1. Collect Patient Information
Start by gathering accurate details from the patient:
- Full name
- Date of birth
- Insurance provider
- Member/subscriber ID
- Group number (if applicable)
- Relationship to subscriber (self, spouse, child, etc.)
Tip: Do this ahead of the appointment—ideally when scheduling.
2. Verify Insurance Information
There are three main ways to verify insurance:
a. Use the Insurance Company’s Website/Portal
- Log into the dental provider portal (e.g., Delta Dental, MetLife, Aetna).
- Search by member ID or patient details.
- Check active status, plan type, and effective dates.
b. Call the Insurance Company
- Use the provider phone number on the back of the patient’s insurance card.
- Prepare to provide NPI, tax ID, and patient info.
- Ask about:
- Eligibility status
- Benefits summary
- Coverage % for services (preventive, basic, major)
- Frequency limitations (e.g., cleanings every 6 months)
- Annual maximum
- Deductibles
- Waiting periods
- Downgrades (e.g., composite vs amalgam)
- Non-covered services
c. Use a Clearinghouse or Practice Management System (PMS)
- Some platforms like Dentrix, Eaglesoft, Open Dental, or Zywave Dental PlanFinder integrate eligibility checks.
- These often give real-time responses and can be more efficient.
3. Document Everything
In the patient’s chart, note:
- Confirmation date
- Representative name (if calling)
- Coverage details
- Limitations and exclusions
- Screenshot or copy of benefit summary, if available
Important: Always verify before every visit, not just once.
4. Inform the Patient
Be transparent about:
- What’s covered
- Estimated out-of-pocket costs
- If preauthorization is needed
- If there are any coverage issues
Use this to get informed financial consent.
5. Optional: Send a Pre-Treatment Estimate (Preauthorization)
For major procedures:
- Submit a pre-treatment estimate to the insurance company.
- Wait for their response with exact coverage info.
- This protects both the practice and patient.
Learn more in our Certified Dental Billing Class
