Let’s face it—very few people like or even understand insurance. It can be complicated, have odd phrasing, and include many exceptions to coverage. However, if you own and operate a dental practice, working with insurance companies probably has a significant impact on your business’s revenue stream. However, sometimes, even though you do not represent the insurance company, you have to act as a resource for your patients regarding their benefits through dental insurance verification and billing.
For instance, many insurance plans include a missing tooth clause, which can affect your patient’s out-of-pocket costs and their attitude toward your practice. Keep reading to learn what this clause is and how it can impact your business if you don’t handle it gracefully.
What Is the Missing Tooth Clause in Dental Insurance?
Just like many medical insurance policies include exclusion clauses for pre-existing conditions, some dental plans come with the missing tooth clause. This statement says that if the patient has had a tooth extracted prior to when the policy takes effect, the insurance company will not cover the cost of initial replacement.
Note: there could be some exceptions to this exclusion. For example, if the patient has already had this missing tooth replaced, such as with a partial denture or bridge and simply requires a new prosthetic while under the policy, dental insurance should assist with this cost.
Why Do You Need to Be Able to Explain the Missing Tooth Clause?
At its core, the missing tooth clause is an insurance issue, so it may seem puzzling why you as a service provider need to understand and be able to clarify it for your patients. Unfortunately, most patients do not take the time to learn about their coverage; in fact, many know next to nothing about benefits until they want or need a certain service. With in-person contact, your team will likely need to go through the details of the plan with the patient and explain what is and isn’t covered.
Without this clarification and transparency, your patient may be surprised and angered when they realize that they must pay the full amount to replace their missing tooth. Although this frustration should be aimed at the insurance company, they can easily blame your practice, which means you could lose this patient for future work. Taking a moment to talk about their plan and the missing tooth clause can prepare them for the bill and help your practice stay in their good graces—even if they are still upset with their insurance and the cost.
In the end, your team must be well versed in dental insurance and be able to explain important bits like the missing tooth clause to show that you’re willing to be transparent about cost. Other financial provisions, such as flexible financing, can also show your desire to make care affordable and accessible to your patients, helping you earn their trust and loyalty and helping your practice thrive in the long run.
About Dental Support Specialties
Dental Support Specialties, as a company, has dealt with insurance companies on practices’ behalf for more than 15 years. We have extensive experience in verifying and billing insurance and know how to help dental practices get paid on time. We can even handle follow-up billing calls with patients. Our team already knows how to work within more software suites, so you don’t need to worry about training us—we can just start working for you! If you are interested in learning more about our services or team, contact us online here.