Insurance can fill a dental clinic’s schedule. It can also quietly empty its bank account. The patients come, the work gets done, and the money arrives months later, short, with no clear reason. By then nobody remembers which visits were in which batch.
Most of that is avoidable. Insurance companies pay predictably when claims are complete, sent on time and followed up. This guide walks through the full cycle, from the patient’s card to the final payment.
Start with the company’s plan
Every insurance company, and often every corporate plan within a company, has its own rules. Write them down in your system once, not in someone’s head:
- Coverage: the percentage the company pays, sometimes different per group of procedures.
- Caps: a maximum per visit and a maximum per year.
- Exceptions: procedures with their own percentage or a fixed amount.
- Pre-approval rules: which procedures need the company’s approval before treatment.
In BeClarified, you add each company and then its plans. A plan holds the percentage per group, caps, procedure overrides and pre-approval rules. When an insured patient is invoiced, the split between company and patient is calculated for you, and reception is warned when a cap is reached or a pre-approval is missing.
Check the card before the visit
Most rejected claims start at reception: an expired card, the wrong plan, a patient who changed employer. Check the card when the appointment is booked, not after the treatment.
Each patient has an insurance card on their file: company, plan, number and dates. Staff can add it, or patients can send a photo of their card from the patient app, where it waits for reception to review. If a patient has no active card, BeClarified says so on the invoice: the patient pays it all.
Ask before costly work
For crowns, implants, orthodontics and other expensive treatment, get pre-approval before you start. It protects the clinic, and it protects the patient from a surprise bill.
The best pre-approval request comes straight from the treatment plan, line by line, showing what the company would pay for each item. Attach X-rays or photos where the company asks for them. When the answer comes back, record it: approved in full, partly approved, or refused. A partial approval is recorded as the amount the company agreed to, and the patient’s share updates.
Let the claim draft itself
The single biggest time-saver is not typing claims. When an insured invoice is issued, a draft claim should already exist with the company’s share calculated.
That’s how it works in BeClarified: an insured invoice makes a draft claim, ready to send. Reception’s job is to check it, not to build it.
Send in batches, on a schedule
Insurance companies usually want claims grouped, one company per batch. Pick a day each week, or twice a month, and send everything that’s ready. A fixed rhythm matters more than the exact day: claims sent late are paid late, and very late claims may not be paid at all.
In BeClarified, you pick the draft claims for one company and send them as a batch. If the company’s portal gives the batch a reference number, record it, so you can quote it when you follow up.
Record what was actually paid
When the company answers, record its decision on each claim: paid in full, paid in part, or refused. Then record the payment itself when it arrives, and apply it to the answered claims.
This is where clinics lose most money. A claim paid short is quietly forgotten, and the difference sits as a debt nobody will ever collect. Decide what happens to every short payment:
- Resubmit the difference with the missing information.
- Move it to the patient, if the company’s rules say it’s theirs.
- Write it off, if it’s not worth chasing, and record why.
BeClarified puts claims that weren’t fully paid on a follow-up list with exactly those three options, and you can add notes such as “called the company, answer in 3 days”.
Know what each company owes
At any moment you should be able to answer: how much does each company owe us, and how old is it? Look at this weekly. A company that owes a lot for a long time is a business decision, not just an admin task.
BeClarified’s insurance reports split what was invoiced between companies and patients, and show what each insured patient has claimed and what’s left of their yearly limit. See billing and insurance.
A weekly insurance routine
- Review cards that patients sent from the app.
- Check draft claims from the week’s insured invoices.
- Send this week’s batches, one per company, with reference numbers.
- Record answers and payments that arrived.
- Work the follow-up list: resubmit, move to the patient or write off.
Thirty minutes a week, done consistently, is worth more than a full day of chasing at the end of the quarter.
Frequently asked questions
What should we do when the company refuses a claim? Read the reason first. If something was missing, resubmit with it. If the procedure isn’t covered under the patient’s plan, move the amount to the patient and explain it clearly. If neither applies, write it off and note why.
Can the patient see what insurance covers? Yes. The patient’s invoice shows the split between company and patient, and patients see their invoices and balance in the app.
How do we handle patients who’ve reached their yearly cap? Your system should warn you before the visit. In BeClarified, reception sees that the cap is reached, and the rest is the patient’s to pay.
Does this work with corporate medical networks too? Yes. Treat each network or employer plan as a company with its own plans, coverage and caps.