assignment of benefits dental

Assignment of Benefit Laws

If your state is not listed, there are no known Assignment of Benefits laws. Please reach out to your state dental society for information on where they are with getting this legislation passed.

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Third Party Issue Tracker

Navigating your way through dental benefits.

Owning a dental practice involves a wide variety of responsibilities and accountabilities, but one of the more challenging aspects of running an office is understanding the complicated world of dental benefits. With so many patients using employee benefit plans, it’s imperative that you know the basics of properly coding for your services and what to do if the claim gets rejected by the insurance company.

Below is a list of important dental benefits terms followed by a brief summary. You may also download the following document with more detailed information, including how to proceed if you encounter denial or delay problems, as well as ADA policy related to many of the terms.

Download Supporting Materials (Free for ADA members) Third Party Issue Tracker

Third-party Payer Terms You Should Know

1. Assignment of benefits

A procedure where a beneficiary/patient authorizes the administrator of the program to forward payment for a covered procedure directly to the treating dentist. Some carriers consider assignment of benefits as a perk of being a participating dentist with the plan and will not honor assignment to non-participating dentists. The patient’s signed request is ignored and the patient is paid directly. This can create problems for dental offices if they base their payment policy on the legitimate expectation raised by the assignment and do not collect payment at the time of service.

2. Bundling of procedures

Claims bundling is the systematic combining of distinct dental procedures by third-party payers that results in a reduced benefit for the patient/beneficiary.

One of the most common examples of bundling issues pertains to radiographs. For example, a panoramic image and bitewings may be combined and a benefit is provided for a full mouth series (FMX), which then subjects the claim to dental benefit plan frequency limitations (many plans will only pay for one full mouth series of radiographs in a five-year period). Usually, the number or type of radiographs taken would not constitute a full mouth series.

Another example is when a dentist has placed a two-surface restoration e.g., mesial, occlusal (MO) and a single surface restoration e.g., buccal (B) on the same tooth on the same date of service; the insurance company may provide a benefit for a three-surface restoration (MOB).

The amount you can bill the patient depends on whether or not you have signed a participating provider agreement with the insurance carrier. The explanation of benefits (EOB) statement should specify the patient responsibility.

3. Changed codes

It is not uncommon for third party payers to change submitted dental procedure codes based on the plan’s processing policies and adjudication procedures. You should submit the procedure code that most accurately describes the procedure performed. The payer must accept that code into the system, but then the plan may adjudicate the claim based on its plan design and processing policies, which may result in a payment based on a different code than what was submitted.

4. Coordination of benefits

Coordination of benefits (COB) is a method of integrating benefits payable for the same patient under more than one plan. Benefits from all sources should not exceed 100% of the total charges.

Coordination of benefits takes place when a patient is entitled to benefits from more than one dental plan. The plans will coordinate the benefits to eliminate over insurance or duplication of benefits. When both plans have COB provisions, the plan in which the patient is enrolled as an employee or as the main policyholder is primary. The plan in which the patient is enrolled as a dependent would be secondary.

In addition, state laws and regulations often mandate coordination of benefits. Plan sponsors should be certain that the plan they select specifies its method for coordinating benefits with other plans.

See the downloadable handout at the end of this article for further discussion of the types of coordination of benefits available, as well as an overview of payment policies when two plans are involved.

5. Delayed claim payments

Delayed claim payments and requests for additional information are two of the most common complaints that the ADA receives from dental offices regarding insurance carriers. Claim payments are vital to the income stream for many dental offices, and when prompt payment is not received, dentists may have trouble paying staff and other administrative expenses.

There are 46 states that have passed prompt-payment legislation; however, those laws apply only to "clean claims," or claims submitted without any missing or incorrect information. Even though the dental office may have submitted a properly completed claim form, what is there to stop the payer from returning the claim form indicating it needs more information? This can be costly and time consuming for a dental office. In addition, this can delay the payment of the claim past the prompt payment law’s time requirements for payment and may impact the dentist-patient relationship. Benefit plans are expected to increase requirements for treatment justification, which may include diagnostic codes and reasons for deviating from accepted guidelines.

