The A B C's of insurance-filing

March 1, 2001
A few dental offices have been able to make the jump from working with patients' dental insurance to leaving the full responsibility for insurance-filing and payment in the hands of patients.

Carol Tekavec, RDH

A few dental offices have been able to make the jump from working with patients' dental insurance to leaving the full responsibility for insurance-filing and payment in the hands of patients. Most offices find that, to keep their patient base viable, working with insurance continues to be an office necessity. The majority of patients need their insurance to help pay for treatment, and most need their dentist's office staff to help them file their claims.

What most practices need is a system for handling insurance that sets realistic guidelines for what the staff will do and what the patient must do when it comes to dental insurance. The system should be based on the dentist's philosophy and set up during an office staff meeting. It then should be communicated to patients before any changes are made. An insurance system can be as simple as A B C. One method might be to:

A. Acquire information and set up an insurance file.

1. Obtain patient insurance information during the initial phone call. Use a de tailed charting form as a "crib sheet," so information is not left out. Ask patients to bring Em ployee Benefits Booklets to their first appointment for information on plan parameters.

2. Be sure to document:
Patient's name; policy holder's name and Social Security number; policy number and/or group number; employer's name and phone number; and insurance company name, address, and phone number.

3. Set up an insurance "crib sheet" for each company in a central paper file or on the computer. Put copies of the sheet in the patient's record as well.

B. Inform patients of your claims- processing guidelines:

1. By mail before the new patient's first appointment (office letter or brochure)

2. With a written "information" sheet, presented at the treatment conference, signed by the patient and retained in the patient's record

C. File claims electronically whenever possible. Send paper claims with attachments daily.

D. Decide how many times your office will bill insurance companies for payment; then stick to that policy. For example, you might:

1. Refile claims at 30 and 60 days

2. Send statements to patients that reflect the fact that their insurance carrier has been billed. Bill patients for their portion of the cost at the time of treatment. (Be sure that this is explained to patients prior to treatment.)

3. No insurance payment after 80 days? Print out the claim, bill the patient for the unpaid balance, and send the claim and statement to the patient with a copy of his or her signed insurance "information" sheet. Remember that this information sheet should state that the patient is responsible for the total amount of the bill, regardless of insurance coverage.

When patients call wondering why they have been billed, the staff should have a thorough answer prepared. For example, you might say, "We are sorry that your insurance has not paid as specified in your contract. As we discussed at your treatment-conference appointment, we always try to do all we can to help patients with filing claims. Un fortunately, we do not have the power to make your plan pay. Why not call your Employee Benefits Co ordinator and see if he or she will help you obtain your benefits directly?"

By following a system, the staff is released from repeated problems with certain "slow-paying" companies, production and payment stays in the black, and patients receive the help they need in the initial claims process.

Carol Tekavec, RDH, is the author of a new insurance-coding manual, co-designer of a dental chart, and a national lecturer with the ADA Seminar Series. Contact her at (800) 548-2164 or visit her Web site at

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