Dental Insurance Puzzle

By Kay Huff

As a dental practice owner, growing your business is often your primary concern. To do so, you have many strategies at your disposal and how you design success around insurance should be one of them.

For example, being with a PPO has its advantages; your name appears on a list to hundreds, if not thousands of potential patients and you might even see participating as a step toward your marketing efforts to get patients in the door. This can be a huge win for your practice, and you may find yourself joining several PPOs over time. However, each provider comes with its own set of rules and regulations and managing this influx of insurance requirements takes some strategy.

One management strategy is to think of insurance like a big picture that is a four-piece puzzle. These pieces represent technology, fees, follow-up processes and your team. How you revise, review and rearrange these insurance puzzle pieces to create a profitable and successful office is an art you can master.

Technology saves time.

While adopting technology into your practice has a definite learning curve, you will quickly see the benefit of time (and frustration) saved from staff using electronic methods to complete tasks. Since most insurance companies provide online patient portals and supporting software, your team should become adept at utilizing these portals to submit attachments and verify benefits electronically rather than faxing and calling to complete such tasks which can be overly time consuming. If additional software training is needed, this is one investment worthy of doing so.

For those of you already using intra-oral cameras and digital x-rays to share images with patients, you’ve experienced the gratifying impact these images can have on educating and even comforting your patients. Being able to then easily upload that image to a patient portal increases efficiency and accuracy when it is time to bill for services.

Ultimately, use the systems function of the technology puzzle piece to increase precision and decrease opportunity for human error as both factors affect profitability.

Manage fees, manage your bottom line.

South Florida Study Club Lecture

How you manage a fair and competitive fee schedule is all about timing and maintaining a broad overview of the marketplace. To start, since insurance companies pay out a percentage of a set fee on procedures, make sure you are billing out your standard fee not a reduced fee. With your standard fees in mind, use fee reporting resources provided by entities such as the National Dental Advisory Service (NDAS) to research dental procedure fees charged in your area by zip code or review dental fee surveys from the American Dental Association (ADA) and set a benchmark to be in the 80th percentile (or higher) of these fees and do this review annually. Additionally, once a year, identify your 30 most-billed or utilized procedures and negotiate increases on these procedures with insurance companies. Finally, set an office calendar to alert your team to update fees internally and with insurance bi-annually. Instituting these strategies will help you stay profitable, organized and efficient in your billing strategy which is a huge piece of the puzzle.

Follow up with your team.

The final components of keeping your insurance puzzle intact involve your team and your follow-up procedures. If you have already assembled a team that is trained, empowered and capable to run your office (with a smile, no less) you’ve accomplished something to be cherished. If not, this is your new goal!

You can provide additional leadership by working with your team to create a written and well-defined follow-up procedure that also attaches team ownership to its function. We know that processes can fall through the cracks, especially those involved with insurance; we are human after all. However, pinpointing and finalizing tasks like reviewing outstanding insurance account receivables, billing completed procedures to insurance reports, and managing aging reports can truly lead to the success you’ve conceived.


Kay Huff

Kay Huff is the Director of coaching for Benco Dental. Whether she’s delivering engaging talks on the lecture circuit, or working directly with dynamic dental teams in practices nationwide, Kay puts decades of hard-earned experience to work for her valued clients. Her natural leadership skills and proven talent for building and motivating teams, continually improving business systems and enhancing practice profitability led her transition to full time practice coaching. Since then, Kay has been a driving force in helping hundreds of practices exceed their goals, as well as an inspiring presenter who brings audiences warmth, laughter and most importantly, tips, tricks and practical advice they can immediately put to work and get tangible results.

Academy of Dental Management Consultants (ADMC)
Speaking Consulting Network (SCN)
American Association of Dental Office Managers (AADOM)

DOCS Membership

South Florida Study Club Lecture

Upcoming Events
San Francisco
November 12- 13, 2021
February 18- 19, 2022

More Articles