Wednesday, July 6, 2022

How To Verify Dental Insurance Benefits

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Fast, Easy Real-Time Dental Insurance Verification

All insurance companies are required by law to provide a uniform summary of coverage and benefits for their Individual and Family Medical and Dental insurance plans. This webpage is an outline of important medical and dental coverage information. We know insurance can be complex and confusing. That’s why we try to make it as easy-to-understand as possible. Because, if you know how your coverage works, you’ll know how to get the most out of your plan. If you have a question about your Cigna Individual and Family insurance plan, please contact us. We’re here to help. Just call Cigna Customer Service. The toll-free number is .

Product details for Cigna Individual and Family Medical and Dental plans vary based on the plan. Read the plan information and policy disclosures, including exclusions and limitations that apply to the policy/service agreement you are interested in purchasing. Do this before you apply for coverage. To find information related to your state, visit

If you have difficulty reading English, we offer language help. For help please call Customer Service.

For TTY/TDD service for hearing impaired callers, please call 711 for Telecommunications Relay Service. Once connected, please enter or provide the toll free number you’re calling.

A Simplified Shorter Eligibility Verification

You may choose a simplified approach to the insurance verification process by eliminating the need for phone calls with insurance representatives. You will utilize information gathered from insurance company websites and faxes to create estimates.

In this scenario, you are using general estimating guidelines without the time investment of the thorough and complete benefits verification process. You will enter eligibility data into your practice management software to create estimates. We recommend you estimate high to reduce the possibility of conflict when the patient balance is higher than expected. With a simplified version of the benefits form, your front office team members will need to clearly explain the estimates on the treatment plan are ONLY estimates; any amount not paid by the insurance company will be the patients responsibility. This approach is less time-consuming while providing a ballpark estimate for the patient.

We recommend you pre-determine benefits for larger cases when using this simplified, shorter eligibility verification process.

Request an editable version of the Short Verification Form from Practice Support Team.

What Is A Participating Dentist

A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for covered services. Negotiated fees typically range from 30 – 45% less than the average charges in a dentists community for similar services.2 Negotiated fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing, and benefit maximums. Negotiated fees are subject to change.

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S To Ease The Dental Eligibility Verification Process

    According to a study in Health Affairs, patients reported that they did not get the dental care they needed because of cost, fear, inconvenient locations or appointment times, and trouble finding a dentist who accepts their insurance. One of the main challenges facing dental offices is dental insurance verification. Some of the issues that a dental practices front office has to deal with when it comes to insurance benefits verification are:

    • Length of time involved in making calls to the insurance company for benefits verifications for both new and existing patients
    • Frequent insurance plan changes by employers, leading to increased number of phone calls that need to be made to obtain new coverage details
    • Risks of insurance misinformation by insurance reps
    • Time involved in updating the insurance information and fee schedules to set up the new plan in the system

    Verifying coverage and benefits is not only important for the practice but for patients as well. These patients rely on their insurance to help pay for their treatment. Here are some tips to help practices streamline their insurance eligibility verification process.

    What Is A Dental Insurance Verification Form

    FREE 6+ Dental Insurance Verification Forms in PDF

    A dental insurance form is a document that is filled out by a practice and used for requesting insurance information for a patient. The form is complied of basic information the insurance company needs in order to find the patient profile and let the dental practice know what insurance options are available.

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    Ways In Verifying An Insurance

    One of the most common ways to verify anything is through making a phone call to the person who will help you verify an information. With regards to insurances, an Insurance Customer Representative will be the one to guide you through the verification process.

    The telephone lines of insurance companies are normally available except during particular holidays. These are maintained open so that they can accommodate and allow inquiries of customers who are in need of deeper insights and explanations regarding their insurance plans.

    Another way to verify an insurance beneficiarys benefits is by visiting the office of the insurance company. This is a direct approach to verifying an information since the beneficiary will be able to negotiate and talk in front of an insurance representative.

    Filling out an Insurance Form will be done during the meeting, and the verification will be done after the submission of the form. However, an individual who verifies information should be prepared with adequate documents since some insurance companies do not release particular information to their clients.

    It would be helpful if a legal identification card will be presented if you are verifying your own information, or a valid and completely filled outÂ; should be handed if you are verifying someone elses information.

    Insurance Verification: Learn More About Dental Insurance

    Are you afraid to visit the dentist due to costs? If so, there are many benefits to dental insurance that can cut costs and make it easier for you financially. With our insurance verification process, you wont have to worry about the financial burdens of dental care any longer. Learn more below and begin the process of setting up your first appointment at the Dental Center of Norcross today.

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    What Is An Insurance Verification Form

    An Insurance Verification Form is the document required by an insurance verifying specialist from a client who wishes to verify his insurance plan coverage and details. The form will aid in knowing if the insurance members coverage isÂ;successfully in line with the shouldered programs of the insurance company.

