Dental insurance portals are so weird…
About 75% of our patients have some kind of dental insurance. Amongst that population, most of our patients have a dental policy with one of the following: BlueCross BlueShield of Illinois; Delta Dental of Illinois; United Healthcare; Humana; MetLife; Aetna; Guardian; Cigna; or Principal. We work with insurance companies in two primary ways: (1) checking eligibility and confirming benefits; and (2) submitting claims and collecting payment. On a normal day, we service ~20 patients.
This means that in advance of our patients’ appointments, there’s a lot of checking insurance. And after we see an insured patient and submit a claim, there’s a lot of checking insurance. I do a lot of checking in with insurers. Some insurance companies force you to call them to get any information (why that’s the case in this day-and-age is beyond me). But most insurers have online portals that display most of the information we need to prescribe and execute the appropriate treatment plan.
I will never cease to be amazed with how varied the user experience is across the multitude of dental insurance portals I use on a daily basis. Log-in protocols are different. Patient authentication is different. Eligibility vs. claim review is different. The order of how patient benefit information is displayed is different (e.g., plan information, deductible information, coinsurance information, frequency limitations, and so on). Some insurers make it easy to search for a claim. Some insurers make it incredibly hard to confirm frequency limitations on full mouth series x-rays. Some insurers enable a simple transition from a web portal -> chat -> phone call. Some insurers won’t tell you the age limitation on fluoride. It’s truly all over the place. Here’s my official power rankings of insurer portals:
BlueCross BlueShield of Illinois (hosted by Dental Network of America) - speedy performance, limited clicking/scrolling, and easy to search for specific codes
Cigna - after logging in you’re immediately prompted with your most recent patients and claims
United Healthcare - some scrolling required, more complicated patient authentication required, but very easy to see frequency limitations and full claims for the office.
MetLife - sometimes you have to enter a patient’s zip code, but otherwise the information provided is right there (and they show the 20 most recent claims).
DDIL - crappy performance (lags constantly). But once you’re in, it’s easy to see frequency limitations and claims information.
A lot of what I’ve come to prioritize is the number of patient identifiers to authenticate and the number of clicks needed to get the information I need. But to be frank, none of this should be necessary. When we schedule a patient, we pre-define the type of service that patient is expected to receive (e.g., new patient exam, standard cleaning, filling, crown, bridge, etc.). All of the procedure codes are entered into the system. Additionally, our practice management software (i.e., Dentrix Ascend) integrates with insurance companies through an exchange (i.e. Change Healthcare). Eligibility confirmations have a standard EDI definition (i.e., 270/271 transactions). Claim payments have a standard EDI definition (i.e., 835). Since we know what procedures are to be performed, and we have an open line of integration with insurers through the Change Healthcare exchange, and the communication protocol operates on a standard EDI, I find it mind-boggling that I have to do the web portal lookups at all. Why isn’t it the case that when I schedule a new patient exam, Dentrix Ascend doesn’t automatically communicate with that patient’s dental insurer to understand frequency limitations for the procedures Dr. Jamie plans to execute? Why isn’t it the case that after a I submit a claim and the dental insurer pays us that the payment and explanation of payment don’t automatically pop in my practice management software? All of this is an eminently solvable integration question.
So I guess we’ll have to solve it :).