Dental Insurance verification: What you need to know

 Healthcare providers owe it to their patients for dental insurance verification coverage. By inquiring about the patient's insurance coverage and benefits and the treatments that will be rendered, you may minimize any confusion or delays in invoicing.

It is important to ask specific questions when confirming a patient's insurance benefits, as this will allow you to confirm the policy specifics, determine the patient's deductible and coverage limits, and spot any exclusions or limitations in the plan. The answers to dental insurance verification questions will help you give your patient the highest quality care while appropriately billing their insurance.

 

Important questions for dental insurance verification

 Patient's data

●      Exactly who is this patient, and what is his or her name?

●      What is the date of birth?

●      Which health insurance provider does the patient use?

●      Where can I find the patient's policy number?

●      What type of insurance does the patient have, primary or secondary?

●      Whom is the policy's principal insured?

●      Is there a deductible or cost that must be met?

●      When you say "copayments," how much are we talking about?

●      Do you have medical, dental, vision, life, or disability insurance?

●      What kind of health plan does the patient have, an HMO or PPO?

●      Where can I find the patient's deductible and whether or not it has been paid?

●      What is the patient's estimated co-pay or deductible?

●      Does the patient have a valid health insurance policy?

●      Does the patient have a valid insurance policy at the moment?

●      Is there an annual or lifetime cap on the patient's coverage?

●      Can I see the patient without a referral or pre-authorization from their insurance company?

●      To what extent does the patient's insurance come from the government?

 

Eligibility and Criteria

●      Will the policyholder be qualified to receive benefits?

●      Does the insurance plan cover the procedure or therapy?

●      Is it necessary to get a recommendation from my primary care doctor?

●      Is prior authorization needed before I get this service or treatment?

●      Does the patient's health insurance include hospitalization costs?

●      Does the plan provide reimbursement for doctor's visits and other non-hospital care?

●      Do pre existing conditions count against the policy's limits?

●      Is there anything the patient needs to know about the coverage's limitations or restrictions?

●      At what point in time will the patient benefit from their insurance?

 

Customer Service

●      If the insured needs help or additional information, how can they get in touch with the insurance company?

●      When can I reach the insurance company's customer care department?

●      Is there a portal through which policyholders can look up their coverage and benefits?

●      Is there information or aid for policyholders to utilize to learn more about the insurance they have purchased?

●      Can the insured person reach out to a specific case manager or representative for help with their insurance?

 

 

Claim and payment

●      Compensation Request and Reimbursement

●      How can an insured person claim benefits?

●      I have a claim to submit to my insurance carrier.

●      What is the procedure for receiving compensation from the insurer?

●      How much, if any, of the service or treatment cost will be covered by insurance?

●      Would I be responsible for payment to my provider, or will my insurance cover it?

●      Do they have to pay anything out of their pocket?