    An example is for a Medical Insurance Verification Form which contains the details regarding the health insurance coverage of a member to be used in events of accidents and medical procedures such as surgeries and operations. Another is an Employer Insurance Verification Form where the company may acquire information that involves the benefits of the employer they have in their company.

    What Type Of Information Are You Looking For

    How to Verify Insurance Eligibility

    The descriptions below may help you identify your dental network.

    A preferred dental program covers any licensed dentist/specialist, but if you choose an in-network provider, costs are typically lower.

    PDP Plus

    This preferred dental program is the same as PDP, but with a larger group of in-network dentists/specialists to choose from.

    Dental HMO/Managed Care

    A Dental Health Maintenance Organization or Managed Care, covers in-network providers only, and you must choose a primary care dentist for all services. Available in CA, FL, NJ, NY, TX.

    MetLife EPO Network

    The MetLife Exclusive Provider Organization contains features similar to PDP & DHMO. You must see an in-network EPO provider to utilize dental benefits. However, you do not need to select a primary care dentist. Available in CA.

    Federal Dental

    This preferred dental program is also the same as PDP, but only available to certain Federal government employees.

    Still not sure of your network?

    Log in to MyBenefits and well fill it in automatically when you search for a dentist.

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    You Don’t Have Time To Talk To Insurance Companies

    With Dental Support Specialties submitting your insurance claims and completing regular follow-ups, you can rest easy knowing that insurance payments will be as consistent as your cash flow. Your patients will appreciate the efficiency and accuracy with which your practice handles their benefits. This will reflect positively on your practice and aid in word of mouth referrals among your patient’s co-workers who carry the same PPO plan.

    Implant & Grafting Services

    Bone graft D7953 ;vs D4263 : Theyre both different and some insurances cover one and not the other, so make sure to verify this.

    Implant Benefits: Implant Placement , Custom Abutment , Pre-Fab Abutment , Implant Crown Verify if there are any implant benefits. Some insurance provide no benefits towards placement, but may provide benefits towards implant restoration.

    Whenever Implant is treatment planned for an insurance patient, I always send out a pre-determination to the insurance with the following codes: D6010, D6057, and D6058. If there are implant benefits provided by the insurance, your office will know the exactly $ amounts for each service. If insurance will downgrade the D6058 , youll know exactly what it is.

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    What Is The Metlife Preferred Dentist Program

    MetLifes Preferred Provider Organization plans feature the MetLife Preferred Dentist Program, which is designed to save you money on dental services.1 You can choose from thousands of participating general dentists and specialists nationwide. Plus, you will enjoy lower out-of-pocket costs for in-network services, freedom to use any dentist, and less paperwork.

    Save Time And Money Too

    FREE 4+ Dental Insurance Verification Forms in PDF

    Our research shows that the average eligibility verification call is over five minutes. If you happen to call at peak call times, your wait to obtain this information can be even longer. Therefore, we have introduced new tools providing convenient ways to access this information saving you and your staff time and money.

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    Johnson Family Dental Amy Buttery Operations Support Manager

    As the Operations Support Manager of a company, I know what a dependable vendor means. And all the qualities that a vendor must possess can be found in the Check Ur Insurance. The company is exceptionally professional when it comes to delivering timely and accurate insurance verification to our company. Our business, Johnson Family Dental, has been working with Check Ur Insurance for several years. There has not been a day when we had to complain about their professionalism, accuracy, and privacy regarding our patient health information. As a result of using their services, our customer care and service has improved dramatically, as our team is no longer tied up on lengthy phone calls to verify eligibility. This has been huge for us as we believe in spending time with our patients creating lasting relationships. Check Ur Insurance allows us this luxury, while providing us the important information we need to create an accurate treatment plan. They value both time and money and deliver their service within the specified deadline. The same can be said about their pricing policy. They are extremely competitively priced. I am extremely satisfied with the way they conduct their business and hope that you have the same pleasant experience with them.

    Verify Patient Benefits And Eligibility In Provider Tools

    Be sure to verify patient;eligibility;before providing services to make sure youll receive the appropriate compensation. Use Provider Tools for up-to-date, unlimited eligibility and benefits information, including remaining maximums and deductibles.;

    Steps to verify eligibility:

  • Log in and select Eligibility & Benefits.;Enter the patients name and select Existing or New.
  • For new patients: Enter the first and last name and date of birth.;Then, select “Find Patient” for eligibility status and benefit details.
  • For existing patients: You’ll see the Eligibility & Benefits Summary first, followed by benefit and covered services, maximum and deductible amounts. Finally, you can find “other provisions” details for missing tooth clause, COB rules and more at the end of the page.;
  • Link to more details.;Use the links in the sidebar to quickly access:
  • Benefit Details: get benefit levels for procedures by category, such as Preventive, Restorative, Endodontics, etc.
  • Benefit Search ;enter up to 10 procedure codes, a keyword or a tooth number for more specific information.
  • Treatment History review benefit limitations and dates of service from claims weve paid from any dentist.
  • Or use another great tool: My Patients.;This tool lists your existing patients and their eligibility status.;Select under Actions at the end of a row to open that patients Eligibility & Benefits Summary. Eligibility and benefits information is also available by using our automated telephone service.;
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    What Do I Need To Submit An Inquiry

    The information youll need depends on the method you use to submit an inquiry.

