3 Dental Insurance Mistakes Practices Are Making

Dental insurance expert Teresa Duncan of Odyssey Management is seeing three big issues with dental insurance that practices encounter.

3 Big Dental Insurance Mistakes to Avoid

  1. Not Switching to the 2019 ADA Insurance Claim Form
  2. Not Asking the Correct Prep Questions
  3. Not Documenting Everything

1. Switch To the 2019 ADA Insurance Claim Form

First, some practices have yet to switch over to the 2019 ADA insurance claim form.

While this form is available in your dental practice management software, it still hasn’t been employed in the everyday routine by many practices.

This causes insurance claims to be rejected before they can even get to the carrier, Duncan said.

“Yes, it’s a 2019 claim form, but this is really the first year I’m seeing a high number of rejection complaints related to using the wrong form,” Duncan said.

She recommends double-checking to make sure you are not still using the 2012 ADA form.

2. Ask the Correct Prep Questions

Second, Duncan says the right questions aren’t consistently being asked before the patient comes into the practice. With a little preparation, you can avoid awkward conversations about surprise bills. 

“I see administrative team members and insurance coordinators not asking about waiting periods for any services and not asking if there are any yearly limits on those services,” Duncan said.

“Those are two key questions that must be asked every time so there aren’t any surprises for the patient or the dental practice.”

For example, if a patient has a waiting period for any major services but the procedure is completed before that time is up, then no benefits will be paid.

Patients are typically not aware that waiting periods even exist.

Remember that the treatment may be needed even though benefits are not available, Duncan says. Checking on waiting periods and yearly benefit allowances allows you to be more confident in your financial conversations.

3. Make Sure to Document Everything

Third, if dental practices aren’t documenting things well, Duncan says they could well be in for a rude surprise.

“I noticed a few years ago that a handful of Delta Dentals changed their documentation requirements to request clinical notes rather than narratives, For example, Delta of Massachusetts required it in 2018 and in 2021, the national Delta Dental handbook contains the same language” Duncan said.

“I have seen carriers ask for a screenshot of a doctor’s clinical notes rather than narratives, which is easy to do if your documentation is solid.

“If you’re not already doing it, now is the time to really ramp up the level of your documentation for every patient.”

Learn More About Dental Insurance Mistakes to Avoid

Want to learn more from Duncan on how your insurance game can be taken to the next level?

Her course, “Dental Insurance: Building the Foundation for Success in Your Dental Practice” is now a part of IgniteDDSUniversity.

You can check out her course and others like it, all for one low annual price, by clicking here.

Note: Photo by tophrrrr 

Kevin Henry

Kevin Henry

With more than 20 years in the dental publishing industry, Kevin Henry is the former group editorial director for Dental Products Report, managing editor for Dental Economics, and editor-in-chief for DrBicuspid.com. He now serves as the co-founder for IgniteDA, a community designed to empower, enlighten, and educate dental assistants, and as director of marketing for Fortune Management. He has spoken to dental assistants throughout the world, in person and through the Dental Assistant Nation podcast series, reminding them of the important role they play every day in their practice. He is also certified as a DiSC trainer, helping dental practices learn how to understand each other better through personality assessments and training.