The True Cost of Insurance Denials and How Automated Verification Can Help

In 2021, nearly 70% of providers noted that insurance denials were increasing. The same research revealed that 27% of those denials are related to registration and eligibility. With those numbers, it’s no wonder that more and more practices are looking for solutions that allow them to automate the insurance verification process and increase their speed and accuracy. Automated insurance verification has significant benefits and one of them is decreasing insurance denials. 

Quick Links

• What Are Insurance Denials?
• Top Causes of Insurance Denials
• The True Cost of Insurance Denials
• How Does Automated Insurance Verification Work?
• How Automated Insurance Verification Reduces Denials

What Are Insurance Denials?

Insurance denials, plain and simple, are when an insurance company states it will not pay for a medical or dental procedure. Denials can occur after treatment, a claims denial or prior to treatment, referred to as a prior authorization or pre-authorization denial.

When insurance is denied, patients and providers can appeal the denial or the patient can pay out of pocket for the procedure.

Top Causes of Insurance Denials

There are countless reasons for insurance denials. It would be difficult to provide an exhaustive list as sometimes claims depend upon the insurer. However, there are a few top reasons you, as medical and dental providers, can prevent.

Necessity- In this case, insurers do not believe the treatment or procedure are necessary.

No coverage- The treatment isn’t actually covered by the patient’s insurance.

Provider is out of network- Some insurance companies require that covered procedures be performed by providers who are in their network.

Cost- Typically, if a treatment is denied for cost, the insurer believes there is a less expensive available option to achieve the same results.

Procedural failure- For some treatments, insurers require prior authorization. Failing to get that authorization may result in a claim denial.

Missing or incomplete information- Requests for procedures often require details about the need or the problem itself. Failure to include that information may result in a denial and require a call back.

Administrative errors- Administrative errors range from incorrect names, birthdates, or even incorrect coding for the procedure.

The True Cost of Insurance Denials

As one can imagine, there are both intangible and tangible costs associated with insurance denials. The last thing most providers want is a frustrated patient who cannot get the care they need.

Often, patients do not fully understand their benefits or stipulations to care (such as in and out-of-network providers), which can create problems for both medical and dental practices, particularly when a treatment or procedure has been either recommended or already performed. So, when the insurance denial occurs, there can be a bit of sticker shock when the true out-of-pocket cost is discussed. This, undoubtedly, has an impact on patient trust as well as the patient-provider relationship and could impact future care and patient retention.

In addition to the very real impact denials have on your patients (and their health), there’s also a significant impact to your practice. Any time you have to resubmit a claim, you not only incur additional costs, anywhere from $25-118 per claim, but you also delay your cash flow.

The same research indicated that nearly 65% of denied claims are never resubmitted which means that money is being left on the table. More specifically, there’s a cost associated with filing the claim to start. If the claim is denied, that money is left behind if it’s never resubmitted and the revenue never actualized.

On top of all of this, you’re likely contending with staffing shortages and the verification process requires considerable human resource utilization. After all, it takes a team member or two to handle verifications, call backs, and address any denials, especially if the error is on your side. That’s anywhere from 20-30 hours a week they could otherwise be focusing on patient care and practice growth.

How Does Automated Insurance Verification Work?

Automated insurance verification solutions, like iCoreVerify, look at your full schedule of patients and, based on connections with over 2000 insurers, verify their coverage as well as any changes in their plans and available benefits. The report is complete in seconds, whether you have a hundred patients on your schedule or a thousand. This frees up your team to focus on additional tasks and customer service.

Further, with those up-to-date insurer connections, you can verify current coverage, but you can also identify coverage for future treatments and book those before your patients even leave your office. In short, automated insurance verification enables you to ensure coverage and cash flow. 

How Automated Insurance Verification Reduces Denials

Not only does automated insurance verification improve your team’s efficiency and your revenue generation, but it can also help you reduce insurance denials.

More specifically, iCoreVerify includes automatic error identification, addressing administrative problems or incomplete information before it becomes a problem. As a result, your error-free claim submissions can mean higher case acceptance and far less time spent on appeals and callbacks or corrections. And, to take one more task off the ‘to do’ list, iCoreVerify automatically resubmits the claim until it’s approved.

Additionally, because your entire patient schedule is verified before they enter the office, with up-to-date benefits information, you can be sure a treatment is covered so there’s no claim denial later. Your team can be prepared well ahead of the patient appointment and share up-to-date claim information with the patient in the office. In short, automated insurance verification can help stop many of the reasons for insurance denials before they happen, ensuring your patients get care, you get paid, and your patient provider relationships flourish.

If you’re ready to talk to the team that brings you one of the leading automated insurance verification solutions on the market, reach out to iCoreConnect. Better yet, book a demo and see it in action.