The problem we are talking about is the problem of writing a good dental insurance narrative. Firstly, how many narratives might you write? Well, you'll write one for buildup and crown, root canal therapy, dental bridge, wisdom tooth extraction, attrition, crown after root canal, and every other procedure you do.
There are 3 main goals in writing a proper narrative:
- For your patients to receive the coverage they are paying for.
- You and your practice to receive the collection on their work.
- The insurance company to be able to clearly understand what is due and why.
It'll be important to keep your goals in mind while writing your narrative. Doing this will help guide you as you write, remind you what you'll need to include, and what information is unnecessary.
Why is it difficult to write a dental narrative?
Dental narratives are hard to write because they are full of fine lines. It should be detailed but not too long, specific but consistent, it should contain x-rays but not always, and the contradictions go on.
It's frustrating communicating unsuccessfully. When writing your narratives, save copies of each one you send out (this is tedious I know). Sort them by insurance company and note the outcome or notable conversation. Tracking all of this is going to tell you what kind of communication works and what doesn't.
You should be checking your KPI's during this process; your Collections specifically. See if your numbers have gone up or down. Take into account all of the factors going into this process, not just your templates.
Solutions and Tips
After tracking and noting your results, begin crafting some guidelines and rules for how you will write narratives. Create templates based off these. You'll read elsewhere that you should not use templates because they aren't specific enough to each scenario. I would argue that templates will help you be more efficient and you don't need to lose the personal touch.
A template is just a simple fill-in-the-blank guideline. If you are wanting a personalized feel, you can leave larger blanks with instructions such as *insert short procedure explanation here*. This still guides you on what you need to say while giving you the freedom for what kind of wording and how many sentences.
Again, this is why crafting guidelines and rules for your narratives is important...so you can have more open ended areas and they will be filled in more consistently. Your templates should be clearly organized by insurance agency and procedure type. That way you can pull from your list of patients with the same insurance provider and get all of them done and so on.
Responding to Claim Rejections
There are several reasons why a dental insurance claim can be rejected. Understanding and training your staff in these scenarios will help prevent future rejections. Insurance companies will reject claims for specific codes, more than one person in a household, and confusion between dental company and the actual insurance company.
Responding to an insurance claim can be tricky for each patient because they don't fully understand most of the terminology. Providing educational information for their insurance is another way you can take care of your patients. ADA Center for Professional Success created a great PDF resource to help your staff and patients understand claim rejections. Sending an informed response will have more success in getting proper insurance coverage because you'll know before responding if you were actually eligible or not.
Dental Insurance Appeal Letter
An additional step you can take to offer your patients proper insurance coverage is providing them with a dental insurance appeal letter template. They can use this if their dental insurance company rejects their request for coverage. In turn, this makes it easy for them to appeal the rejection and speak the language the insurance companies use.
Insurance companies are a great resource for your practice and patients. They make more expensive procedures possible. The disconnect is an insurance company will not pay more than what's been agreed upon when either partnering with a patient or a company that a patient works for. This means you need to be very clear and direct in your insurance narrative when writing them.