How Dental Insurance Drives Dental Offices Crazy
TL;DR: Know your own dental insurance policy, and keep track of the treatments you get so you don’t scream at the receptionist about how you’re being billed $50+ for your full-mouth x-rays. It’s because you got one at your last dental office less than three years ago, and insurance only covers one every three years.
Applies mostly to America. I don’t know how this goes elsewhere.
Before a new patient comes in for their first appointment, the front desk must verify that the insurance information given is up to date. Hold music and audio ads abound.
If the patient has more than one insurance, their secondary insurance* will ask for information on the first one. More music and ads, and then the representative may inform the front office that for security reasons, they will only accept information from the patient.
The office receives summary of benefits and when the patient arrives, the total cost of the appointment is given with an estimate of what the insurance is covered. Front office has been trained to say “estimate” because things go wrong.
Sometimes patients will ask why their treatment costs that much. When we explain the benefits information from the insurance, they’ll get mad. Most common reason adult patients don’t get fluoride is because it isn’t covered. Sometimes they’ll pay but mutter about how this is bullshit. They’ll be screaming similar things when the office calls about a balance on their account.
Treatment gets done and all necessary forms are sent electronically to insurance. If it doesn’t get lost on the way, sometimes we’ll get the claim returned through snail mail with no payment and an explanation. If more documentation is needed, it is sent, again through snail mail because the original claim and “why we didn’t pay” explanation needs to be present or else it’s a duplicate. This process can go on for months.
If appeals fail, the bill collector financial coordinator sends a notice to the patient about the balance. After 30 days, the bill collector calls the patient, praying that it goes to voicemail.
Half the time the amount is small enough or the patient is understanding enough that the amount is paid off. Some of the time eventually becomes sick amusement, like the patient who owed $20 but refused to pay because of a grudge against the office, or the former employee who paid but forgot to cover the receiver when she called the still-working manager a “fucking bitch”**.
Rarely, it’s just unfortunate, like the three-digit claim for a scaling and root planing was denied because the patient’s condition was too severe, which is why dentists do scaling and root planing to begin with.
Delinquent accounts build until they’re sent to collections and written off, with the patient banned from further treatment unless the amount is paid.
Bonus: Office mistakenly believes they were in-network with a particular insurance company, but weren’t and were billing the patients the wrong amounts the entire time. The manager calls for a halt on all claims being processed until the quagmire is sorted out.
I then ask Mom about having a practice that doesn’t accept insurance, only to learn that doing so would mean I’d have no patients. Cosmetic dentistry isn’t an officially recognized specialty in the U.S., but insurance rarely covers procedures done for cosmetic purposes, so if I go this route I’d get rich patients who pay the full amount up front.
* If the patient has dental insurance from their job but is also covered under their spouse’s family plan, the former is their primary insurance because the policy is under their own name while the latter is the secondary because they’re covered under someone else’s policy. We once had a couple with different last names, and when we called the insurance company, the insurance company needed the patients to call to prove that they were married because of the different last names.
