You just received an out-of-pocket for service you thought would be completely covered. What happened? The process of dental billing can be quite confusing. This article is going to break down what happens with your insurance from the time you visit the dentist, to the time you get your bill.
- Patient Registration: When a patient visits a dental office, they provide their personal and insurance information during the registration process. This information includes details such as name, address, contact number, and insurance coverage.
- Treatment Planning: After the initial examination, the dentist creates a treatment plan outlining the procedures or services needed. The treatment plan includes the associated billing codes for each service.
- Coding: Each dental procedure is assigned a specific code from a standardized coding system. These codes are used to document and billing for said procedures and services.
- Verification of Insurance: The dental office verifies the patient’s insurance coverage to determine the extent of the benefits and any applicable copayments or deductibles. This step ensures accurate billing and helps estimate the patient’s out-of-pocket costs.
- Claim Submission: The dental office submits a claim to the patient’s insurance company. The claim includes details such as patient information, treatment provided, and the corresponding billing codes. Electronic submission is common, but some offices may still use paper forms.
- Adjudication: The insurance company reviews the submitted claim and determines the coverage and reimbursement amount based on the patient’s plan. This part is important in estimating your out-of-pocket costs.
- Explanation of Benefits (EOB): The insurance company provides an Explanation of Benefits to the dental office and the patient. The EOB outlines the covered services, the amount covered, and any remaining patient responsibility.
- Patient Billing: If there are any out-of-pocket costs for the patient, the dental office sends a bill for the remaining balance. Patients are typically responsible for copayments, deductibles, or services not covered by insurance.
We hope this breakdown helps you understand the billing process a little better. What you receive after the adjudication is a good estimate at what you should expect, but a lot of times your costs may vary, sometimes greatly. Keep in mind that your dental office is there to advocate for you in these times! If you feel that your out-of-pocket is not what it should be, you can always file an appeal.