Simplify Patient Co-Pay & Responsibility Calculations

Common Issues & Solutions

Even with a robust process, you may encounter these common challenges—and here’s how to address them:

• Issue: Missing procedure codes or patient info.
  Solution: Pause and retrieve details from the EHR or clarify with the provider before proceeding.
• Issue: Coverage rules are unclear or unavailable.
  Solution: Use benefits breakdowns, insurance portals, or call the provider for direct confirmation.
• Issue: Calculation errors.
  Solution: Double-check coverage percentages, deductibles, and frequency limits; have another team member review complex cases.
• Issue: Patient confusion about the estimate.
  Solution: Rephrase in simpler terms, illustrate with examples, and highlight key details like “estimated, not guaranteed.”
• Issue: Disputes after the claim is processed.
  Solution: Reference documented estimates and clearly communicate any known uncertainties up front.

Best Practices to Follow

• Always verify insurance details before the day of appointment.
• Log every interaction with insurance providers or patients regarding estimates.
• Use the same methodology for all estimates to ensure fairness and consistency.
• Update your knowledge base with new coverage rules as plans change annually.
• Train staff to explain estimates in plain language—avoid technical jargon.
• Record patient acknowledgment that estimates may change based on final insurance processing.
• Stay up-to-date on HIPAA, billing codes, and insurance regulations affecting dental billing.