6. Downcoding

Downcoding is a practice of third-party payers in which the benefits code has been changed to a less complex and/or lower cost procedure than was reported except where delineated in contract agreements.

A common example of downcoding is when a payer changes the code for a posterior composite restoration to an amalgam restoration. When a third-party payer downcodes a procedure, it may be understood by the patient that the payer is making a determination that a lower level of care was needed or should have been provided, but it really is that the benefit pays for a lower level of service with no judgment made about the level of service provided. Dentists feel that they, and not the insurance company, should make the determination of the level of care necessary for the treatment of their patients. Unless the business reason for the payer decision is explained, this may wrongfully interfere with the dentist-patient relationship.

7. Least Expensive Alternative Treatment (LEAT) clauses

A dental plan may not allow benefits for all treatment options. A least expensive alternative treatment provision is a limitation found in many plans, which reduces benefits to the least expensive of other possible treatment options as determined by the benefit plan, even when the dentist and patient agree that a particular treatment is in the patient’s best interest.

The dentist may recommend a fixed bridge, but the plan may allow reimbursement only for a removable partial denture. The benefit plan will allow the more expensive procedure, but will only provide a benefit for the less expensive treatment. The patient may not always understand the payer’s least expensive treatment policy, and what the out of pocket costs are, until the explanation of benefits is received. In some cases, this provision in the benefit policy may cause the patient to select a less than optimal treatment due to cost.

8. Non-covered services

Twenty-nine states now have laws that prohibit dental plans from controlling what a dentist may charge for services that dental benefit plans do not cover. Provisions in the laws differ depending on the state and some are stronger than others. A noted trend among insurance companies has been to offer a capped fee plan in states that already have non-covered services laws.

The ADA’s legal and state government affairs divisions have developed legislative strategies and passed them on to state dental societies so each state doesn’t have to reinvent the wheel. As a result, the states save money because the legislation is pre-packaged and adjusted to suit their local issues.

The ADA legislatively opposes the practice of capping fees on non-covered services. The ADA opposes any third-party contract provisions that establish fee limits for non-covered services, according to ADA policy passed by the House of Delegates.

Under a plan that caps fees on non-covered services, participating dentists may charge no more than the dental plan’s set fees for services the plan does not cover. In addition to the basic unfairness of this practice it may, and probably will, mean that dentists will lose money when they provide some of the non-covered services subject to the fee cap.

In states with non-covered service laws, the only fees a dental plan may cap are fees for services the plans cover. At least one dental plan has shifted previously non-covered services over to the “covered services” category by reimbursing them at a very low rate (e.g., 5 percent of the allowed amount).

In doing so, the plan is in a position to cap these fees because the services are now technically covered. Some state laws mitigate such activity — called de minimis reimbursement — by requiring reimbursements to be at or above 50 percent in order to fit the definition of a covered service.

9. Predetermination

Predetermination of benefits is an administrative procedure that may require the dentist to submit a treatment plan to the third party before treatment begins. The third party usually returns the treatment plan indicating one or more of the following:

• Patient’s eligibility
• Covered services
• Benefit amounts payable
• Application of appropriate deductible
• Co-payment and/or maximum limitation

Under some programs, predetermination by the third party is required when covered charges are expected to exceed a certain dollar amount. Predetermination is not a guarantee of benefits. For example, predetermination does not consider any coordination of benefits.

10. Utilization review

Statistically based utilization review is defined by the ADA as a system that examines the distribution of treatment procedures based on claims information and in order to be reasonably reliable, the application of such claims analyses of specific dentists should include data on type of practice, dentist’s experience, socioeconomic characteristics and geographic location.

It is not uncommon for dentists to be placed on post-utilization reviews, also called retrospective claim audits, by insurance carriers based on reporting of certain procedures to the carriers. Typically, these audits begin with the carrier internally monitoring use of the dentist's claims and usually the dentist is unaware of this.

If the carrier determines that the dentist has a practice of reporting certain procedures at a much higher frequency than his or her peers, the carrier may flag the dentist in its claims adjudication system. When this happens claims for those procedures are reviewed internally by claims staff.

