Posted on 01/02/2016 · Posted in Health Information from Affiliated Dentists, Information

There are thousands upon thousands of different dental insurance plans through just one insurance company alone. Whether you are looking into the different plans offered through your employer or just looking for an individual dental insurance plan, things can get quite confusing. Not only are there different types of plans offered such as Premier, PPO, HMO and so on, but there are countless limitations to remember, like waiting periods for dental work, frequency limitations for x-rays and much, much more.

Our front office staff at Affiliated Dentists is trained to submit your dental insurance claims to your insurance company properly, regardless of the type of dental work done, so you don’t have to.

Affiliated Dentists’ Front Office Staff: Insurance Experts

It is impossible for anyone to know every single plan and its limitations, which is why it is the patient’s responsibility since they are the ones who purchased the plan and have all of the information mailed to them. However, we here at Affiliated Dentists can at least go over your plan with you to help you understand it once it’s purchased.

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Always Keep Your Dental Office Updated When Your Insurance Changes!

Many patients think that if their insurance plan changes or terminates, their dental office staff is notified by the dental insurance, but this is far from true. Your insurance company will never tell your dental office anything unless they are informed to contact them first. They do, however, send this information to you, the patient. This is why it is your responsibility to always provide this information to your dental office before your next appointment. This allows us to have the updated information so your claims don’t come back denied, or so we can know if you are even covered at that office anymore. If you do not want any surprises or out of pocket costs, it is imperative for you to contact your Affiliated Dental office as soon as a change occurs.

How Does My Dental Office Work With My Insurance?

Our staff can do many things to help you. In fact, there are so many things our front office does with your dental insurance to help our patients, there is too much to fit all in one article! This one focuses on how they work with your dental claims after your visit, attachments and narratives required from them and how they submit your dental insurance claims.

Dental Insurance Claims

After your visit at Affiliated Dentists, the specific procedures performed are submitted to your dental insurance on what is called a dental claim. We submit these claims for you at no charge as a courtesy to you, something not all health care facilities will do for free, or at all, as some make the patient submit their own.

Every single time you visit us and there is a procedure done at charge, as long as your insurance covers the procedure in some way or you are not maxed out at the time of your visit, we will submit these charges to your dental insurance. Many times we will collect the portion that is estimated to be your out of pocket cost at the time of your visit and will wait for your dental insurance to pay the rest of the claim. You are responsible for whatever your insurance doesn’t cover, so if the claim comes back denied partially or in full, you will be billed for the rest of the balance. This is why it is so important to communicate with your dental insurance before each of your visits, or request that we do so on your behalf. Regardless of who does contact them, it is still not a guarantee of coverage.

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Submission

Most dental insurance claims are sent electronically either the same day or the day after your visit. This means after the claim has been reviewed by the dental office staff and all necessary attachments and narratives have been included, it is submitted electronically to your dental insurance and received immediately. This process is quick, and dental insurance claims tend to be paid in a matter of days.

Sometimes dental insurance claims have to be mailed, though, which takes much longer to be received, processed and paid in the end compared to electronic claims. Another thing that can hold up your dental claim is your dental insurance requesting more information via mailed letter to your dental office after they have received a claim, mailed or electronic.

Attachments

As stated above, some dental claims need attachments for them to be processed. Not all claims do, such as cleanings and exams and fillings, but most claims for major work like dental crowns or dental bridges will almost always require attachments and narrative.

  • Narrative: This is a description of the dentist’s clinical findings before and during the procedure. It includes areas of decay, fractures, missing parts of the tooth, large restorations that are failing, or any reason at all that your dental work was needed.
  • Attachments: Can be attached electronically, however, many times a dental insurance will mail us a request for more information, meaning the attachment either wasn’t received, wasn’t sent, or wasn’t something your dental insurance needed for the claim until they received it. The most common claim attachments requested are:
    • X-Rays – Of the tooth or teeth getting the work done
    • Periodontal Charting – for any periodontal work completed, your pocket depths and bone loss must be proven for this work to be covered

Working With Insurance Can Be a Hassle

As we work with insurance on a daily basis, we understand just how confusing it can be for most people. We can’t stress it enough to everyone that it is important to read through your coverage benefits, even before signing up for a plan. We see so many patients come in for work only to have it denied due to a waiting period or frequency limitation they didn’t know about because they declined to read their plan’s benefits. We are here to help you understand your plan, but we won’t know you need help unless you ask! We are happy to go through your plan with you, and if there are any questions we cannot answer, you will be directed to your dental insurance company. Together we will work with you to help you not only understand the plan your are interested in or have already purchased, but to explain your benefits to you so there are no surprises in the end.