“How much is this going to cost me?” Sound familiar? This doesn’t always need tobe a difficult or dreaded conversation! In fact, it is a wonderful opportunity to gain trust and confidence with your patients by helping them understand their medical insurance benefits, which may have never been explained to them before.  

For dental practices billing their patient’s medical insurance as out-of-network providers, the answer to this question may not be straight forward for the first couple of claims. The reason for this is because commercial medical insurers do not typically reveal the dollar amounts or their Usual, Customary and Reasonable (UCR) fees that they “allow” for services paid to out-of-network providers!  However, once you start billing medical claims for sleep apnea appliances, oral surgeries, CBCTTMJ splintsexams, etc., estimating benefits becomes easier. Although medical plans vary, you can estimate future allowed amounts after having processed a claim or two. That allowed amount is revealed on the Explanation of Benefits (EOB) received after the claim is processed. 

We wanted to share some tips to help this conversation go smoothly and stay positive from Nierman Practice Management! 

 1. Verify medical insurance benefits prior to the appointment when possible. 

Verifying benefits

By verifying the benefits prior to the appointment, this allows you to have the information to begin this discussion. Although you may not know exactly what the medical insurer is going to allow for the services you render just yet, you will be able to confirm the remaining deductible amounts and co-insurance percentagesPrevious EOB’s will help you create an out-of-pocket estimate for future cases 

2. Use positive language, confidently.  

Rose Nierman confidently using positive language

When a patient asks if the service is covered by insurance, use positive language such as “Great news! – Yes, many patients can use their medical insurance benefits to help cover the costs of treatment. This means you can save your dental insurance benefits for dental procedures that are not covered by medical insurance.” 

3. Break the costs down into bite-sized pieces. 

Anjoo Ely break the costs down into bite-sized pieces

Instead of overwhelming the patient with a large amount, break costs down into a monthly or even daily cost! For example, if you are talking to the patient about a custom-made oral appliance for sleep apnea, instead of saying “We are estimating your out-of-pocket expenses to be $1200” try saying“these appliances typically last for 5 years, so for the equivalent of about $20 a month, or $0.66 per night, this therapy can help you sleep and breathe better”.   

4. Be sure the patient understands the deductible. 

Rose Nierman Be sure the patient understands the deductible  

No one likes deductibles, but if the patient does still have deductible remaining, it can only be waived in cases where there is a true, documented financial hardshipEven if a large amount of your treatment fee will be applied to the deductible (meaning the patient pays you that amount out-of-pocket), you should present this as a positive to the patient. “Once this claim processes, your deductible is met for the remainder of the year!.” 

To help make treatment more affordable, dental practices should offer patients financial options such as payment & financing plans (i.e., care credit).  It behooves the dental office to work with their patients’ medical insurance, whether on their own or with the help of a third party (some dental practices outsource medical billing to companies such as Nierman Practice Management) for procedures that may be considered medically necessary.   

The more options that are presented to help finance lifechanging treatments such as sleep apnea appliances, TMD treatment, oral surgeries and other procedures, the more likely patients can get treated. Billing medical insurance from a dental office is not hard, it’s just different than dental insurance.  And what is more worthwhile than helping patients get the treatment that they need? 

Article by: Courtney Snow, Nierman Practice Management

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About: Nierman Practice Management

Nierman Practice Management is the leader in dental-to-medical billing and cross-coding solutions for dental practices.

They have been helping dental practices expand into medical billing, sleep apnea treatment, & TMJ/orofacial pain since 1988, with innovative technology platforms, training, and medical billing services. Their proprietary DentalWriter Software is the leading dental practice management system for narrative report and medical billing.