At this point, dentists may have to submit a substantial amount of additional documentation regarding the necessity of the procedure in order to get the claim paid. For example, if the carrier suspects that the dentist is submitting a disproportionate number of crowns, the carrier may ask for radiographs, photographs and a narrative description of the need for the crown.

If you are not an ADA member, you can purchase this whitepaper in the ADA Store .

• IDA INSURANCE

Assignment of Benefits Legislation Signed by Governor

13 mar assignment of benefits legislation signed by governor.

SEA 132 addresses a number of healthcare issues, including IDA-supported language that would require insurance companies to honor patients’ request that benefits be assigned to the dental office that provides care. While once the assumed payment method, in recent years some carriers used Assignment of Benefits (AOB) as leverage to pressure dentists into joining their provider networks.

“The decision to join or not join a network should be based on each dental office’s individual circumstances and business plan,” said IDA Executive Director Doug Bush. “Our contention was that it was unfair and inappropriate to push dentists into networks that might not be in their best interest by creating a payment hardship for the patient and a collection problem for the dentist.”

The bill also requires insurance companies to notify the dentist before selling or leasing their network to another insurance company.

“A dentist could choose to join one network and later find that that network had been leased to multiple other insurance companies,” said Bush. “Instead of making a calculated decision to join one plan, the dentist could later learn that now they were a member of multiple networks. The new law requires insurance companies to notify dentists before selling or leasing their networks to other insurance companies. Dentists will be allowed the option of opting out the networks, if they so choose.”

According to IDA Director of Governmental Affairs Shane Springer, passage of these important initiatives would not have been possible without the involvement of many IDA members.

“I had multiple legislators tell me, ‘My dentist called me… you’ve got my vote!’ That’s why the grassroots involvement of IDA member dentists is so important.”

Springer extended special appreciation to Dr. Megan Keck, Dr. DeLayne LeFevre, Dr. Paul Fisher and Dr. Mark Stetzel, who took the time to travel to the Statehouse to testify in support of the bill during committee hearings.

The insurance industry attempted to amend the bill in committee to remove the IDA supported language. “The vote was incredibly close,” said Springer. “They needed a majority vote to remove our language. Their amendments twice failed by a split vote of 6-6. I have no doubt that the testimony from our member dentists made the difference.”

Mr. Springer also commended Sen. Liz Brown, Rep. Denny Zent, Rep. Brad Barrett, and Rep. Rita Fleming, all of whom spoke forcefully in favor of the IDA-supported measures. The bill passed unanimously in the Senate and 93-1 in the House.

“Going into this year’s legislative session, we knew it would be an uphill battle taking on the insurance companies,” said Dr. Steve Holm, chair of the IDA Government Affairs Committee. “Ultimately, we were successful. This success was due largely in part to the hard work of Government Affairs Committee and our members. Whether it was testifying in committee, attending a legislative forum, or personally contacting your legislator, all of membership stepped up to get this done.”

The new law will go into effect on July 1, 2024. If may not affect all patients, as self-insured plans have generally been viewed as regulated by federal ERISA regulations, not state law. However, the ADA is monitoring a recent Supreme Court decision that may challenge that long prevailing exemption assumption.

If you have insurance companies ignore these laws after July 1, you are encouraged to contact Mr. Springer at [email protected] so that this information can be forwarded to the ADA for further study.

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Insurance Plan

Add new or edit existing insurance plans from the Edit Insurance Plan window.

In the Family Module , double-click an existing insurance plan.

Alternatively:

• Double-click a plan in the Insurance Plans list.
• Add Insurance to a patient.

Patient Information

This information is specific to the patient.

• In the database, it is stored in a table called patplan .
• Set the background color in Definitions: Misc Colors , Family Module Coverage.
• If editing a plan which is not attached to any patient as current coverage, this upper section may be blank.

Relationship to subscriber : (required) If the patient is the subscriber, the default is Self . Otherwise a relationship must be selected.

Optional Patient ID : ID used instead of a Subscriber ID. Used automatically on paper claims if added. To send the patient ID on e-claims, enable On e-claims use Optional Patient ID instead of Subscriber ID in Preferences . If no Optional Patient ID is added, Subscriber ID is used.

