Insurance Made Easier: A Quick Guide for Dental Teams

Let’s be honest—dental insurance can feel like a puzzle with too many pieces. But as a dental practice, you’re expected to help patients make sense of it all and get the most out of their benefits. That’s where the right tools (hello, Open Dental!) and a little know-how go a long way.

Whether you’re brand new to insurance workflows or just need a refresh, understanding the different types of plans and how to manage them efficiently in Open Dental can save your team time, reduce stress, and boost patient trust. Here’s a straightforward breakdown to help you navigate it all with confidence.

1. PPO (Preferred Provider Organization) Plans

The Basics:
PPOs are the most common insurance plans. Patients can choose from a network of dentists at discounted rates, but they also have the flexibility to go out-of-network (usually at a higher cost).

How Open Dental Helps:

• Fee Schedules: Load those in-network fee schedules so your team can give patients accurate co-pay estimates before they sit in the chair.

• Insurance Estimates: With Open Dental’s estimate tool, you can break down coverage for preventive, basic, and major services. No surprises = happier patients.

• Claim Tracking: Submit and track claims with ease. You’ll stay on top of reimbursement timelines without needing a spreadsheet marathon.

2. HMO or DHMO Plans

The Basics:
These plans are more restrictive. Patients must see a dentist within the network and often need referrals to see a specialist.

How Open Dental Helps:

• Capitation Tracking: If you’re receiving monthly payments from an HMO provider, Open Dental helps you stay on top of them.

• Treatment Plans with HMO Fees: Input plan-specific fee schedules so patients know what to expect—and you avoid awkward billing conversations.

• Preauthorization Management: Open Dental can keep track of what’s pending so your team isn’t left guessing.

3. Out-of-Network or Indemnity Plans

The Basics:
These offer the most freedom—patients can see any dentist, but they often pay up front and get reimbursed later.

How Open Dental Helps:

• Claim Submission Support: Generate detailed, itemized treatment plans with insurance codes so patients can file claims easily.

• Custom Insurance Plans: You can customize plan setups based on typical reimbursement rates, which helps your team provide clearer estimates.

4. Discount Dental Plans

The Basics:
Not insurance, but a membership model where patients pay a set fee for access to reduced service rates.

How Open Dental Helps:

• In-House Plan Setup: Use Open Dental’s discount plan tools to manage your own membership program.

• Auto-Apply Discounts: Apply percentage-based discounts right at billing—no calculator needed.

• Recurring Payments: Set up monthly or annual payment plans that work for your patients and your bookkeeping.

Boosting Insurance Efficiency with Open Dental

Stay Organized with Family Account Notes
Use the financial note field to track key info—like pending preauths or overdue balances—so your team can follow up quickly and clearly.

Work the Insurance Verification List
Pull this list before each day or week begins so you know who’s coming in and what their insurance looks like. It’s a small habit that prevents big surprises.

Keep AR and Insurance Aging Reports on Your Radar
Regular reporting helps you catch aging claims or unpaid balances before they turn into a mess. Open Dental makes this easier than ever.

Invest in Team Training
Whether it’s internal training or partnering with experts (like SKF Practice Solutions), make sure your team knows how to use the tools you already have. Confidence here makes everything run smoother.

Final Thoughts

Dental insurance doesn’t have to be the dreaded part of running your practice. When you understand the different plan types and use Open Dental to stay organized, things get easier—for you, your team, and your patients.

The more efficient your insurance workflows, the more time you can spend where it really matters: building relationships, delivering great care, and growing your practice.

You’ve got the tools. You’ve got the team. Now let’s make insurance work for you.