Using predeterminations to your advantage in your dental practice

I’m guessing that many dental insurance coordinators do not think to predetermine everything. Yes, I mean everything. In my experience, predetermining everything combats denials and helps increase treatment plan acceptance. For example, authorizations have helped our office encourage patients to change their silver fillings to resin. It put the costs associated with treatment back on the insurance company.

I use words such as, “This is what your insurance company says you owe.” This takes out the negative sound of, “The dentist says you owe...” What patients perceive is the reality we live. Learning to combat their perceptions is just one of the many ways that prior authorizations can help cash flow in your office, just like it has in ours. There are an unlimited number of treatment plans that patients can easily accept when the guesswork is taken out of the financing.

Education
Predeterminations teach patients about their insurance. Our office sends their predetermination to the insurance company. When these come back we call patients and go over it with them. Oftentimes patients beat us to the punch and call us to tell us they’re ready to schedule an appointment. Information literacy is the only way to help our patients understand their insurance and how it relates to their wallets and oral health needs.

By using this technique, our office has been able to keep treatment plan acceptance at a steady 96%.

How to schedule
I know what you’re thinking. We’ve all been told that patients need to leave the office with two visits scheduled — one for recare and one for operative. We can still have patients leave with two visits, and this can be done one of two ways. First schedule the recare appointment, and then schedule the operative about two weeks later. Scheduling the operative appointment a few weeks out will make sure there’s time for the predetermination to come back. The second way to do this is to wait to schedule the operative and call the patient when the authorization comes back. This lets patients know we care. We take the time to make sure everything is ready and medically necessary for their treatment. Besides the personal call, we also email and text patients to let them know the authorization is back in our office.

What about same day treatment?
Did you know that many insurance companies do predeterminations over the phone? You can even do a three-way call with a patient and insurance company. Many online formats give a predetermination on the insurance company's website. This way you know exactly what the insurance company will pay and exactly what the patient is responsible for.

I hope you find this information helpful. It takes about two weeks to change habits. If we train our patients to become knowledgeable about their own insurance, this leads to a stronger and long lasting dental/home relationship. I dare you to try it out and see how it works for you and your office.

ALSO BY AMANDA WEBER:Negotiating with insurance companies