Drop : Drop Insurance Plan from the patient when the patient no longer has insurance coverage or changes carrier. The insurance plan is not deleted and the plan remains in the Insurance Plans for Family window.

Patient Plan ID : A system generated unique identifier that is useful for third-party reporting.

Order : Determines the order this plan shows in the Family Module (primary, secondary, or supplemental insurance). 1 = primary, 2 = secondary, etc. The number can be changed at any time.

Eligibility Last Verified : The date that patient insurance eligibility was marked verified (manually or using the Insurance Verification List ). Click Now to insert today's date.

Pending : Informational only. Identifies insurance information that is incomplete or unverified. If the the insurance company name is unknown, create a dummy carrier called Pending , check the Pending box, then come back later and fix it.

Hist : View history for procedures completed outside of the office. This is useful when tracking insurance frequencies. See Insurance History .

• Fee : Defaults to the fee set in the Ortho Tab. Uncheck Use Default Fee to enter a patient fee override.
• Next Claim Date : The date the next claim will be created using the Tool. Defaults to a date based on the last auto-created claim and the frequency (i.e., Auto Proc Period).

Adjustments to Insurance Benefits : Displays any entered Adjustments to Insurance Benefits for the benefit year. Click Add to enter additional adjustments.

Plan Info Tab (Insurance Plan Information)

This information is specific to the insurance plan and can only be edited by users with the Insurance Plan Edit Permission . Carrier information can only be edited by users with the Carrier Edit permission.

Pick From List : Select an existing insurance plan from the Insurance Plans list. Requires the Change existing Ins Plan using Pick List permission. Alternately, drop the insurance plan before picking a new plan.

Note: Users who do not have the Carrier Create permission, must use Pick From List to assign a carrier to a plan.

Insurance Plan ID : A system generated unique identifier that is useful for third party reporting and to filter the Insurance Plan List.

Medical Insurance : Check this box if this is Medical Insurance rather than dental. Only visible if Medical Insurance is turned on.

Employer : Optional. The Employer associated with the insurance plan. Begin typing and select an existing entry from the Employers List. If an entry is not selected, a new entry is added to the Employers List.

Carrier : Required. Click [...] to pick an existing carrier from the Carriers list or begin typing to select an existing carrier from the dropdown. If a user manually enters carrier information or changes carrier information, a new entry is automatically added to the Insurance Carriers List.

• Carrier information is grayed out if the logged-on user does not have sufficient permissions.
• Carrier information can only be edited from by users with both the Carrier Edit and Insurance Plan Edit permissions.
• If the logged-on user changes information in any carrier field, a new carrier is created. If a different user has a plan open with the same carrier, and carrier information is edited by that user, a new carrier is also created.

Electronic ID/Payer ID : Provided by the insurance company if they accept E-Claims . Enter the ID manually or click Search ID to search the Payor ID list. If the carrier does not accept electronic claims, there are two choices.

• Leave the ID blank and submit the claims electronically anyway. If the clearinghouse cannot match the insurance carrier name with a known name, the claim will be printed by the clearinghouse and mailed.
• Select a don't send electronically option for Send Electronically (see below). These claims will be marked as paper .

Send Electronically: Determines whether e-claims can be sent electronically for this insurance plan. Defaults to the setting for the carrier (see Carriers ) but can be changed by insurance plan..

• Send Claims Electronically: Allow sending e-claims for this plan.
• Don't Send Claims Electronically: Do not allow sending e-claims for this plan (e.g., claims must be printed).
• Don't Send Secondary Claims Electronically: Do not allow sending secondary e-claims (e.g., when plan requires that secondary claims are mailed with a copy of the primary EOB).

Group Name : Typically the same as the employer. Used to identify differences in plans (i.e., if the same employer has multiple plan options.)

BIN : Benefit Identification Number. Issued by the carrier. Only displays when EHR is enabled in Show Features .

Group Number : Issued by the carrier.

Other Subscribers : Indicates the number of subscribers who use or have used this plan. Click the down arrow to see other subscriber names.

Plan Info Tab (continued)

Plan Type : Choose the Insurance Plan Types from the dropdown. Affects availability of other options.

