the type of dental insurance plan you choose. For example, dental services like bridges, crowns, dentures, and root canals may not be covered if you only buy a preventive dental plan. Here are some kinds of dental treatments that may not be covered:

  • Anything cosmetic, such as teeth whitening and veneers.
  • Orthodontic appliances such as braces, removable teeth aligners, or retainers may not be included in all types of dental plans. If you are looking for dental insurance with orthodontic benefits, be sure you understand the details of any plan youre considering. For example, there could be differences in coverage for the orthodontists services vs. the coverage for the actual orthodontic appliances, like braces or retainers.

The key to making sure your dental plan covers certain types of treatment, is to plan ahead for the dental care you and your family expect to need.

How Does Having Two Dental Insurances Work

How does Ameritas Dental Work?

When you have two dental insurance plans, both insurers work together to determine your coverage and who pays for what. The formal process of sorting out your double coverage is called coordination of benefits. Both dental plans will determine who the primary carrier is and who the secondary carrier is. Coordination of benefits impacts how your claims are paid but not necessarily the actual benefits available to you. Occasionally having two dental plans makes no impact on your coverage at all.

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How Do I Introduce My Dental Team To An Outsourced Dental Billing Company

As weve mentioned, theres a possibility not everyone on your team will be ready to embrace the change that comes with outsourcing your billing.

Have you communicated with your administrative team what this change will look like and how it will benefit them?

If you dont have a plan to introduce your team to this billing company, they could feel blindsided, nervous they are being replaced, judged that their work wasnt good enough, or just flat out annoyed that they have to learn to communicate with someone outside of the office.

Here are some tips for how to introduce your dental team to an outsourced billing company.

Getting Started: Choosing Your Dental Plan

When it comes to selecting a dental insurance plan that best suits your needs, there are several factors to consider. Each plan works differently in terms of out-of-pocket costs, benefits, deductibles, and so on, and well dive into those words a little later. Generally, dental insurance plans are divided into the following categories:

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On Out Of Pocket Dental Expenses

The office should let you know aproximatly how much out of pocket expense you will incur and notify you well before treatment. It is reccomended that a predetermination of benefits be sent to your insurance company prior to treatment. The dental office will send your treatment plan to the insurance company upon reciept they will calculate the excat dollar amount they will pay and the amount you will owe.

It is worth mentioning that as of this blog the dental insurance carriers are only willing to pay for silver fillings. Often times dentists will use a white filling material you will be responsible for the difference between the price of the silver and the white fillings.

If properly understood and managed, dental insurance can be a great benefit.

Does The Outsourced Dental Billing Team Replace My Current In

Dental Financing With Bad Credit

The short answer: NO. But well explain.

When introducing your team to a dental billing company, or even bringing up the idea of hiring one, your employees will naturally have a lot of questions like:

In the early days, it can be difficult for the administrative team to keep an open mind when working with a dental billing service.

But the truth is, the outsourced dental billers serve as an extension of your team.

Sure, a remote biller wont be in the office. They wont be creating that same in-person connection with your team, but they will hone in on getting your claims paid and helping your employees have more time to focus on patients, scheduling, and taking care of the office.

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The Biller Does Not Boss Around Your Admin Team

A common fear among office managers, or other members of the administrative team, is that the outsourced biller is going to take control away from them, but this isnt true.

The remote billers sole responsibility is going to be your insurance billing. Their purpose isnt to take over your office, its to handle insurance billing and in turn, eliminate the stress your team faces surrounding it.

The admin team will not report to the biller, and the biller wont really report to the admin team. Theyll technically report to the dentist or business owner.

If the remote biller is hired on and notices a lot of the claims they submit for the team are being denied for the same reasons , theyll address it with the admin team and figure out where the process could be improved.

The biller isnt going to offer advice or solutions unless problems arise that affect how they perform their own duties.

How To Get The Most From Your Dental Insurance Premiums

One of the key differences between major medical health and dental insurance that youâll notice as you start shopping for plans is that dental insurance tends to have significantly lower premiums, because, in part, of the annual benefits maximum. The cost to buy a typical individual dental policy is about $350 a year.

