• Dr. David Alfaro

Dealing with Dental Insurance



Many of our patients have dental insurance of some sort to help reimburse part of their dental care costs. There are dozens of companies, all with different plans, that employers and individuals can subscribe to. This means that dental offices routinely interact with these insurance providers…… mostly on hold 😉

How do dental insurance companies distribute reimbursements?

There are two ways that insurance companies pay out the benefits: payments are either distributed directly to the patient (non-assignment), or to the dental clinic (assignment).

Assignment

Traditionally, many practices were “on assignment” where after treatment was completed, the dental office obtained an estimate of what the insurance company would cover, and then only collected from the patient the portion that was not to be covered.


Behind the scenes in assignment offices there is a lot of accounting that must be done. The practice must wait a couple of weeks for payment, and quite commonly, the amount dispersed by the insurance company is not the same amount as what was estimated, so a discrepancy remains, which is usually carried over to the next appointment. Offices often run in to challenges collecting the balances ("what do you mean I owe $6.45 from last time?"), and it just makes for messy accounting.

There have been some recent changes to how insurance companies distribute the payments to dental offices that have made the accounting process even more complicated and have created situations where patient privacy can be broken.


If the office is still receiving paper cheques, the insurance companies have started “batching” the claims, so that an office receives a lump sum for many claims over the month. This not only delays payments, but because the report combines the information of many patients in to one printout, it also complicates patient privacy. When we scan that record in to the patient chart, either we enter it as is and include the information of other patients, which is a privacy concern, or we have to MacGyver a way to block out the other information when scanning. It is not an ideal scenario either way.

The insurance companies have recommended that offices move to online reports and direct deposit. This may seem reasonable, but the challenge is that they do not file the reports by office, but they do it by dentist. The person in charge of the insurance accounting must log in to the insurance website and download the reports for each dentist that works at the office. This is very time consuming. In larger offices you may have staff completely dedicated to this task! That is not an efficient use of resources when there are much more reasonable options.


Where the real privacy breach occurs with the new online system is when a dentist works at various locations, and many dentists do! Because the insurance companies hold the records by dentist, when the staff of one office log in to that dentist’s insurance accounts, they can see the insurance reports from the patients that the dentist has treated at other offices. This is a violation of patient privacy. A receptionist at one office has no right to see the patient information of a patient at another office.

I have called the various insurance providers to discuss this, and they just say….well this is just how it is. Shocking in this era of concern of data breaches.

Non-Assignment

There is a very simple workaround to all of these patient privacy, logistical, and accounting challenges that come with being an assignment office: have the insurance company pay the patient directly. Many practices have moved to this method of handling insurance reimbursements.


The challenge with becoming a “non-assignment office” is that many patients have grown accustomed to paying very little, if anything, at the end of their dental appointments if they have insurance. When they are asked to pay up front and to be reimbursed by the insurance company, it can be quite a shocking change to the patient, even though the amount that the appointment ends up costing the patient is the same as in the “assignment” offices. What patients complain about is that they must have the cash available in their bank accounts, or that amount of space available on their credit cards, to pay for the treatment once it is completed. And I get it…. cash can be tight at the best of times.

Unlike when the insurance companies reimburse the dental office, however, the payment made to the patient by the insurance provider usually happens within days, especially if the subscriber is set up with direct deposit, and this is much safer for patient privacy. For the office, the accounting is much clearer, accounts receivable are much lower, and staff can spend more time taking care of patients instead of taking care of the insurance companies.


Most patients after being explained these reasons why dental offices are moving towards non-assignment, understand these changes and continue on with the practice. Some, however, get upset, and search for an office that is still “assignment”.

Switching to non-assignment is a tough decision for a dental practice to make because of this reason, but many offices are making the change.

Thanks for reading!

Dr. Dave

Dentist and Prosthodontist

Nelson Avenue Dental

Nelson BC

#Nelson #DentalInsurance #CostsofDentalCare

Nelson Avenue Dental

623 Nelson Avenue

Nelson, BC V1L 2N4

Tel: 250-354-4244

Email: info@nelsonavedental.com

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Tuesday: 8am-4pm

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