Business of
Dentistry
12 Rules for the Insurance Game
Learn how to efficiently work with insurance
to help your practice get paid.
F
irst, take a deep breath and realize insurance is a
game with the cards stacked in favor of the insurance
company. They get to make the rules, change the
rules, and they like to keep their money. Do not get
emotional. It is a game. Learn as many of the rules as you
can so you can play the game better. Here are a few.
1. Send all insurance electronically daily. Batch the
claims, and be sure all clinical staff check their day
sheets for procedure correctness before sending
claims. Check the claims submission report and fix any
rejections or problems.
2. Take good x-rays. Show the apex of the root for
prosthodontic procedures. Show the crestal bone
(upper AND lower) for perio. Attach these digitally.
3. Over prove for perio and prosthodontic procedures.
Send everything you can with the claim.
• For crowns, send a pre-op x-ray and an intraoral
camera picture of that tooth.
• For perio, send an FMX with vertical bitewings—the
insurance carrier has to see bone loss and a full perio
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chart with recession and bleeding points charted, not
just pocket depth.
• For implants, partials, and dentures, send a panoramic
x-ray. Send a narrative if it is not abundantly obvious
that the service is needed.
4. Get the clinical team involved. Have them complete
a procedural form (Figure 1) for every prosthodontic
procedure.
5. Ask patients to update their insurance information
annually. Employers are changing their carriers at a
rapid rate. Do not rely on the patient to tell you that
their insurance has changed. Create an update form
and use it consistently.
6. Get insurance data before the new patient comes in.
Verify coverage, benefits available, what the patients
has already had done, and intervals for basics like
panoramic x-rays, bitewings, fluoride, etc. Use the
eCentral eligibility feature or look this up online, if
possible. If not, call the carrier or use an insurance data
service. Enter the proper information into the specific
group plan in the Family File. When a new patient
comes with a new insurance group, have a system that
everyone follows so you do not duplicate insurance
groups in Dentrix.