Understanding Dental Insurance Pre-Estimates vs Pre-Authorizations
Understanding dental insurance pre-estimates is tricky. So, let’s begin with a definition. A pre-estimate is a document and a process. The dental office sends a pre-estimate to dental insurance. It’s sent as a claim form marked “pre-estimate.” We do this to receive a cost estimate for our patient. And we wait for the insurance carrier to process. The patient receives a copy. And the dental office does too.
Are Pre-Authorizations Required?
Some insurance policies require pre-authorization. And often for major procedures. But sometimes for periodontal treatment too. And this is a different thing! It’s a great question to ask during an insurance verification. “Are pre-authorizations required for dental services?” This is a great question to ask!
How Are They Different?
Pre-estimates and pre-authorizations are different. Pre-estimates give us patient benefits. Pre-authorizations allow patients to receive dental treatment and use benefits. And often come with expiration dates. A pre-estimate expires as well. So we want to watch this!
Flag Accounts for Required Pre-Authorizations
Flag accounts for required pre-authorizations. Create an attention getter! Something no one can miss. And be sure not to skip this step. Or a patient might just miss out on their benefits. It doesn’t happen often. But it does happen. And creates a case for careful consideration.
Understanding Dental Insurance Pre-Estimates & Requirements
Some offices send pre-estimates for everything! And I understand why. The pre-estimate numbers are the foundation for financial conversations. However, we must watch these numbers carefully. Pre-estimates are often not accurate. And we may need to do our own math!
Re-Calculate Upon Receipt
You’ll be so glad you did! Know the patient’s benefits. Verify patient benefits as they enter the practice. Track benefits used. And be sure to understand as much as you can. Then re-calculate based on what you know. A few steps now saves many more later. And fosters better patient relations too.
Understanding Dental Insurance Pre-Estimates – No Guarantee of Payment
There is no guarantee of payment. This is one thing dental insurance repeatedly tell us. We can count on nothing! Anything a dental insurance plan pays is a bonus. I like to share this with patients. And let them know I am here to help. I want them to receive all the benefit they can. And I avoid the words “insurance coverage”.
Use Pre-Estimates to Your Advantage
Take advantage of what the pre-estimates offer. This is an opportunity to help educate patients about their benefits. And the challenge in calculating their copay with accuracy.
I always call patients with the pre-estimate information. And explain why I see their insurance may pay something different. Especially with yearly maximums. PPO providers are able to charge UCR once a patient’s maximum is reached. And this may not be reflected in the pre-estimate.
Dental Practice Operational Manual