1. Confirm treatment performed and with which doctor
2. Make sure insurance is active and patient is eligible
3. Check whether we are in or out of network
4. Verify breakdown percentage for that procedure is correct and that there is not a waiting period by checking the uploaded breakdown in file cabinet
5. Verify if procedure is covered and there is not a frequency or age limitation issue
6. Check if patient’s deductible has been met.
7. Check the patient’s insurance maximum (be careful for claims pending – maximum will not be accurate!)
8. Make sure if it is a weird/uncommon insurance, ask and triple check before continuing
9. Make sure the treatment plan is UPDATED (click update button) and verify that it has the accurate office fee, allowable fee, and patient portion
   • Check allowable fees on the tracker
10. Print off treatment plan, present, and schedule the patient on Eddson and PUT the portion due on the appointment right then and there. Give the patient the appointment card with the patient’s portion due at the time of service

Example #1:

Crown #14 with patient that has Delta Dental Premier (build up/filling was done already)

1. Notes indicate which Dr. B diagnosed the crown thus make sure to schedule with Dr. B

2. Insurance is active and patient is eligible because they have been manually confirmed and the web portal report in the file cabinet indicates that it is effective

3. We are IN-NETWORK with Delta Dental Premier thus the Non-Par Plan should be unchecked (if we are OUT-OF-NETWORK, it would be checked)

• 4. Crowns are considered major so the crown is correctly entered as being covered at 50% and there is NOT a waiting period

5. Insurance limits the patient to a crown every 60 months, shouldn’t be an issue since this tooth has never gotten a crown before. Patient is over the age limited required for a crown.

6. Patient’s deductible balance is $0.00 and we can see that patient has already met their deductible by having other treatment already this year

7. Patient still have available coverage of approximately $984.40, NOT including todays services however. Thus the patient has not maxed out and reached their annual max yet.

8. Delta Premier is a common insurance, so we can predictable trust that this will be accurate

9. Uncheck the DNU and click the Update Fees button, if everything is correct, it will remain the same. Verify the allowable is correct and that the coverages looks like its 50% of the allowable, $934 x .50 = $467. Thus it look correct. Patient will not need to pay their deductible this time since it has been met already.

10. Print off the treatment plan, have patient sign it and then schedule the patient

Give the patient the appointment card and write the patient portion on there. Patient portion is $467.