How to Properly Check Eligibility for Membership Patients and Stop Giving Away Free Services

Worried that you are overbilling membership patients? Or giving away services for free?  

To run an optimal, efficient front office means having the same process for all your patients, regardless of their insurance status. No exceptions to this rule!   How many times is your dental assistant filling in at the front desk because someone is out sick? Or you train the  temp on the   important things, but overlook the exceptions.

As these situations compound on each other things can get out of hand quickly, leaving your administrative process a chaotic mess.

Here’s the solution to ensuring there are no exceptions:  think about members just like insured patients and check their eligibility for plan services, on the Plan Forward dashboard. 

Best practices for insured patients lookes like this:  

Pre-appointment

• Ask the patient “Have your benefits changed?”
• Check eligibility, remaining benefits, plan start date (for scheduling)

Day of appointment

• Confirm everything in the patient account is accurate - appropriate insurance company, group number, discounts applied, fee schedules applied, update remaining benefits, etc.
• Present treatment plans with accurate information detailing fees, frequency limitations, out-of-pocket responsibilities, discounts, etc.
• Collect all balances from the patient
• Reappointment for hygiene per the plan year, and schedule any accepted treatment.

Post appointment 

• Ask for reviews, referrals, send appointment “save-the-date”

Best practices for membership patients typically looks like this:

Pre-appointment

• Ask the patient if their benefits have changed, and mention you see they are on your membership plan.

Confirm the patient is up to date with their billing for the membership plan. Create a dummy code for membership and post it to the ledger on the day the patient joins the plan (or renews). 

Confirm the date in the PMS, that the dummy code was posted.

• Ensure that the patient is eligible for the included services based on the date. 

For monthly plans, confirm in the PMS  that the number of months the payments have been posted are actually documented. 

Confirm that membership payment was actually collected.

• Count the number of services the patient has used since they joined/renewed to be sure they are eligible for included services. 

Day of Appointment

• Confirm everything in the patient account is accurate

Most times this looks something like:

• Correct insurance company/employer is attached to the account
• Correct Membership Plan fee schedule
• Correct Discount is applied
• Correct Patient Alert is attached to the patient
• Correct Renewal Date is noted somewhere on the account/appointment

• Present treatment plans with accurate information

Once you’ve confirmed the patient’s account is up to date, the membership plan payments are current, and the patient is eligible, your treatment plans should populate with the accurate billing amounts and discounts.

Reappointment for Hygiene

The renewal date is noted somewhere on the appointment, this should make it easy for the hygienist, treatment coordinator, or front desk to make future appointments. 

Post Appointment

• Ask for referrals and reviews!

“We love having you as a patient and would love to serve more people in your network. Please keep us in mind when your friends and family are in need of a dental home.”

Want to learn about how membership software can help you streamline this eligibility process? Book a demo with someone from our team and we’ll tell you more!