Feeling the Effects of Insurance Insanity? Put Down the Policies & Try These Tips!

By David Nye, Guest Contributor

Practice Administrator, Center for Oral & Maxillofacial Surgery, Aiken, SC

Want to know the easiest way to get an OMS administrator stuck in a tireless hamster wheel of confusion and questions? Ask them about insurance. You’ll most likely spark an interesting conversation with countless tales of head-scratching, phone calls, emails, and wasted effort trying to sort things out on behalf of your office and, most importantly, your patients. (And as an OMS admin, you know insurance is double fun because most of us work with both dental and medical health insurance companies, every day.)

It’s a part of the job, and sometimes it feels like it can be your only job. We’re here to give you some advice on how to stress less about insurance and make your work life a little lighter. 

Beware of Falling Plans (Don’t Get Buried)

Have you ever found yourself inundated with plans to evaluate? As OMS offices tend to become more successful and possibly even grow to multiple locations (even states), there become more insurance plans to assess before beginning acceptance. Out of nowhere, you find yourself with what feels like a mountain of paperwork, new/existing plans that you need to go over, and the relationships you have with existing dental and medical insurances. More plans are being accepted, more coverage for you and patients, and more questions to top it all off. 

(Cue that hamster wheel and the confusion.)

It’s easy to find yourself getting calls from referring offices or patients asking if you participate in the “X”, “Y” or “Z” plan, leading you to some detective work. You end up spending your time trying to learn for yourself or your office team what your office participates in so you can understand the benefits and clearly communicate them with your patients. We know there’s also a hidden dilemma where some insurances have a “backdoor” relationship, where one company says it’s part of a larger organization. It becomes a real challenge to know who the real players are because of these interrelated relationships that the end-user, the insured, and even the provider doesn’t know or understand. 

Patients Aren’t Insurance Experts (Even Though They Might Think Otherwise)

How many times have you been a part of or heard about this scenario? A patient calls saying they have dental insurance that covers a procedure, but they actually don’t have it at all, and now you’ve got to break it to them. One of the most misfortunate things is that some insurance companies don’t always provide an identification or coverage card to patients and that complicates things even more. Once again, you’re left to put on your Sherlock Holmes hat to play detective to figure out what coverage they have or who the coverage is with. It all goes back to that issue of these insurance companies being interrelated, where you think you’re dealing with one company, but it turns out to be someone completely different. 

Your best bet for smooth sailing for both dental and medical insurance acceptance is to find and work with those that are willing to work with you and your patients. We all know some companies are the more prominent players in the market, making the loudest noise and carrying a big voice. They can also be some of the more challenging insurances to work with. Some companies simply do insurance better and play better in the sandbox with both providers and patients. However, some prefer to play nice with patients while others side with providers. The bottom line is that it’s your job to find the right balance, working with the right insurances and being a patient advocate, but also work well in terms of relaying, paying, and processing the insurance claims for the provider. 

It’s All About Finding the Right Rep & Reading the Fine Print

One of the biggest ways you can help your OMS office navigate your insurance needs is by finding the right representative or resource at whatever dental or medical insurance companies you work with. You want someone who’s reliable and is genuinely interested in helping your practice and doing their job as an insurance company. It’s critical to find those key people that can be a real help. 

As you go through contracting, enrollment, and getting all of your providers enrolled in whatever network your office chooses. Find a point person that can be an advocate for you, who has your best interests at heart. 

This tip is especially crucial for new practices. If you’re able to find that perfect person that goes to bat for you and also gets their job done, it will make your life so much easier. You’ve got things under control, and you’ll feel like you’re underway. Another key tip for both new and seasoned OMS admin is ALWAYS to read the fine print of your insurance contracts because things that can be small in print can add up to a big deal in real life. Know what you’re signing up for, what your agreement is, and what all of the ramifications can mean for your practice and your patients.

In Conclusion…

If you’re feeling utterly overwhelmed with insurance at your OMS office, maybe it’s time to talk about bringing in someone who can help. (Not because you can’t handle it, but because insurance is a beast too big for one person to tackle alone.) Maybe you hire someone part-time or full-time like an insurance coordinator whose sole role is benefits. There are also third-party companies like Five Lakes Professional Services that can help you maximize your profitability by optimizing your insurance participation. They only deal with dental insurance, but partners like this can help change the way your office feels about insurance claims. 

The whole goal of these tips is to help you be, feel, and look more organized in terms of what insurance coverage options you offer to your patients. You want to feel firmly positioned with patients and referrals, knowing what networks you’re in and what you’re not. We hope you feel a little less overwhelmed a maybe a bit more informed. Don’t forget to check out the SOMSA forum to help with your insurance questions. It gives you a place where you can find OMS experts like yourself and troubleshoot issues or brainstorm ideas for your office. (We’re sure you’ll have a “been there done that” moment or two.)