Has dental insurance taken their refund from other patients on your EOB?

Dental Insurance Training Tips for Dental Staff Training

Finding the needle in the dental EOB haystack

Have you had to send money back to a dental insurance company? You may have received a letter informing you that a patient received benefits but then turned out to be ineligible and now the insurance company wants their money back. Hopefully, you sent them a check for the amount they expected to receive and then you’re on your own to collect from the patient.Forex Money for Exchange in Currency Bank

However, sometimes the insurance company does not send you a refund request letter. Sometimes they send you a remittance letter simply stating that again, a patient received benefits they should not have and now the insurance wants its money back. However, in this letter they inform you that they will be taking this money from your next EOB. So, you are keeping an eye out to see how that will happen and which patients will be affected.

Dental Insurance taking its refund from another patient

Soon, you may receive the next EOB and start your own ‘Where’s Wally?’ game. Starting with the first patient, you see the normal column showing submitted fee, adjustment required, copay, insurance payment and patient portion. Everything looks normal. So, did the insurance actually pay on this claim? It sure looks like it. But wait, here’s the clue: in the top right corner of your EOB beside the line for “Check number” its blank. That”s how the insurance company is telling you that no, they didn’t actually pay for any of the patients listed on that EOB. Even though the columns for each patient say “Insurance paid”‘ they didn’t!

So, you’ve figured out that EOB, how about the next one? You start by looking at the “Check number” line and you see EFT. So, they must have paid on this one, right? Wrong. There are several patients listed on this EOB, and you could tell from the summary on the first EOB that there is still money owed, but there is no way to tell which patient they took the money from. Ok, its time to wave the white flag and call the dental insurance company. After your standard wait time, a very nice representative explains that, in fact, they didn’t take it from any one patient, they just subtracted it from the total. And, she reminds you that you have to give credit to the patients even though you didn’t actually receive the money.

So, what can you do? There are two options for practices who have to send money back to the dental insurance company: refund or remittance. Ask to be set up in their system for the refund option, this means that when this happens again, your office will receive a letter asking you to refund the money. The other option is what you are stuck dealing with now: the insurance takes money out of their next remittance (insurance payment).

Dentrix Insurance Manager

For more resources to help you stay on top of outstanding dental insurance claims, you may want to check out the Insurance Manager through eServices. By signing up for this service, your team can save time calling the insurance plans to determine eligibility. To learn more: http://www.dentrix.com/products/eservices/ecentral/insurance-manager

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Filling the schedule is just one way to 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
jill@dentalpracticecoaching.com
4 Comments
  • C. Smith dds

    Thanks. I’ll pass this on to my secretaries.

    Dr. Smith

    January 17, 2015
  • Wendi

    But how do you account for the fact that the insurance shorted you? You have to list what they paid for each claim but then your check is less than the amount on the ledger.

    January 23, 2015
    • Wendi,

      You’re absolutely right. What I’ve done is to enter an adjustment and a good explanatory note on the account. That way the account is “paid in full” and the patient won’t end up showing up on a list for collections.

      Then, I would call the insurance company and have them change their records to send you a request for refund directly rather than taking their money back from another patient.

      Hope this is helpful.

      Jill

      January 23, 2015
  • Hello All, here is my situation, question.
    A family came into our office for dental treatment. Their insurance was checked and was eligible at the time of the treatment, at the time of the payment.

    Now almost a year later, the dental insurance send me a letter saying that I must send the money back to them because the patients insurance had been terminated 2 months prior to them coming into our office. Furthermore, it makes me responsible to collection from the patients for their mistake.

    Why is this now my responsibility? I checked the insurance before and on the day of treatment so why do I have to pay for the insurance’s mistake? Its their responsibility to keep their records up to date. I did my part so now not only are they making me responsible for the money but we can now potentially lose the family as patients as well.

    Is there a legal challenge for this or am I stuck with losing the money, the patients or both?

    Regards,
    JGM

    January 10, 2017