With the Cost Estimator, employees can get personalized estimates for their dental cost calculator treatment. This tool can encourage in-network utilization and demonstrate the value of dental benefits.
Dental insurance deductibles and coinsurance can make the process of calculating patients’ out-of-pocket costs confusing for them. Knowing how to calculate these expenses correctly can build trust between you and your patients.
Calculate Your Patients’ Out-of-Pocket Costs
Dental insurance often includes coinsurance or “shared costs.” This means the plan pays a certain percentage of a procedure and the patient is responsible for the rest. For example, a plan may pay 80% of basic care like fillings and 50% of major care like crowns, leaving the patient responsible for the remaining 20% of the cost. The exact amount of coverage varies between dental plans, so it’s important to understand the details of each.
Additionally, many dental insurance plans have deductibles — typically per family member — that must be paid before the benefits kick in. This can add up quickly if the deductible is not met. Also, some preventive services are not subject to a deductible at all, including annual exams, cleanings and fluoride treatments.
Getting these calculations right is crucial for building trust between patients and your practice. When a patient is not charged correctly, it can cause them to be upset, and can even lead to disputes over the amount they owe. Incorrect calculation can also lead to lost revenue, so it’s important to verify that the insurance company’s predetermination is accurate before charging your patient.
To help make this process easier, Dental Intelligence Insurance offers a free tool called Dental Cost Estimator. This provides participants of Ameritas dental insurance and their doctors with a range of estimated treatment charges for out-of-network general dentists in their ZIP code, which are then subtracted from the plan’s coinsurance or deductible payment to calculate the patient’s out-of-pocket costs.
Calculate Your Practice’s Profitability
Whether you plan to sell your practice in the future or not, it’s important to have an accurate understanding of your profitability. This will help you make better decisions regarding marketing channels and procedure types.
Many people use different methods to calculate the value of a dental practice. These include the capitalized earnings method, which involves multiplying the practice’s prior year’s (or average of recent years) net income by a cap rate, or discounting cash flows, which projects 10 years of gross revenue and practice costs and then discounts them using an interest rate and risk premium.
Another popular valuation method is based on the estimated market value of all tangible assets in the practice. This includes equipment, furniture, instruments, files, etc., plus an estimate of the fair market value of intangible assets such as goodwill.
It’s also important to consider the competitive landscape when calculating your practice’s value. If the dental office down the street charges less for a service, it can impact your profit margins. Similarly, if you’ve been running your practice very efficiently and are able to minimize overhead costs, this will likely have an effect on the valuation of your business.
By regularly evaluating your prime cost, you can ensure that your fees are optimized to current industry standards and patient demographics. This will allow you to keep your profit margins high and maximize the value of your practice if you ever decide to sell it in the future.
Communicate Your Patients’ Out-of-Pocket Costs to Your Patients
When it comes to insurance, patients are often confused about how much they’re paying and why. Miscalculating a patient’s out-of-pocket cost is a major mistake that can cause them to lose trust in you, and can also result in billing errors—which could cost your practice valuable revenue.
When your patients are aware of their potential financial responsibility and how it will impact their care, they’re more likely to visit their dentist regularly—as evidenced by a recent Empire BlueCross BlueShield survey* that found that four in 10 adults don’t see the dentist as frequently as they should because they fear a surprise bill.
To help your patients avoid this, make sure they know what to expect with our free Cost Estimator Tool. Powered by Ameritas Dental Network providers, this tool allows patients to select a procedure, enter their ZIP code and receive estimates for both in-network and out-of-network dentists—as well as their estimated total out-of-pocket costs.
The tool even accounts for downgrades—which can happen when an insurance company determines a less expensive option would be sufficient, such as a composite filling instead of a silver filling. Downgrades can significantly increase a patient’s out-of-pocket costs, so letting them know about them ahead of time will save you the hassle of back-and-forths with frustrated patients down the line.
Avoid Billing Errors
When dental teams get calculations for out-of-pocket costs wrong, it can lead to frustrated patients who either pay too much or receive a surprise bill in the mail. These mistakes can also impact insurance reimbursements. Using the right dental billing software with an accurate cost calculator helps ensure that your team is properly calculating out-of-pocket costs and communicating those costs to patients.
In addition to getting the math right, it’s important that dental practices clearly communicate what their patients’ out-of-pocket costs are when recommending treatment. Providing transparent pricing can help motivate patients to follow through with their treatment plans, even if it will push them to their plan’s deductible.
Another common error in out-of-pocket cost calculation involves “bundling” procedures that are billed separately on claims. This occurs when third party payers combine distinct services for payment as a series (for example, a panoramic radiograph and bitewings) instead of paying them individually. Dental practices can avoid bundling errors by thoroughly reviewing EOBs for coding changes or reimbursements that do not meet their contract provisions.
If you’re looking for dental billing software that can accurately calculate patient out-of-pocket costs, verify insurance quickly and more, contact us today to schedule a demo. Our experts can teach you how to use the tools in our Dental Intelligence platform to build trust with your patients, reduce claim denials and more.