• Category Percentage : Traditional percentage insurance plans.
• PPO Percentage : Preferred Provider Organizations. Set this as the default for new plans in Preferences.
• PPO Fixed Benefit : In-network plan that calculates write-offs and covers insurance at a fixed amount.
• Medicaid or Flat Co-pay : All categories are computed at 100% coverage. Disables all other percentages.
• Capitation : HMO and DMO type plans. Disables all other percentages.

For help choosing the correct plan type and setup, see: Insurance Flow Chart or Capitation Flow Chart .

Fee Schedule : The fee schedule used by this plan. If none , the provider's fee schedule is typically used. The only exception is if a fee schedule has been set on the Edit Patient Information window (e.g., a discount/cash fee schedule); this overrides other fee schedules.

Use Blue Book : Only displays when Plan Type is set to Category Percentage . When checked, the plan uses Insurance Blue Book to determine estimates. When unchecked, the plan does not use Blue Book for estimates. A confirmation message displays when unchecking this box.

Carrier Allowed Amounts : Set the fee schedule for out-of-network plans. Only one may be set at a time.

• Out of Network (Old) : Used for out-of-network insurance plans.
• Manual Blue Book : Used when Blue Book is enabled.

Other Fee Schedules : See Types of Insurance Plans for more information.

• Patient Co-pay Amounts : Used for patient co-pays per procedure.
• Fixed Benefit Amounts : Only visible when plan type is set to PPO Fixed Benefit . The fixed benefit fee schedule for the plan.

Other Ins Info Tab

Use Alternate Code : Use alternate procedure codes when submitting claims (e.g., Medicaid). To associate alternate codes (Alt Code) with procedure codes, see Edit Procedure Code . Only available when Medicaid is enabled in Show Features.

Substitution code options : These options determine whether or not estimated fees for procedures are downgraded based on substitution codes. Associate substitution codes to procedures in the Procedure Code List. Also see Estimate Downgrades .

• Checked: Do not use substitution codes to calculate downgraded insurance estimates. All estimates are be based on the fee of the completed procedure and substitution codes are ignored.
• Unchecked: Use the substitution code associated with the procedure (if entered) to calculate downgraded insurance estimates. This affects all procedures with substitution codes, unless there are specific substitution codes marked to exclude.
• Checked: Calculate write-offs when a procedure code is substituted. The write-off is calculated between the amount billed to the patient (i.e., office fee) and the allowed fee for the originally charted procedure.
• Unchecked: Do not calculate write-offs when a procedure is substituted.
• Subst Codes : Control which procedure codes have downgraded estimates for this insurance plan (also uncheck Don't Substitute Codes ).

Claims show UCR fee, not billed fee: Show the UCR fees of the treating provider on claims instead of the insurance fee. Set the default value for new plans in Preferences.

Hidden : Hide this insurance plan in the Insurance Plans List so it can't be copied for use by other subscribers. If this plan has multiple subscribers, and it should be hidden it for all subscribers, also select the Change Plan for all subscribers radio button.

Claims show base units : Check this box to show base units on claims. Usually applies to medical insurance claims only. Base units are entered on the Edit Procedure Code window.

Claim Form : The form used for printed claims. Set the default in Claim Forms .

COB Rule : Select a Coordination of Benefits ( COB ) rule option.

Filing Code : For e-claims. If the carrier has an Insurance Filing Code , select it. By default, Commercial Insurance is used. If the filing code is incorrect, then the carrier will reject the claim.

Filing Code Subtype : If the insurance filing code has a specific subtype, select it.

Billing Type : The plan's Billing Type. If the preference for Adding new primary insurance plan to patient sets billing type is checked, and this is a new primary insurance plan, setting a Billing Type here also assigns the Billing Type to the patient in Edit Patient Information . (If an existing plan's Billing Type is changed, it does not automatically change the patient's Billing Type).

Write-Offs for Non-Covered Services Override: Choose the behavior for this insurance plan when handling write-offs for procedures that are not covered by insurance.

