Who should be responsible for understanding a patients dental benefits? The patient or the dentist office?

Having been a dental assistant for 10 yrs., I have always been told that it is the patients responsibility to know their own benefits. However I see patients daily who don't understand a thing about their dental insurance, especially when it comes to going out of network. It seems like when you try to explain it to them, they get mad at the dental office instead of their insurance company, as if they think we are making it all up. They have usually heard things about insurance from friends, family or coworkers and take that as the gospal. Who should be responsible for knowing details of the insurance plans? Taking into consideration that most dentists accept numerous insurance plans, and each plan has hundreds of individual policies, each having different rules and regulations.

Who should be responsible for understanding a patients dental benefits? The patient or the dentist office?
It's a tough question and I don't think there's one, deffinitive answer.





Having worked as long as you have in the dental field, I have aquired a huge amount of information about insurance plans. I've spent countless hours attending seminars, getting phone support, and reading explanation of benefits (EOB's). There are things I can help patients understand about their insurance benefits and I do this as part of my job.





On the other hand, there are still clauses and exceptions that surprise me all the time. Plans change, people max their coverage at other offices, employers don't pay premiums, employees don't work enough hours to qualify, waiting periods come and go.... There's just NO WAY I can be an expert on each of the thousands of plans out there.





So, most reasonable people would expect the person who is BUYING the plan to know something about what they purchase. (Employees "buy" the plan by trading their work hours for the benefit the employers offer.) Sadly, this is often not true. Once they hear "dental insurance", all they get is "two free cleanings a year" and that's about it.





One of my pet peeves is people not taking responsibility for what is their own - and one of those things is knowing their coverage. If you are intelligent enough to work, you should be able to find out what your plan does - and more importantly, does not - cover. If you don't understand the wording, call someone and ASK a few questions until you do understand it.





You bought it, you're paying for it in labor, you should know what it does.





People get mad at the dental office over insurance because we have conditioned people to think we're experts in their insurance. For decades, we have accepted assignment of benefits, letting people walk out the door without paying a dime for their services. "Just bill my insurance and I'll pay if there's anything left." We have given them the impression that our "estimate" is exact and if there's any mistakes, it must be the fault of the dental office.





They also get mad at us because we're easier to reach than a faceless insurance company. We make handy targets.





I'm glad to help our patients understand what "coordination of benefits" means, or "missing tooth clause." But like you, I'm disappointed that more people won't take responsibility for becoming informed on what is - after all - a contract between themselves, their employer, and the insurance company.
Reply:It is the patient's responsibility to understand their benefits. All too often, people don't take the initiative to understand what they've bought or is provided to them through their place of employment. Maybe ignorance is bliss, but it doesn't help pay the bills and it certainly may leave money on the table.
Reply:I believe the patient should be responsible. With that being said, when the insurance companies mail out the cards and benefits booklets they should include in LARGE TYPE that the patient is responsible for understanding the benefits. Something to that extent actually does appear in small type--usually in the area that everyone skips. How do I know this? I am not only a medical professional, but also a consumer of health/dental insurance, and I am one of the very few that takes the time to read the fine print.
Reply:I understand exactly what your saying, I work in a Physicians office and it is the same thing, Patients think that there is only 1 insurance out there and we are supposed to know exactly what their personal deductible is, what their family deductible is, what their copay is what there script coverage is etc... They ask us if a certain procedure is covered and when we give them the codes to call their insurance company to find out...they get mad at us, like it's our responsibility to find out for them. It is the PATIENT'S responsibility to know what their individual coverage is, we help as much as we can but we don't know your coverage until we bill it.
Reply:I think it is both parties responsibilities. However, if I had to choose one I would say the dentist office but only because they're the ones at work. Therefore, the workers have an obligation to know what's going on. The patients are just there to get the service they signed up for and pay for it. Nonetheless, there is nothing worse than someone (a patient) getting an attitude because they're ignorant to what's going on. (That's more of a character issue than anything else.)