A Win-Win Situation: Help Patients Maximize Insurance Benefits & Increase Your Year-End Production

How to help patients use the insurance benefits they pay for before they renew at the start of the new year.

Updated 10/20/2021

The start of the fall season means cooler weather, football, and pumpkin-flavored…everything!

It also means it’s time to think about what you can do for your patients during the fourth quarter of the year. We are all experiencing challenging times and some patients may be experiencing financial hardships. Your dental office should be doing everything you can to make your patient’s treatment affordable. One way you can do this is by helping your patients use their dental insurance benefits.

Here are a couple of ways you can help patients take full advantage of those benefits.

Continuing Care

Due to the pandemic, patients may have missed out on their recall appointments. I would suggest generating a Continuing Care report for patients who are past due for recall, as well as for patients are due for recall in the upcoming months. You could use a due date range of January 1st, 2021 – December 31st, 2021 to view patients who were due earlier in the year or who are going to be due for a prophy or periodontal maintenance sometime before the year ends.

If you have made a habit of documenting frequency limitations in the insurance plan note, view those notes before contacting the patient to schedule. You can help patients to make the most of their insurance benefits by reviewing this information. For example, if a patient was seen in July for a prophy, and that was their first prophy of the year, they technically aren’t due for six months, which would be in January 2022. But, if their insurance allows for a prophy two times per calendar year, you could schedule them to come in for another prophy in December, so they can maximize their insurance benefits. This research may take a little more work, but would be worth it to get your patients their maximum benefit.

Outstanding Treatment Plans

The Treatment Manager in Dentrix is my favorite tool to find patients with outstanding treatment plans towards the end of the year. You can use filters when setting up the Treatment Manager to generate a list of patients whose insurance benefits renew in January and who have an outstanding insurance maximum remaining.

This can be very beneficial for patients, especially those with several treatment-planned procedures, as they can split up their outstanding treatment and do part of it in 2021 and the remainder in 2022. This can result in both a higher insurance reimbursement for your practice and a lower out-of-pocket expense for the patient.

I like to generate a list of patients that is filtered by procedure code range. This allows me to search for a specific procedure codes like a crown or bridge and get an idea of how many patients have those procedures treatment planned, but not scheduled. Another reason I would search for a crown or bridge is because those procedures take two appointments two weeks apart. Many insurance companies pay based on the seat date so it’s important to get both appointments completed before the insurance renews.

Another useful filter is a minimum treatment plan dollar amount which can help you find high production cases. High production cases will result in higher revenue for the practice, so I like to contact those patients first.

You could also use filters to view only patients whose insurance renews in January. These patients are going to be motivated to schedule an appointment before their insurance renews on January 1st.

Once you have set your filters and generated a list of patients, you can display the insurance benefits each patient has remaining, letting you know which patients might be more likely to schedule.
The Show Columns option allow you to choose which type of information is displayed for each patient. For example, if you wanted to contact patients with treatment plans and outstanding insurance benefits, I would recommend viewing columns for:
  • Patient Name
  • Last Treatment Plan Date – shows you the last date treatment was diagnosed.
  • TP Total Amount – allows you to see the total amount, so you can contact the higher production treatments plans first.
  • TP Dental Ins Estimate – shows you the estimated insurance portion of the treatment plan. You can use this to educate your patients. For example, I could explain to a patient that the estimated insurance portion for the treatment plan is $1000. If the patient doesn’t use that benefit before January 1st, they will lose these benefits.
  • TP Patient Estimate – gives the patient portion of the treatment plan.
  • Pri Dental Ins Benefits Rem – shows the amount of primary insurance maximum remaining.
  • And if your office accepts secondary insurance benefits, you could also view Sec Dental Ins Benefits Rem as one of your columns.

Once you have the list of patients that fit the filtering criteria you’ve set, it’s nice to have all this information in front of you so you can answer any questions they have regarding their treatment plan when you contact the patient. The Treatment Manager also allows you to select a patient’s name on the list and go directly to other Dentrix modules like the Patient Chart, so you have easy access to their clinical notes if the patient asks you a clinical question.

Help your patients maximize the insurance benefits they pay for, before those benefits renew in January! It’s not only a service to your patients, but can also help your practice keep a full schedule and consistent production during the final quarter of the year.

Learn More

To learn more about finding patients who may be overdue for continuing care, read Don’t Let Patients Fall through Cracks in Your Hygiene Program.

For more information about filling your hygiene schedule, read How to Fill Open Time in Your Hygiene Schedule.

By Charlotte Skaggs
Certified Dentrix Trainer and The Dentrix Office Manager columnist

Charlotte Skaggs is the founder of Vector Dental Consulting LLC, a practice management firm focused on taking offices to the next level. Charlotte co-owned and managed a successful dental practice with her husband for 17 years. She has a unique approach to consulting based on the perspective of a practice owner. Charlotte has been using Dentrix for over 20 years and is a certified Dentrix trainer. Contact Charlotte at vectordentalconsulting@gmail.com.