Corvesta News

Be Alert to Changes in Dental Benefits in the New Year

It’s a new day, it’s a new year, and there are new benefits waiting for most of your patients. If you are like most of our dental practice clients, you already know the importance of verifying benefit details for your patients. As the new year begins, don’t assume that nothing has changed. Something most likely has changed.

As employers continue to grapple with the rising cost of providing healthcare benefits, they are looking for innovative ways to save money. Dental insurance companies are finding their business more and more competitive and are getting creative in designing plans to satisfy their employer customers.

What does that mean for dental teams and our patients? Increasingly, dental benefit plans include cost saving measures like exclusions, waiting periods and deductibles. The time-tested 100/80/50 benefit structure is no longer standard and shouldn’t be assumed. Groups are choosing plans with lower coverage percentages and higher deductibles.

Teresa Duncan, MS, FADIA, FAADOM of Odyssey Management reports seeing a rise in benefit structures that place more cost-shifting to the patient. “Offices today are changing the practice management system defaults of 100/80/50 more often than ever before,” she shared. “It’s another reason why checking benefits and eligibilities is essential – the wrong percentage leads to the wrong copayment which usually leads to an increase in accounts receivables.  In another example she cites several plans have carved out periodontal surgical services and have subjected them to a separate periodontal maximum (which is great because it leaves the larger maximum for other work).”

This cost-shifting to the patient is an important communication opportunity for your dental team. Most patients are unaware of the details of their dental plan and typically assume full coverage for recommended treatment. When financial surprises arise they often result in an unhappy patient. Be prepared and proactive by sharing coverage details with your patients when proposing treatment. They’ll be appreciative that you are concerned about their financial health as well as their oral health.