• Practice Default: Behavior is determined by the Ins plans with exclusions use UCR fee (zero out write-offs) .
• Do Nothing: Exclusions are billed normally based on plan fee schedule.
• Use UCR Fee: Write-offs are automatically zeroed out if an exclusion exists for a procedure code.
• Default: Behavior is determined by the preference Ins plans use UCR fee (zero out write-offs) when annual max is met .
• Yes: Write-offs are automatically zeroed out if the patient has met their annual max.
• No: Write-offs are not changed if the patient has met their annual max.
• Default: Behavior is determined by the preference Ins plans use UCR fee (zero out write-offs) when frequency or age limits are met .
• Yes: Write-offs are automatically zeroed out if a procedure is not covered due to a frequency or age limit.
• No: Write-offs are not changed due to frequency or age limit.

Per Visit Amounts: For insurance plans with per-visit copays, enter the amounts the patient and insurance pay.

• Patient Copay : Flat amount the patient pays for an office visit. The Patient copay procedure code , set in Preferences, is automatically added to new appointments for the specified amount.
• Insurance : Flat amount insurance pays per office visit. The Insurance procedure code , set in Preferences, is automatically added to new appointments for the specified amount.

The Ortho tab shows when Show Auto Ortho in account module is selected in Ortho Setup . Use it to enter plan information for orthodontic claims. This information is also in the Auto Ortho tab. Information can only be changed by users with the Insurance Plan Ortho Edit security permission.

Ortho Claim Type : Select how the carrier wants to receive orthodontic claims.

• Initial Claim Only : Send a single orthodontic claim for the initial procedure.
• Initial Plus Visit : Send an orthodontic claim for the initial procedure and each subsequent visit.
• Initial Plus Periodic : Send an orthodontic claim for the initial procedure, then send claims periodically for a certain fee and procedure. Selecting this option makes claims for this carrier eligible for automatic claim generation using the Auto Ortho Tool.

If Initial Plus Periodic is the claim type, the following fields are also editable.

• Ortho Auto Proc : The procedure code to put on auto-generated orthodontic claims. Set the default in Ortho Setup. Click [...] to select a different procedure. Click Default to reset the default. Only the first 5 digits of procedure codes are sent to insurance.
• Ortho Auto Fee : The procedure fee billed in the claim.
• Auto Proc Period : Select the frequency of which the claim will be auto-generated.
• Wait 30 days before creating the first automatic claim : If the insurance carrier requires that there is a minimum amount of days after the initial visit before periodic claims can be sent, check this box. When checked, the next claim will show in the Auto Ortho Claim list 30 days after the initial procedure is completed.

Subscriber Information

The subscriber is set when first creating the insurance plan.

Name : Displays the subscriber name. Click Change to choose a different subscriber.

Subscriber ID : Required and cannot be blank. If the patient has Medicaid, use the Medicaid ID number, then also fill in the Medicaid ID on the Edit Patient Information window.

Effective Dates: The effective dates of the insurance plan. The effective start date is required when using waiting periods. The end date does not terminate the plan; A user must drop the plan if it is no longer in use. If using Automation , the effective end date is used for the Condition, Insurance Not Effective . Set benefit renewal dates (calendar year or service year) in the Benefit Information section (see below).

Release of Information : Check this box if the patient has signed a form that states that the patient consents to the use and disclosure of protected health information to the insurance company in order to carry out payment activities. Signature on File shows in box 36 of the printed ADA Claim Form .

Assignment of Benefits : Determines whether insurance payments are paid directly to the patient or provider.

• Checked: Insurance payments are sent directly to provider.
• Enable the preference Auto receive claims with no assignment of benefits to automatically mark claims received with $0 payment once they have been marked sent.
• The permission, Insurance Plan Change Assignment of Benefits is required to change this setting.
• Changes made to Assignment of Benefits are logged in the Audit Trail.
• If using Clinics, this setting can be overridden by the Clinic setting, Always Assign Benefits to the Patient . When the Clinic setting is checked, Assignment of Benefits is always enabled, regardless of whether checked or unchecked in this window.

Note : Notes specific to the subscriber and associated family members. These appear in bold red in the insurance grid. Right-Click the text box for additional options.