    If youre using AVA, youll need:

    • Provider TIN or NPI
    • Patient ID or subscribers Social Security number
    • Patient date of birth
    • ADA code
    • Fax number

    If youre submitting online, youll need:

    • Provider TIN and NPI
    • Patient ID or subscribers Social Security number
    • Patient date of birth
    • NOTE: some vendors may require more information to process your request.

    Why Verrific Was Built

    Benefits of tab32 Dental Insurance Verification Service – Technology for Dentist

    Most dental offices have a collections problem. What they produce, they are never able to collect. Dentists get frustrated with denied claims and the usual culprit is dental insurance. However, what we found was most claim denials are not due to a clinical disagreement between the treating dentist and the insurance provider. They are because some limitation of the policy was not verified beforehand. Once an office starts getting detailed breakdowns and reviewing them with the patient, both the office and the patient get a full understanding of which recommended procedures are at a risk of not getting paid by the insurance. Patients are ok with bills, just not surprise bills. Obtaining a full breakdown takes away that uncertainty which gives the patient the appropriate expectation of what his/her estimated copay would be. Great collections begin with great verifications!

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    From Routine Visits To Dental Emergencies We Want You Make Sure You’re Getting The Most From Your Dental Plan

    Using Your Dental Insurance

    While it’s common knowledge that a solid routine of of brushing and flossing daily at home is essential to keep your smile bright and healthy, it’s also essential to schedule regular dental visits to maintain your oral health.The good news is you’ve got a great dental plan that makes it both simple and affordable to get the care you need.The following are some tips and suggestions for before, during and after your dentist visits to help you get the most benefit; from your dental insurance.

    BEFORE YOUR VISITHere are the three things you should do BEFORE your dentist appointment:

  • Review your dental benefits: Check out what’s covered and what’s not in your dental plan by logging into your MySmile® account, or reading your benefits booklet. Eliminate any surprises during your upcoming visit to the dentist office by knowing your facts before you go!
  • AT YOUR VISITHere’s a short list of three things you want to do during your visit to the dentist:

  • Let them know you are a member of Delta Dental of Connecticut. If you have more than one dental benefits plan, be sure to bring that information as well and clarify the coverage with the office staff. Since they will be submitting the bills to the insurance company, they need all the details required to insure the proper billing is done from the start.
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    What Is Dental Insurance Verification

    Dental insurance verification is when a practice reaches out to a patient’s insurance provider to see what they qualify for. They are verifying what kind of work or treatments are covered for their client. They’ll also find out what rolls into the new year and what their patient should take advantage of now while it’s still covered.

    This is why a dental insurance form is important. Practices can base their sales and re-care strategies on the information acquired through these forms. Understanding a patient’s insurance when treatment planning or rescheduling is an added bonus. These forms also allow the opportunity for patients to get the best care at a low cost.

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    Consider This Following Scenario To Understand The Importance

    You need to verify with both the patient AND the insurance company whether its the primary or secondary insurance.

  • Fee Schedule:
  • There are certain insurances that you may not be aware youre in-network with, but if those companies follow the fee schedule of a company you ARE in-network with, you can take that insurance.;

    When I started my office, I got my self credentialed with the most commonly heard insurance companies: Delta, Aetna, Guardian, Cigna, MetLife, etc. But sometimes youll get a patient on the phone asking your staff if your office takes their insurance and youve never heard of the name.

    Dont automatically assume youre not in-network and say no to the patient.

    Get the policyholder information and provider services phone number, and call the insurance company to find out what fee schedule they follow.

    If the insurance company follows the fee schedule of an insurance youre in-network with, you can let the patient know theyll have coverage when they come to your office.

    For example, first time a new patient called to ask if we take Principal Financial Group insurance, my front desk person did not know as she didnt see this name in the list of the insurances we have on our website.

    After calling the provider services at Principal Financial Group, she found out they follow the Ameritas fee schedule, which we are in-network with. She called the patient back and scheduled an appointment for her as a new patient.

  • Deductible:
  • Benefits Used To Date

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    This applies to new patients who recently left their old dentist during the benefit period. Youll need to inquire how much the patient used during the rest of the benefit period.;

    Afterward, update this information on your offices record. It will help you know if the amount for treating the patient is above the maximum their insurance covers.

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