Itâs still a good idea to get the most out of every dollar, though. Here are some tips to make sure youâre getting the most out of your dental insurance.

Get a quick quote online and compare dental coverage and costs.

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Deductibles Copays And Coinsurance

An insurance deductible is the minimum amount that must be paid before the insurance policy pays for anything. For example, if the deductible is $200, and the covered individuals procedure is $179, the insurance does not kick in and the individual pays the entire amount. Copays, which are a set dollar amount, may also be required at the time of the procedure.

When a dental deductible is met, most policies only cover a percentage of the remaining costs. The remaining balance of the bill paid by the patient is called coinsurance, which typically ranges from 20% to 80% of the total bill.

Costs and what procedures are required may also differ based on the patient’s age. Seniors on Medicare, for instance, will have a different definition of what constitutes the best dental insurance possible than other age groups.

Most dental insurance plans follow the 100/80/50 payment structure: They pay 100% for preventive care, 80% for basic procedures, and 50% for major procedures.

How Are Benefits Coordinated

How Do Dental Plans Work | :DentalPlans

When you have a dental procedure done with us, we will send a claim to your primary insurance provider to receive reimbursement. The claim will be paid based off of your employers benefit schedule. If there is a service or amount that your primary insurance provider does not pay, the secondary carrier will cover it. This means that if your primary carrier pays 70 percent of your services, your secondary carrier will cover the other 30 percent, and you pay nothing. In these instances, having two insurance plans come in handy, but there are exceptions.

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Does Dental Insurance Cover

Missing Tooth Replacement?

Dental insurance plans may not cover the costs for some treatments, no matter how long you wait such as replacing a tooth that you lost prior to purchasing the policy or dental work that is already in progress. Look for the missing tooth clause when you are reviewing plan details.

Cosmetic Treatments?

Most dental insurance plans do not cover elective procedures such as teeth whitening or porcelain overlays.

Dental Implants?

Typically, no, since there are less-expensive ways of restoring missing teeth. But some plans, like Cigna Premium, do cover dental implants.


Some dental insurance plans do. But check the annual lifetime coverage limit for orthodontics and ask your dentist/orthodontist for a cost estimate. You may be able to save more money on braces with a dental savings plan.

Dental Plan Categories: High And Low

There are 2 categories of Marketplace dental plans: High and low.

  • The high coverage level has higher premiums but lower copayments and deductibles. So you’ll pay more every month, but less when you use dental services.
  • The low coverage level has lower premiums but higher copayments and deductibles. So youll pay less every month, but more when you use dental services.

When you compare dental plans in the Marketplace, youll find details about each plans costs, copayments, deductibles, and services covered.

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How To Use Your Dental Insurance

After you locate a dental policy and enroll, using the benefits is fairly straightforward. Hereâs how to use your dental insurance:

1. Become familiar with your benefits

Because some policies categorize certain services â like root canals â differently, and cover them at different levels, itâs important to verify how different services you may need are covered.

2. Schedule an appointment

If your dental plan requires you to visit network providers or offers a discount when you use providers in a certain network, search the insurance companyâs provider directory to locate a provider that accepts your policy. Once youâve located a provider, contact them to verify that they are still in your network and, if so, schedule your visit.

3. Present your ID card and pay your copay, if applicable

When you check-in for your appointment, have your dental insurance card handy. At that time, you may owe a copayment for services. Not all plans and services require copays, which is another reason to become familiar with your dental benefits.

4. Look for an explanation of benefits and your bill â these are not the same thing

What Is A Dental Annual Maximum

How does the dental insurance work? What is the best dental plan? What ...

A dental insurance annual maximum refers to the amount of money that the provider will pay in a year to help cover the cost of care you receive. This, too, will vary from one plan to the next.

If youre the type of person who typically needs a lot of expensive care, opting for a plan with a higher annual maximum can help you save more money.

Example: a plan that has an annual maximum of $5,000 will pay out that much money before youll be responsible for any additional treatments you need.

Once your plan renews at the start of a new year of coverage, the annual maximum will be reset.

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