Benefit Information

Request Electronic Benefits : If the practice has signed up for Electronic Eligibility and Benefits with a clearinghouse, and a Subscriber ID is entered, click Request to request benefit information or History to view a history of requests.

Import Benefits :

• If the practice has set up the Trojan Bridge , click Trojan to copy exported Trojan data. The Trojan ID number shows at the right.
• Click Notes to view benefit notes if available. They are created when importing benefits and usually read only.

Benefits Last Verified : Indicates the date that insurance benefits were last marked verified (manually or using the Insurance Verification List ). Click Now to insert today's date.

Don't Verify : Check this box to always exclude this plan from the Insurance Plan Verification List. To also exclude patients with this plan, see Insurance Verification Setup .

Double-click the grid to enter Benefit Information .

Miscellaneous

Plan Note : Enter notes specific to the insurance plan. This note will show for all subscribers on the plan. These appear in bold red in the insurance grid. Right-Click the text box for additional options.

Label : Print the insurance carrier name and address on an individual mailing label.

Delete : If the plan has only one subscriber, this will delete the plan (remove it from the Insurance Plan List). If there are other subscribers, the plan will only be removed from this subscriber and associated family members on the plan.

Saving Changes

The radio buttons at the bottom of the window determine if Fields that Trigger New Plan create a new insurance plan or affect all subscribers.

For details on using the options and how to create or update insurance plans, see Change Insurance Plan Information

Troubleshooting

When Blue Book is enabled, adding a fee schedule to a Category Percentage plan will delete the Blue Book data for the plan. Only click Yes if this change is intentional.

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Assignment Of Benefits Explained

Helping patients access quality dental care.

If your dental office bills directly to your insurance carrier and does not require you to pay up front for the services your insurance covers, your dentist is providing you with a service called assignment of benefits. We are Calgary NW’s top family dental clinic, book your next appointment now!

As part of our exceptional service to our clients, we provide what’s called an assignment of benefits. This service ensures that our dental office bills directly to your insurance carrier and does not require you to pay upfront for the services your insurance covers. In a non-assignment office, patients must pay the full cost of treatment and complete a dental claim form that the patient can submit to their insurance provider for reimbursement.

The health of your teeth and gums is connected to your overall well-being. Damaged teeth and a misaligned bite can lower our confidence when interacting with others while a severe toothache can become a constraint in our day. These are just two examples of how oral health can impact our quality of life.

At Brentwood Village Dental Clinic, we recognize that the costs associated with treatment can be stressful for some families and paying the full bill upfront can be a financial constraint. We believe that dental care should be accessible for everyone, which is why we strive to make your experience as smoothas possible, including the payment and claims process.

Professional dental care is an important part of your overall health. Give us a call today to speak about your options – we are ready to answer your questions!

How it Works

Assignment services are a benefit for you.

In offices that do not provide this service, patients, regardless of their insurance status, are required to pay for their dental treatment at the time of the appointment. Patients are then left to pursue their insurance companies for reimbursement personally.

It is estimated that no more than 30% of dental offices today provide assignment services. The following is an abbreviated list of the reasons why most dentists do not provide assignment services.

• The provider ends up waiting usually weeks or months for payments to arrive from the insuring agency.
• In order to cope with the large amount of paperwork required to submit and follow up on insurance claims, offices providing assignment must staff considerably more employees than those offices that don’t provide assignment services.
• Once a payment is made to the provider, if any treatment was denied due to exclusions or limitations in the patients insurance plan, there will be a balance owing. In this circumstance the provider now has the responsibility of tracking down the patient for the rest of the payment; sometimes meeting with distrust and hostility on the part of the patient.

So in short, dental offices who provide this service are doing so as a courtesy to their patients to make dental services more accessible. They are making it possible for you to have your dental work done and not be out of pocket for the expenses. They are not required by any provincial or federal legislation to do so and yet they will wait sometimes months for payment on the patient’s behalf.

Did You Know?

It is your responsibility to provide the staff with the proper numbers and insurance information.  The limits, restrictions and deductibles on your dental plan were put there by your insuring agency, not the dental office.  The dental office has nothing to do with these limitations nor can they do anything about them. Offices that provide assignment services have the right to revoke them at any time.

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