I’m assuming you’re asking about allowance amount when patient has two insurances. The primary insurance determines the allowance amount for the procedure. Whatever you collect for a procedure (prim ins + secondary ins + pt copay) cannot by be more than what the primary in-network fee for that procedure. Hope this helps!
Is that ok/legal to just use the primary ins and collect copays and than send to secondary and give pt credit in the ledger since you have to submit the same amount to the secondary? Not sure if that made sense but i was trying to understand what you meant lol
Great question @AgnesVelez. By saying that we don't look at the secondary insurance when patient comes in for work - it doesn't mean that we're not generating a claim for the secondary. What we're saying is - when patient comes in for work, we collect their copays based on primary insurance info only. Once the primary claim gets paid, we generate a claim for the secondary. If the secondary claim pays anything, it's complete credit to the patient. As long as you're refunding the patient since they have credits on the account, you're doing nothing wrong. You're obligated to send to both insurances. What we're doing is collecting in advance and not relying on secondary in case they pay nothing. If the secondary pays nothing, it now means, we have to do extra work to chase the patient for their balance. To answer your question, there is nothing illegal here! Hope this made sense!
Yes! If they have credits on their accounts, you should let the patient know. Then they decide whether they want to apply to their future work or just want a refund.
@nilaygshah sounds great. Thank you so much for the information and the help. 🙏🏽 I truly appreciate it. I am going to strategy using your version of the dental insurance verification form in the new office I am in. I am going to add a little lol, but it's the best I've seen so far. Thank you for that. 🙏🏽
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Thank you for sharing this insightful video! It's crucial for dental practices to prioritize persistent collections to maintain financial health.
How do you base your allowance amount?
I’m assuming you’re asking about allowance amount when patient has two insurances. The primary insurance determines the allowance amount for the procedure. Whatever you collect for a procedure (prim ins + secondary ins + pt copay) cannot by be more than what the primary in-network fee for that procedure. Hope this helps!
Is that ok/legal to just use the primary ins and collect copays and than send to secondary and give pt credit in the ledger since you have to submit the same amount to the secondary? Not sure if that made sense but i was trying to understand what you meant lol
Great question @AgnesVelez. By saying that we don't look at the secondary insurance when patient comes in for work - it doesn't mean that we're not generating a claim for the secondary. What we're saying is - when patient comes in for work, we collect their copays based on primary insurance info only. Once the primary claim gets paid, we generate a claim for the secondary. If the secondary claim pays anything, it's complete credit to the patient. As long as you're refunding the patient since they have credits on the account, you're doing nothing wrong. You're obligated to send to both insurances. What we're doing is collecting in advance and not relying on secondary in case they pay nothing. If the secondary pays nothing, it now means, we have to do extra work to chase the patient for their balance. To answer your question, there is nothing illegal here! Hope this made sense!
@nilaygshah yes thank you so much for clearing that up. So if a patient states they would rather not have it as credit, do you reimburse them?
Yes! If they have credits on their accounts, you should let the patient know. Then they decide whether they want to apply to their future work or just want a refund.
@nilaygshah sounds great. Thank you so much for the information and the help. 🙏🏽 I truly appreciate it. I am going to strategy using your version of the dental insurance verification form in the new office I am in. I am going to add a little lol, but it's the best I've seen so far. Thank you for that. 🙏🏽
Great! Thank you for the feedback! I’m glad it’s helpful!!