FREE 4+ Dental Insurance Verification Forms in PDF

Having dental insurance and any other insurance coverage is convenient especially during emergency situations where immediate surgeries and treatments should be taken. However, before an insurance coverage holder can receive the benefits, he will have to undergo a verification process which varies on the type of service that the dentist and any medical professional have administered to him. For this process, a dental insurance verification form will be used.

Dental Insurance Verification Form Sample

What Is a Dental Insurance Verification Form?

A dental insurance verification form is a document which is used by dentists or dental health service providers for their patients who are claiming to have dental insurance or are claiming to be a dependent of an insurance coverage holder. This form is important to be completely filled out in order to determine and verify the claims of the patient, as well as correct other details which need to be updated from the patient’s recorded insurance information.

Benefits of Using Dental Insurance Verification Forms

Dental insurance verification forms are not mere documents to fill out and stash away since these are essential for ensuring that the claimant or the patient is indeed a beneficiary of an insurance company. Below are some of the benefits of using dental insurance verification forms:

It documents the information to be used for the verification process.

This is the most important benefit and the reason why dental health service providers must use the verification form. The form will collect all range of information which can be useful in effectively identifying the claimant and his insurance coverage. In addition, the patient will also be required to disclose the contact information of the insurance company along with his claimed insurance account number which will be used by the dental health care service provider to inquire about the validity of the patient’s claims.

Helps ensure that payments will be given.

Different insurance companies offer different types of inclusions for their beneficiaries which is why there are some beneficiaries who can obtain services which could not be acquired by others through insurance. To properly identify the types of services that a claiming patient is entitled to in his insurance coverage, the dental insurance verification form should have the details of the patient’s insurance plan benefits and insurance amounts. By acknowledging the amount that the insurance company will be paying, the dental service provider will be able to inform the patient if there is a need for him to give a specific amount to complete the required payment to the dental service and treatment that he took and will be taking.

Records the number of patients under specific insurance companies for survey purposes.

Conducting a patient feedback survey is one of the protocols of some health care providers after a service is given to a patient. In lieu of this, surveying which insurance companies have more members who are visiting the office or clinic of a dental health care provider can also be done with the use of a dental insurance verification form. Basically, the staff can simply create a record and update it accordingly whenever a verification of the insurance claims of a patient is fulfilled.

Retirement Dental Insurance Verification Form

Essential Sections Found in Dental Insurance Verification Forms

Although there are different formats, arrangements, and even different data or information to be collected in varying types of dental insurance forms, there are sections which should be present at all times in the form to be used by the dentist and his staff, and these essential sections are enlisted below:

• Patient information – This is the section which will have the general information of the patient ranging from his name, age, address, and his phone numbers. Other pieces of information to include in this section is the employment details of the patient and his relationship to the subscriber or the account holder of the insurance coverage.

• Subscriber information – The data of the insurance subscriber will be stated in this section of the form which should have the name that he is using in the registration and records of the insurance company, his social security number, his date of birth, address, as well as his insurance account identification number. In addition, the group name or the category and level of insurance benefits that the subscriber has will also be indicated in this section along with the name of the insurance company.

• Insurance plan benefits information – This section of the form can only be filled out with the assistance of an authorized representative of the insurance company where the patient and the subscriber are both enrolled in. Some of the details to be placed in this section of the form are the dates of the starting and the expiration of the insurance coverage, the annual maximum amount which can be used by the patient and subscriber for paying the dentist’s fees, and the individual deductible amount as well.

• Coinsurance amount information – The details of the payments to be made by the insurance company and the subscriber for the services taken by the patient will be specified in this section of the form. It will indicate the percentage of each service to be paid by either party, the limited frequency of the number of exams and dental treatments that the patient can have every year, and the types of dental services that the patient can take which will be covered by both the insurance company and the subscriber.

Examples of Dental Insurance Verification Forms

Below are some examples of dental insurance verification forms which can be used by dental health care service providers and their staff for patients who wants to pay for the services using their insurance coverage benefits:

Dental Insurance Dependent Verification Form – This is the type of verification form to be used if an employee of a company wants to name a dependent in order for the dependent to be part of his medical and dental insurance coverage. The form will have three sections which must be filled out by the employee. The first is the employee information section which will state the basic details of the employee such as his name, address, email, phone number, and social security number. In the second part of the form, there are two subsections which are for different dependent categories. If the dependent who will be enrolled by the employee is his legal spouse, then he must mark the “legal spouse” checkbox and proceed on submitting the requirements stated in the first subsection. On the other hand, if the dependent of the employee is only his domestic partner, then he must fulfill the requirements to prove his relationship with the identified partner.

Dental Insurance Dependent Verification Form

In lieu of the second subsection, the employee must complete the third section which is for determining the types of legal forms and documents which are prepared to be submitted by the employee. In addition, there is also an affirmation statement in the third section of the form which serves as a written proof that the employee affirms the information disclosed in the form to be true and are based on facts.

Dental Oral Surgery Patient Insurance Verification Form – Some dental health care service providers prefer to let their patients contact and engage with the process of verifying their insurance benefits. For this, the dental staff or the dentist will require the patient to call and ask questions to the insurance company and to complete a dental oral surgery patient insurance verification form before going to the appointment.

Dental Oral Surgery Patient Insurance Verification Form

In a dental oral surgery patient insurance verification form, there is an insurance questionnaire which should be asked by the patient to the insurance company’s representative. The questions focus on the insurance policies, the deductibles, and even the waiting period or the number of days that the patient will have to wait before the insurance company can send the payment to the dental health care service provider.

Family Dentistry Insurance Verification Form – This verification form does not only verify one insurance account but two. The form contains sections for the primary and the secondary dental insurance information of the patient. Some of the information which needs to be disclosed in the form are the details of the subscriber, the name of the insurance company, the name of the subscriber’s employer, and the group and identification number of the subscriber’s insurance coverage.

Family Dentistry Insurance Verification Form

Tips in Using Dental Insurance Verification Forms

First off, when using a dental insurance verification form, one should be specific with the entries to be stated in each data field. Being specific ensures that the verification will be smoothly conducted especially when it comes to determining the limitation amount for the services to be paid by the insurance company based on coverage of the patient.

Another tip to keep in mind is to avoid leaving blank spaces when using the form unless the form is to be reset for another patient. Leaving blank fields in the form will only hinder and slow down the process of verification. In the event that the patient does not know a specific data, then it is essential to obtain the account number of the patient’s insurance account and the name of the patient which is used in the account as well as the phone number of the insurance company or provider where the patient is registered either a beneficiary or a dependent.

Lastly, if the dental insurance verification form was obtained online and is ready-made, it should be customized or be edited before it can be used by dentists for gathering their patient’s details. This is to make sure that the data to be gathered are related to the goal and purpose of the dental service provider, and that the header which contains the name of the dental health care provider and his contact information is of the provider himself.