The True Cost of Insurance Denials and How Automated Verification can Help

The True Cost of Insurance Denials and How Automated Verification can Help

Robert McDermott

Over the past few years, nearly 70% of providers noted that insurance denials were increasing. The same research revealed that 27% of those denials are related to registration and eligibility. With those numbers, it’s no wonder that more and more practices are looking for solutions that allow them to automate the process and increase their accuracy. Automated insurance verification has significant benefits, and one of them is decreasing insurance denials.

Top Causes of Insurance Denials

There are countless reasons for insurance denials. It would be difficult to provide an exhaustive list as sometimes claims depend upon the insurer. However, there are a few top reasons you, as dental providers, can prevent.

• Necessity—In this case, insurers do not believe the treatment or procedure is necessary.

• No coverage—The treatment isn’t actually covered by the patient’s insurance.

• Provider is out of network—Some insurance companies require that covered procedures be performed by providers who are in their network.

• Cost—Typically, if a treatment is denied for cost, the insurer believes there is a less expensive available option to achieve the same results.

• Procedural failure—For some treatments, insurers require prior authorization. Failing to get that authorization may result in a claim denial.

• Missing or incomplete information—Requests for procedures often require details about the need or the problem itself. Failure to include that information may result in a denial and require a call back.

• Administrative errors—Administrative errors range from incorrect names, birthdates or, even, incorrect coding for the procedure.

The True Cost of Insurance Denials

Often, patients do not fully understand their benefits or stipulations to care (such as in and out-of-network providers), which can create problems for both medical and dental practices, particularly when a treatment or procedure has been either recommended or already performed. So, when the insurance denial occurs, there can be a bit of sticker shock when the true out-of-pocket cost is discussed. This, undoubtedly, has an impact on patient trust, as well as the patient-provider relationship, and could impact future care and patient retention.

In addition to the very real impact denials have on your patients (and their health), there’s also a significant impact to your practice. Any time you have to resubmit a claim, you not only incur additional costs, anywhere from $25 to $118 per claim, you also delay your cash flow.

The same research indicated that nearly 65% of denied claims are never resubmitted, which means that money is being left on the table. On top of all of this, you’re likely contending with staffing shortages and the verification process requires considerable human resource utilization.

How Does Automated Insurance Verification Work?

Highly productive automated insurance verification solutions have the potential to look at your full schedule of patients and verify their coverage, as well as any changes in their plans and available benefits. This modern, cloudbased software often completes reports in seconds, whether you have a hundred patients on your schedule or a thousand. This frees up your team to focus on additional tasks and customer service.

Further, with up-to-date insurer connections, you can verify current coverage, you can also identify coverage for future treatments and book those before your patients even leave your office. In short, automated insurance verification enables you to ensure coverage and cash flow.

How Automated Insurance Verification Reduces Denials

Not only does automated insurance verification improve your team’s efficiency and your revenue generation, it can also help you reduce insurance denials.

More specifically, when you are carefully vetting modern verification software, look for products that include automatic error identification, addressing administrative problems or incomplete information before it becomes a problem. As a result, your error-free claim submissions can mean higher case acceptance and far less time spent on appeals and callbacks or corrections.

Additionally, because your entire patient schedule is verified before patients enter the office, with up-to-date benefits information, you can be sure a treatment is covered so there’s no claim denial later. Your team can be prepared well ahead of the patient appointment and share up-to-date claim information with the patient in the office. In short, go forward prepared with automated insurance verification to help stop many of the reasons for insurance denials before they happen, ensuring your patients get care, you get paid and your patient provider relationships flourish.

Mr. McDermott is president and CEO of iCoreConnect. NYSDA-endorsed iCoreVerify automated insurance verification software is like gaining an extra team member without the overhead. iCoreVerify completes automated insurance verifications—up to seven days in advance—for every patient on the schedule. Book a demo at iCoreConnect.com/NY10. NYSDA members receive a discount on iCoreVerify by iCoreConnect.