On a regular basis, we attempt to evaluate certain services and processes, break them down into their basic components and let you evaluate whether or not those services are worth paying for. Today, we take a look at getting enrolled with insurance plans, especially for new practices. A number of services will handle this for you for a fee, but the question is this: Is the service involved enough that I need an expert to handle this for me?
Simple conclusion. Is the process time consuming? Yes. Is it complicated? Not at all. Here’s how the process operates:
Step 1: Gather a list of insurance companies and contact numbers.
Of course, this varies by state, but here’s a good generic list of some providers that are generally found in every state and provide some type of dental coverage (along with information on how to get to their enrollment information):
Aetna - https://www.aetna.com/about-aetna-insurance/contact-us/forms/doctors_hospitals/dental_plan.html
Affordable Healthcare – Call 866-519-7667
Blue Cross/Blue Shield – Call 866-947-9398
Careington - https://provider.careington.com
Cigna – Call 800-244-6224
Connection Dental – Call 800-505-8880
Delta Dental – http://deltadentalins.com. From there, click on dentist and scroll down to administrative
Dentemax - http://www2.dentemax.com/Dentists/Apply.aspx
Guardian – http://www.guardiananytime.com. From there, click Healthcare providers
MCNA Dental - http://www.mcna.net/provider/general-information-2/. (Florida, Texas, Kentucky only)
Premier Access Dental - https://www.premierlife.com/providers/forms-and-materials/
Safeguard – Call 855-638-8371
United Healthcare Dental – Call 888-887-9003
United Concordia – Call 800-332-0366
Obviously, there will probably be some state specific plans (including Medicaid) with which you want to enroll, but the process is no different.
2. Gather supporting information to provide to the insurance companies as part of the application.
Every insurer has its own requirements as to which information they need. Some want a lot. Others basically want to know you exist. Generally, this information falls into one of 3 categories:
Education/employment information – A copy of your college diploma, a copy of your dental school diploma, an up-to-date curriculum vitae, information related to any current employment
Identifying numbers – Your social security number, copy of your dental license, the SS-4 with your professional corporation/LLC identification number, your National Provider Identifier (visit nppes.org if you haven’t gotten it yet) and a W-9 form which gives reporting information to the IRS when the insurer pays you.
Insurance information – Namely, information on your malpractice coverage
3. Contact the insurers to request a provider application (see #1 above for a starter list of companies)
4. Prepare the applications, attach the supporting information and send them in.
This is probably the most time consuming part of the process. For the most part, the applications are not complicated, but some of them (especially the Medicaid ones) can involve a number of pages. But anyone with the basic demographic information on the practice along with the supporting information in #2 can work through it. The few questions that are more in-depth can usually be resolved without significant complication. Of the insurers listed above, if you wanted to sit down and knock them out, give yourself a good half a day.
5. Follow up with the insurers on a weekly basis to check on the progress of your application
The pitfalls here are no different than in any other line of work. Paperwork gets lost. The insurer needs an extra piece of paper from you. Your application is at the bottom of a stack of papers. And on and on. Insurers are usually very good at letting you know exactly what you need, but you need to stay on top of the process. As you would guess, this can take some time each week. If you follow up weekly, it would probably max out at 60-90 minutes per week. Obviously, as applications are completed, that time will gradually decrease.
Now that you know how to go through the process, what are some of the options for getting enrollment done?
You can use a service like the one in this link – Obviously, there are fees here, perhaps hourly ones which can grow as your needs or complications arise.
You can use a general tasks service like oDesk, eLance or TaskRabbit – Here you go directly to the outsourced solution that a lot of service companies use. One oDesk application offered a price of $400 to handle all of the applications listed in #1. One benefit is that you can cap fees at your budget. On the downside, if the company does not have a local presence, communication may be difficult. We’ve used several services. People that have done it before are generally competent, but you need to stay on top of them and make sure that they keep you updated.
Hire someone you know who is looking to pick up a couple of extra dollars – This can be and has been handled by someone with little or no training. Just give them the basic information, the supporting documents and let them have at it. This could be someone as young as high school aged who is willing to work at it and keep you updated. Again, there’s nothing seriously technical or involved. If you do hit a pothole in the process, feel free to contact us. No charge.
Do it yourself – This does take time, but consider our new office development podcast that described a 6-9 month process to get up and running. If you devote a little time each week to the process and start early enough, you can get it done. As mentioned above, we can give you some help if you run into a problem.
In the end, the decision comes down to your tolerance for paperwork and whether or not you feel you can dedicate the time to the process. If you don’t want to deal with it or cannot, definitely look elsewhere, but if you feel up to it, it may free up some additional dollars for you to dedicate to marketing your practice.
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