How to Build Trust with Insurance Verification

June 2023
Tiffany Wesley, FAADOM
Admin/Record Keeping/Charting

Arguably, insurance verification is one of the most critical steps in the revenue cycle pipeline of a dental practice. With approximately two-thirds of Americans enrolled in private insurance plans, insurance verification is an essential step in creating accurate treatment estimations, maximizing legitimate reimbursement, and building trust with teammates and patients. Then why is insurance verification the #1 missed dental billing process in dental practices nationwide? 


Look ahead

While advancements in technology have streamlined the insurance verification processes in many ways, insurance verification often gets pushed down the priority list due to a lack of time. With all of the dental billing processes to complete to keep the dental practice revenue consistent, dental administrators are often overwhelmed with the day-to-day. Insurance verification should be completed at least 24-48 hours prior to the scheduled appointment. This can prove to be difficult for dental practices that see more than the average number of new patients, have a high cancellation rate, or are operating with less than the ideal staff level. 

But when patients receive a copy of the EOB or a billing statement that has information that is inconsistent with what they were told in the office, it can quickly deteriorate any trust the patient has for the dental practice. Insurance benefit information is often a mystery to patients, and they want to trust that the dental practice has a confident understanding and handle on the dental billing processes. 

Know when to verify

There are two different types of insurance verification:

  1. Checking eligibility

  2. Complete comprehensive breakdown

When a new patient is being seen for the first time in the practice, a complete comprehensive breakdown should be completed to ensure clean claim submission and timely reimbursement. For any follow-up appointments that year, an eligibility check can be done if the insurance plan information has not changed. The same process applies to a patient of record, with the comprehensive breakdown occurring at the first appointment of the year to catch any insurance plan updates. If new insurance plan information is presented at any point in the year, a comprehensive breakdown of benefits should be obtained and the practice management software (PMS) updated. 

Complete insurance verifications should include all of the information needed to confidently present a treatment plan with estimates that are as accurate as possible. Below are a few, but certainly not all, of the pieces of information that should be obtained during the insurance verification process:

  • Confirm the plan is active by obtaining a policy date

  • Confirm patient information is accurate in your PMS by cross-referencing with the payor

  • Confirm participation status for each dentist in the practice, if more than one

  • Outline important plan-specific benefit details necessary for accurate treatment estimations

  • Details on limitations, frequencies, and non-covered services

As previously stated, insurance verification should be completed at least 24-48 hours prior to the patient’s scheduled appointment. Should it be discovered that the patient’s policy is inactive, there would be time to contact the patient prior to them receiving any treatment. This builds trust with patients, team members, and providers because it communicates that their time is valuable and respected. 

Stay consistent

Given the roadblocks discussed above, insurance verification should be delegated to a team member with dedicated time each day to ensure this often overlooked step is not only completed for each patient but done so with great attention to detail. Whether that team member is in-house or remote depends on the needs of your dental practice. 

Consistently completing the insurance verification process builds trust with patients and team members by creating a seamless patient check-in, ensuring the most accurate estimation of patient responsibility is provided during treatment plan presentation, and reducing the surprise patient billing statements and frustrated phone calls to the dental practice. 

Gain the confidence

Dental Administration with Confidence dives into insurance verification – complete with sample breakdown forms – Coordination of Benefits, copay forgiveness, and so much more. This tool is a must-have for dental administrators and is widely popular with the American Association of Dental Office Management (AADOM). Grab your hard copy or ebook!


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