Dental insurance is designed to help reduce the overall cost of your care. However, your policy often has deductibles and maximums that need to be met before dental work is covered.
While no one loves discussing money, it’s important that patients understand how their insurance coverage works so they can build trust with your team. The key is accurate billing calculations.
How to use the calculator
Members can use the Ameritas online dental cost calculator to get an estimate of typical costs for out-of-network general dentist services. They can search by procedure code or treatment category (e.g. root canal or RCT). The site will also provide pricing for in-network services based on the usual and customary charges for those services in their ZIP Code. Please note, though, that this tool does not make any recommendations about which services should be obtained, which providers to see, or whether you should obtain specific treatments.
It is important for front desk staff to understand how this tool works and the “why” behind the numbers. This will help them accurately communicate to patients their out-of-pocket costs – including insurance factors, such as deductibles and coverage percentages. It will also give them a better understanding of how to compare costs when choosing in-network and non-in-network dental providers. In addition, it will help them avoid the top 5 billing reasons employees leave their employer’s plan. This will result in more grateful patients and less back-and-forth over money.
Enter your information
A big reason that many front desk teams struggle with insurance billing calculations is that they often don’t fully understand the “why” behind the calculations. That’s why it is important to learn how to properly calculate a patient’s out-of-pocket costs and enter them correctly into your software. This will help you avoid common errors that can create friction between your patients and your team.
For example, let’s say a patient needs one filling that your insurance company estimates will cost $80. Your patient would be responsible for 20% of that cost, or $20. However, if you decide to downgrade the filling to a silver color (am amalgam) filling instead of a composite (white color) filling, the cost will be less ($50). This is an example of a common insurance downgrade and can significantly impact a patient’s out-of-pocket responsibility.
The calculator shows estimated fees for procedures from in-network providers, based on usual and customary charges submitted to MetLife by dental service providers. The calculator is not a guarantee of eligibility, coverage or payment, nor does it determine the benefits, limitations or exclusions of your dental coverage. For a complete description of your coverage, refer to your coverage documents. In addition, the calculator may group together services that are commonly delivered in conjunction to address a particular dental problem or condition and may not reflect your unique treatment plan.
Select a procedure
When employees use the tool to compare costs for a specific procedure, they will see how much their plan covers and what portion of the fee is out-of-pocket. The tool also shows the cost for an in-network provider and the out-of-network option, highlighting the savings available when they select in-network dentists.
Additionally, the tool allows members to view the fees for a specific dental service by entering a treatment code or keyword. The tool then displays the average cost for that procedure in their zip code and provides a list of the available options at that location. This allows employees to see the full range of options available in their area and how they may affect costs, including the option to add a cleaning or x-rays to their visit.
By providing transparency for cost, the tool encourages in-network utilization which can reduce out-of-pocket expenses and help control benefit costs. Additionally, employees can view their benefits usage and history for themselves and anyone on their plan, which helps them become more informed consumers.
When it comes to insurance billing, the calculations can be complex and are often miscalculated. Those errors can lead to frustration with patients and ultimately lost revenue for your practice. By understanding how to calculate patients’ out-of-pocket costs and why those numbers are different than what is shown in your software, you can build trust between yourself and your patients.
Select a dentist
Most dental insurance plans have deductibles, coinsurance or other cost-sharing. These are amounts you and your dental insurance company pay for care, after which the plan begins to pay benefits. Deductibles vary from plan to plan, and range from $50 for an individual per year to a lifetime deductible. Dental plans also typically have maximums on how much they will pay in a given year or lifetime for care, as well as waiting periods before certain procedures will be covered.
Using the calculator on the dental portal allows employees to understand what their out-of-pocket costs would be at in-network and non-network dentists. It also helps them understand the benefits of choosing in-network care, which can help lower their group’s dental insurance rates.
Employees can use the tool to get a list of dentists in their area with prices for a specific procedure, which they can then compare. They can also add other services such as cleanings and x-rays to see how those might affect their total out-of-pocket costs.
Many people are concerned that they could end up paying a lot for their care, even with dental insurance. This can lead to them not going to the dentist at all, which can have serious health consequences in the long run. This is why it’s so important to build trust with your patients by being transparent about the cost of their care.