Why Should Dentists Verify a Patient’s Insurance?

Most dental patients cover their bills with insurance. Just as you would expect any other health procedure to be, dental treatments can be expensive and patients rely heavily on their coverage to actually get the job done — but that’s not as easy with cosmetic dental surgery; patients will be paying out-of-pocket for those.

Insurance can be tricky and most patients don’t fully understand the benefits and coverage of their policies. If dentists don’t verify a patient’s insurance and proceed with treatment, they could end up cutting their pay for an expensive dental job.

Verifying your patients’ insurance data

What you should ask in order to verify your patient’s insurance:

• Who is your insurance carrier?
• What’s the Patient’s name and birth date?
• What’s the Name and social security number of the primary insured?
• What’s the ID number?
• What’s the Group number?
• What’s the contact information of the insurance company: phone number, website and claim submission address?

Verifying your patient’s insurance

As obvious as it sounds, it’s completely necessary that you contact your patient’s insurance company and verify the following:

• Is the patient actually covered by insurance?
• What are the coverage effective dates?
• What is the in-network and out-of-network coverage?
• Is the service you’re providing to your patient covered by insurance?
• Does the service you’re providing to the patient need pre-authorization?
• Does the service you’re providing the patient need a referral report from a primary care physician?
• Is there any co-pay for the service? If yes, what amount?
• Has the deductible amount been met for the year?
• Is the patient up-to-date with the insurance fees?

Once you’ve verified this information, the next step is to make sure your patient can cover their dental costs and bill according to the insurance company’s preferences. This way, you’ll be able to maximize reimbursement and minimize denials. If you don’t want to verify on your own patients, we recommend hiring a company that can verify a patient’s insurance, while multiplying patient cases by 60%.