Mastering Dental Insurance: How to Stop Losing Revenue to Insurance Games

Dental insurance can be a major source of frustration for your practice, causing chaos for your team and potentially affecting your bottom line. Have you ever stopped to consider what your staff endures just to ensure your practice gets paid? We recently participated in a continuing education (CE) course focused on helping dental offices collect payments faster, and it’s shocking that practices often need extensive training just to receive the compensation they're rightfully owed.

One of the most frustrating tactics used by dental insurance companies is something called "downcoding" or "bundling." This practice occurs when insurance companies combine multiple procedure codes into one, often resulting in a lower payout than you expected.

Here’s an example: Imagine your new patient, Jill, needs both bitewing X-rays (D0274) and a panoramic X-ray (D0330) during her first visit. You expect to be paid $60 for the bitewings and $100 for the panoramic X-ray, totaling $160. However, many insurance companies will bundle those two codes and reimburse you for a full-mouth series (D0210), which typically pays around $120. That’s a loss of $40 on just one patient. Now think about how often this happens with other patients!

One way to avoid downcoding is to separate these procedures. In Jill’s case, you could take the panoramic X-ray at her first visit and save the bitewings for her next cleaning. This approach reduces the risk of downcoding and ensures you receive proper payment for each procedure.

Tired of dealing with complicated insurance games? You’re not alone. This year, 33% of dental practices across the country have chosen to go out-of-network, freeing themselves from the endless negotiations, denied claims, and downcoding that cut into revenue. Your practice can break free, too—and EmpowerDDS can help make it easier.

A Win-Win for Patients and Practices

One of the best ways to ensure consistent, quality care for your patients without the hassle of insurance is by offering a dental membership plan. These plans are particularly beneficial for patients without dental insurance, as they provide a straightforward, affordable solution for preventative care. With EmpowerDDS, dental practices can offer a membership program that provides patients access to essential dental services on a predictable monthly or annual basis.

Patients get the peace of mind of knowing they’re covered for routine care like cleanings, exams, and X-rays without the stress of dealing with insurance claims or unexpected costs. Meanwhile, your practice benefits from a reliable source of recurring revenue and stronger patient loyalty. It’s a solution where everyone wins—patients receive the care they need, and you maintain a steady cash flow while eliminating the insurance middleman.

With EmpowerDDS, you’ll have the tools and support to easily implement a dental membership program that enhances patient satisfaction and streamlines your operations.

Ready to Take Control? EmpowerDDS can help you transition out-of-network with minimal impact on your patients. Visit our website to learn how we can simplify the process and boost your practice’s revenue. It’s time to put the focus back where it belongs—on providing quality care, not chasing down payments.