Are you leaving money on the table? Submit your full fee to dental insurance

H23 BB00934850 * $100 'star note'Dentists agree – dental insurance is a necessary evil. Necessary to help fill schedules since we’re all trained (thanks to health insurance) that we must follow our insurance plan. Evil because it almost physically hurts to write off 15% – 40% of our fees.

We all know that we’re taking a huge hit thanks to dental insurance, but are we also leaving money on the table that’s our own fault? Depending upon your set up for submitting claims to dental insurance, you could be losing money.

To make sure you’re getting paid the most on every claim, submit your full fee to each dental insurance plan. There are several benefits:

  • Your full fee will print on the treatment plan. The dentist can see the full fee, the insurance contracted fee and the patient portion. When a dentist can see the hit she is taking on a specific patient’s treatment plan, the dentist can make sure that the plan includes all appropriate charges.
  • The insurance company receives your full fee. Supposedly, this helps create the statistics they use to create future fee schedules. More importantly, different employers have different benefits – even with the same plan. Deductibles may be different, coverage may be different. If you submit your full fee, you’ll make sure that you are receiving every dime you’re entitled to receive.
  • You avoid under-charging. If you submit the contracted fee to an insurance plan and this employer has paid for any extra coverage, you’re missing out on receiving any extra payment – because you didn’t bill for it.

I know it takes time to manage the insurance adjustments for a dental practice. Just talk with an insurance/collections manager sometime – she knows. So, my recommendation is to set up your dental practice management software so it does the work for you. As you know, I’m a big fan of Dentrix – and one thing it does especially well is handle insurance submission. Here’s how:

  • Go to Family file, then double click the Dental insurance box
  • Click on the insurance data button, this brings up a window: Primary Dental insurance plan information
  • Look at the Claim format and select: DX2007F

This claim format will submit the full fee to the dental insurance plan and enter the contracted fee into your ledger. This setup saves the most time. You’ll never escape all the manual adjustments, as more and more insurance plans are adding “risk pools” which force you to enter yet another insurance withhold adjustment to the claim. Supposedly they’ll pay you back at the end of year – after they earn their profit, of course.

So – give this article to your dental office manager and have her check the claim setup in Dentrix to make sure you’re not leaving money on the table!

Handling dental collections is just one way you can run a successful dental practice. If you’re interested in new ideas on running a dental practice, please subscribe to my weekly blog:

One of the biggest challenges to managing a dental practice is managing dental insurance. With dental insurance handled, then dental marketing for new patients becomes a primary focus. In today’s day of online reviews, handling patient complaints well is essential. As your practice grows, hiring dental staff becomes more important. With 16+ years of dental practice management experience, I’m open to your questions to help you run a successful dental office.

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AUTHOR: Jill Nesbitt
  • Ira Brand

    Our dental insurance company is billing us for an “undercharge” that occurred 8 months ago. We do not have an itemized statement of the undercharge, nor do we understand how this could have happened.
    If it was a clerical error, how do we handle it?

    Ira Brand

    April 29, 2015
    • Ira,

      Sounds like your dental insurance company determined that they overpaid on a claim and now want their money back. Is that right? To find out the patient and the claim, call them and talk with them about this situation. Ask their representative to explain what happened.

      Likely, you will have to send the money back to the insurance company – and if you don’t, they may turn around and withhold this amount from another patient. And that is very confusing!

      Once you understand the entire situation, review this with your team to determine if there is any way you can avoid this from happening in the future.

      Thanks for your comment – and best of luck to you with this situation!

      May 7, 2015