Estimates Are Not Meant to be Accurate That is Why They Are Called Estimates

Trying to collect an estimated coinsurance from a patient can be challenging if the patient wants an exact figure.  If you are in-network or out-of-network, the insurance companies do not guarantee the amount of payment to be your estimate.   Explaining to the patient that the insurance company reserves the right to decide payment based on the policy provisions set forth by the employer, the insurance company’s agreement, and the covered benefits along with the exclusions and frequency limitations.  All of these factors that are considered prior to issuing the insurance check have little to do with the quality of care or the necessity of the care for the patient.

Update standard fee schedules

Many practices enter only the standard fee schedule of the dentist even though they are in-network for PPO plans.  Most dental software programs allow the PPO network fee schedules to be added and used per individual to calculate a patient’s coinsurance which can easily be demonstrated in a printed treatment plan but not on the ledger.  The claim can still be filed with the standard fee schedule as preferred by all insurance companies.  The problem arises and gets complicated when you post to the ledger after receipt of the EOB.

It is important to update your standard fee schedule yearly and to do so when allowed for all in-network plans to avoid adjustments to correct an undercharge.   I find that many practices have not updated their fees in several years for fear of losing patients even though the insurance company’s UCR for the area is higher than the dentist’s standard fee schedule.

Dentirx and estimates

Dentrix has been trying to solve the problem of “accurate estimates” and has introduced Dentrix Ascend.  You are allowed to enter the PPO fees and it will only apply them to the insurance estimate, not to the ledger.  This can give an insurance estimate on the treatment plan but it doesn’t enter these reduced fees into the ledge.  When posting the business manager can follow the EOB and enter the total adjustment without additional calculations or the worry of undercharging patients.  

Insurance filing and posting can be very complicated and avoiding the loopholes is sometimes left to experts who can save thousands of dollars just by understanding the posting of payments and understanding the language of EOBs. At eAssist, our Success Consultants are experts on EOBs and payment posting. To learn more, schedule a consultation. 

Dr. James V. Anderson

CEO & Co-Founder, eAssist

Dr. James Anderson is a practicing dentist and the CEO and Co-Founder of eAssist Dental Solutions, the nation’s leading platform for dental billing. A serial entrepreneur, Dr. Anderson has built multiple successful ventures, including eAssist and nine dental practices in Utah, all driven by his mission to help dentists, their teams, and their patients achieve peace of mind. He co-founded eAssist in 2011 to give dental practice owners the ability to fully outsource their billing departments—a vision that now serves over 2,400 practices nationwide. Under his leadership, the company has formed strategic partnerships with the California Dental Association and Henry Schein, and earned a spot on the Inc. 5000 list for nine consecutive years. In 2020, Dr. Anderson was recognized as Entrepreneur of the Year by Business View Magazine and ranked among the top entrepreneurs in the country by Entrepreneur Magazine. He holds a B.S. in Finance from Brigham Young University, a D.M.D. from Oregon Health & Science University, and completed the three-year O.P.M. program at Harvard Business School. He also serves as Chairman of the Dental MBA Advisory Board at Roseman Dental School.