What You MUST Have In Place Before Seeing Your First Insurance Patient


If you’re going to be accepting dental insurance in your office, there are important elements that must be in place prior to you seeing your first patient.

This is the third video in the series of videos on Getting Started with Dental Insurance Before Opening the Doors to Your office!

If you have not watched our first and the second video in this series, make sure to watch them because I discussed the basic differences of what it means to be in-network vs out-of-network with an insurance plan.

In the 2nd video, I discussed the details of the credentialing process – how to become in-network with dental insurance plans.

In this video, you’ll learn the importance of systems that must be in place to make dental insurance process work smoothly in your office when you’re starting out.

Specifics include the following:

  • Entering insurance fee schedules into your practice management software
  • How to let your potential patients know of your insurance participation prior to opening your doors
  • Front desk systems

Continue to read on for the full video Transcript:

Hey Guys, this is your host Nilay Shah with Dental Startup Academy. Welcome back!

This is the third video on this series of Getting Started with Dental Insurance Before Opening the Doors to Your Office.

So if you’re watching this video at this point, you may have finished applying to different insurance plans. If not, make sure to watch our 2nd video in this series, which covers the specific topic of credentialing.

Before you open the doors to your office, there are specific things you must have in place to start seeing your first set of patients.

1. Entering the fee schedules into the practice management software.

I’ll explain why that’s important in a minute.

2) letting your potential patients know of the specific plans you accept.

And finally the 3rd and most important of all, is the,

3) Front Desk System.

These are specific things your front desk needs to have in order to allow them to do their job.

So let’s get started.

So the first thing is to load up or enter the specific fee schedules of the insurance plans into the practice management software system.

Here’s an example fee schedule by Guardian.

It’s basically a list of services with the maximum allowable fees, or the contracted fees. You should enter these fees for all the procedures on the fee schedule.

But you can see there may be procedures you don’t do at all in your office. You can obviously skip over those.

Let’s talk about why the fee schedules are important:

If the fees are entered into the system, the Practice Management Software should be able to calculate the patient copays for their out-of-pocket responsibility for all the treatment plans that you generate.

Depending on what the insurance coverage is for the patient, the software will only be able to calculate the insurance reimbursement if the fees are entered.

Let me show you an example.

I use OpenDental in my office. OpenDental, if you haven’t heard of, is another type of Practice Management Software.

So let’s take a look. Here’s a list of plans whose fee schedules have already been entered into the system.

Let’s click on Aetna. Here are the fees for the corresponding procedures.

Here’s the MetLife fee schedule. Now let me show you what this does for us, so you understand why it’s important.

I’m going to pull up a treatment plan for a patient. If all the insurance details are entered into the system prior to the patient coming in, then going over the finances with the patient becomes really simple.

Here’s the treatment plan. This column shows the insurance estimate, and this column shows the patient portion.

It’s that simple, but it can only happen if the fee schedules are loaded in and all the coverage details are loaded into the system as well.

Don’t worry about it if the last part was too much. I’ll go over the entire process of insurance verification as well as entering all the detail, the coverage details into the system.

I’m going to go over the entire process of seeing the patient for the first time, creating the treatment plan to presenting all the financial details in future videos for you.

Entering all the fees into the system is extremely time consuming process, but at the same time, it’s very important.

You’re going to need to update these fees from year to year as all plans will change fees for certain codes.

Let’s move on to –

Getting the word out about your insurance participation.

You’re already accepting insurance plans, well, you’ve got to let your patients know about it.

It starts with your website. Your website needs to show which plans you accept.

Here’s a simple list on my site. Make it easy to read. Put each plan on a separate line. Don’t just put a comma separated list of all plans in one paragraph.

So, next is your Direct Mail.

You’re already spending money for your flyers – your direct mail. Your flyer should also have on it the list of all plans you take – but in the form of logos, images – mini images.

Why? Because it grabs people’s attention. You simply do not want a long text of plans. People are not going to pay attention to it.

Here’s an example from my current direct mail campaign – use the logos of the different plans.

Most plans are national brands – their logos are recognizable by most of the population. If not, most of the logos have names of the plans in it.

And last, make sure to verify your contact information on the insurance website themselves.

If at the time of applying to insurances, you used your personal contact number because your office phone system wasn’t set up – now it’s time to call up the plans and immediately change the contact information to match your office information.

Let’s move onto the very last important one –

Your Front Desk Systems

This is a very big topic. I’m going to be bringing you a whole series of videos to cover this topic. But for now, let’s just focus on the few details that your front desk needs to have together before you start seeing your first set of patients.

First, they need to be AWARE of all the plans you accept. He or she needs to literally memorize this list in their head. Why do I bring this up?

Because my first two hires stumbled numerous times when patients simply asked this question of whether or not we accepted a certain plan.

When patients call to make an appointment, and they’re covered by a certain plan you accept, your front desk is going to need certain pieces of information before they start verifying their benefits.

That information is going to the subscriber or the policy holder’s DOB, policy holder’s ID, or the subscriber ID, the group#, etc.

I’m going to go over all these details in the future.

Insurance verification is really important, especially, when it comes time to finding out the patient’s coverage.

But you need a SYSTEM to make things work correctly and efficiently.

So, let’s RECAP. Here’s what you’ve got to do next to set your office up so you can start seeing your first patient.

First, start entering your fee schedules into the practice management software.

Your front desk should be doing this. If you’re few weeks away from opening the doors to your office, then that task should be part of their training and setup.

2nd, contact your web developer or your web design company and send them the list of all plans you accept, so they can put it on the website.

3rd, if you’re doing direct mail, make sure to send the company you’re working with the logo files of the insurance plans and let them know where you need to have them placed on the flyer.

Make sure your front desk knows which plans you’re enrolled with. Make sure he or she has this list memorized.

If you have an inexperienced front desk person, make sure they know what details they need to ask the patient over the phone before they start the verification process because the insurance company is going to want this information to pull up the patient record.

And last, create a system for verifying insurance for patients.

And that’s all for today guys.

Thanks for tuning in. leave me any questions or comments you may have.

Don’t forget to subscribe. Until next time, take care!