Top Challenges in Dental Insurance Verification and How to Overcome Them

Confirming dental coverage comes with many challenges such as errors in patient information and communication gaps with insurers.

Dental insurance verification is a vital component of a dental practice’s revenue cycle and serves as the essential first step in the dental billing process. Verifying coverage is crucial to ensure that patients receive the benefits they’re entitled to while minimizing the risk of claim denials and payment delays. Key elements to verify include patient demographics, insurance details (policy numbers, effective dates), coverage categories, deductibles, annual maximums, and more. Confirming these coverage details provides both patients and providers with a clear understanding of benefits and any requirements before treatment begins. However, this process is often challenging, leading many dental practices to rely on professional dental eligibility verification services for accuracy and efficiency.

This article discusses the top challenges in dental insurance verification as well as strategies to overcome them.

Dental Insurance Verification: Challenges and Solutions

Incomplete or Inaccurate Patient Information

One of the most common issues relates to incomplete, outdated or inaccurate patient information. Even minor discrepancies in names, birth dates, or policy numbers can cause delay in payments and claim rejections, negatively impacting the financial stability of the practice and patient care.

This can be addressed by setting up an insurance file for each patient. This file should include all relevant patient and plan details. Verifying insurance eligibility before treatment saves time and helps the dental team provide an accurate cost estimate when the patient arrives. It’s also essential to update insurance details of existing patients returning for treatment. This will enable any changes or added benefits to be identified and verified.

Complex Insurance Policies

Dental insurance policies can be complicated, with varying coverage limits, waiting periods, exclusions, varying coverage percentages, and specific requirements for different procedures. Dental coverage differs based on the provider, state, plan type, and access method. This includes private plans from employers, individual plans purchased directly, and public plans provided by the government.

This complexity can make the insurance verification process time-consuming and error-prone.

To resolve this, create a database of common insurance plans and ensure your staff understands the deductibles, annual maximums, and exclusions. This will enable faster identification of policy details. Grouping patients by insurance plan and recording commonly used procedure codes and other key details in the practice’s insurance verification form can also improve efficiency.

Long Wait Times and Communication Barriers with Insurers

Contacting insurance providers to verify insurance can be a lengthy, frustrating process, often involving multiple phone calls, long hold times, extensive paperwork, and miscommunication about policy details.

One solution would be to use digital insurance portals whenever possible to quickly check coverage and eligibility. Implementing verification software will automate routine checks and speed up the process. Many tools can integrate with practice management systems, reducing time spent on manual verifications and allowing staff to focus on patient care.

Dental insurance eligibility verification specialists conduct pre-verification of insurance details during the appointment scheduling process. They also maintain communication with payers and call them directly if needed to verify patient coverage.

Frequent Changes in Insurance Policies

Dental insurance policies are subject to frequent updates, such as changes in covered procedures, eligibility, and coverage amounts. Insurance plans change frequently for a number of reasons, such as changes in plans and prices, changes in family status, such as marriage, birth, etc. According to a JAMA study published in 2022, between 15% and 20% of both privately and publicly insured individuals experience coverage disruptions or change plans each year. If these changes are missed, it can lead to inaccurate information in claims.

Establish a system for reviewing major insurers' policy updates and encourage patients to inform your office about any recent changes to their coverage. Importantly, re-verify insurance details for returning patients. Companies providing dental insurance verification services maintain open lines of communication with insurance representatives to stay informed about any changes.

Data Entry Errors

Human error in entering or interpreting information can lead to verification mistakes, resulting in delayed payments or denials. Common errors include misspelling a patient's name, entering an incorrect date of birth, or using an invalid Social Security number, entering incorrect provider information and missing documentation.

Ongoing training can help staff recognize and prevent common errors during the verification process. It can also help to implement a double-check system where verification details are reviewed before finalizing.

Patient Misunderstandings

Most dental plans offer 80% coverage of basic dental care. That includes sealants, fillings, extractions, periodontal treatment, and non-routine X-rays. Plans usually cover the complete cost of preventative treatments like routine cleaning and oral exams. However, patients may not fully understand their dental coverage, leading to confusion and dissatisfaction when they receive unexpected bills.

Efficient insurance verification allows practices to provide patients with clear, concise explanations of their coverage during their first visit and before treatment.

Outsource Dental Eligibility Verification

Dental insurance verification is crucial to the financial health of a practice and smooth patient experiences, but challenges can create bottlenecks. Outsourcing the process to a specialist is the ideal option. Dental eligibility verification companies can ensure up-to-date insurance coverage details using advanced software, eliminating the hassle of navigating payer systems and long hold times. Their experienced teams can also manage calls to insurance companies, so that practices have accurate eligibility and benefits information well before the patient’s visit. Partnering with an expert helps minimize the risk of claim denials caused by errors in patient and insurance information, boosting accuracy and enhancing cash flow.