A Guide to Dental Insurance for New Dentists

What is dental insurance?

Like other forms of medical insurance, dental insurance provides coverage to help pay for dental care. Generally, your patients pay a premium for coverage, including deductibles, copayments, and coinsurance. They can get dental insurance from their employer or buy an individual or family policy directly from dental insurance companies.

These policies typically provide three levels of coverage, such as:

• Preventive care: Routine oral exams, X-rays, cleanings, sealants, and fluoride treatments
• Basic services: Diagnostic X-rays, fillings, simple extractions, teeth and gum pain emergency care, root planing, periodontal scaling, and root canals (Note: This is considered a major procedure in some policies.)
• Major restorative procedures: Bridges, crowns, implants, impacted teeth extraction, anesthesia or sedation, complex oral surgery, and denture work.

However, always look up the terms of their policies since they will depend on whether you are paid directly or reimbursed for covered costs.

Why dental insurance matters to your practice

Nearly nine out of ten adults aged 20 to 64 in the US have experienced tooth decay, but most will remain untreated due to various factors, such as financial concerns and a lack of access to dental practices.

With a dental plan, the insurance companies can shoulder significant costs of your patients’ treatments to avoid out-of-pocket expenses. This also helps them schedule regular preventive checkups so you can detect their problems early and save them money in the long run. Studies show that they save $50 or more for every preventive service you perform.

On the business side, patients tend to choose a dental clinic based on its insurance networks and coverages. As a new practice owner, you can enhance patient retention and foster trust by having a solid understanding of dental policies. This can result in increased visits and higher revenues.

Different types of dental plans

Here are the different types of dental insurance you should be aware of:

• Preferred Provider Organizations (PPO): If you agree to provide dental services at reduced rates, this plan can help patients save money by choosing any dentist within the network.
• Dental Health Maintenance Organizations (DHMO): This involves a “capitation” system in which dentists are paid a fixed amount per patient, irrespective of the amount of dental work performed.
• Direct Reimbursement (DR): Unlike the previous plans, DR has no networks, allowing patients to choose any preferred dentist. For dentists, reimbursement is based on the dollars spent on dental care, not the type of treatment received.
• Dental Discount Plans: Members pay an annual fee for reduced rates from their dentists.

Dental insurance trivia: Most dental plans cover 80% of basic dental services and 50% of some dental treatments.

How to work with insurance companies

Every dental practice can benefit from working with insurance companies, especially as a new dentist. It can greatly contribute to the clinic’s expansion and operational efficiency when patients can visit you as one of the providers in their network.

To get started, you need to be an approved provider through provider credentialing. This insurance company’s review process qualifies a dentist for a contract as an in-network provider.

Dental credentialing is similar to medical credentialing with a few differences, such as:

• Shorter time: Dental credentialing takes up to 30-45 days compared to medical, which is 90-120 days
• Fee scale: Dental credentialing is based on specialty and not by procedure/service.
• Coverage: Dental credentialing has a smaller list of specialties and procedures

While it sounds simple, many inexperienced dentists experience delays, lost revenue, and disruptions in patient care during the application process. Fortunately, Synapse Dental Billing has helped countless dental practices overcome the credentialing hurdle.

Check Our Case Study: Start-Up Practice With No Billing Cycle Achieved Proper Credentialing

Through Synapse’s all-around services, this client received a superbill tailored to their practice, software for billing and EHR with a complete fee schedule, credentialing and contracting with major insurances, and more.

Ready to unlock dental insurance success with Synapse?

Navigating the complexities of dental insurance as a new dentist can be challenging. A reliable partner where you can handle both billing and insurance-related tasks can be a game-changer in ensuring smooth operations and maximizing reimbursements.

With Synapse Dental Billing, we can easily streamline operations, reduce administrative burdens, and handle provider credentialing with the same level of care you give your patients.

Our teams have expert knowledge of insurance codes, claim follow-ups, and industry-specific regulations to help your practice gain a competitive edge and grow. Synapse is the pathway for many dental practices to sustain thriving businesses. Contact us today to get started on your successful RCM journey: (844) 384-7532 or dentalsales@synhs.com.

Products – Data Briefs – Number 197 – May 2015. (2019).
https://www.cdc.gov/nchs/products/databriefs/db197.htm

The Value of Preventive Oral Health Care | College of Dentistry | University of Illinois at Chicago. (2016, November 2). Dentistry.uic.edu.
https://dentistry.uic.edu/news-stories/the-value-of-preventive-oral-health-care/

U.S. Bureau of Labor Statistics. (2018, April 13). Dentists: Occupational Outlook Handbook: U.S. Bureau of Labor Statistics. Bls.gov.
https://www.bls.gov/ooh/healthcare/dentists.htm