THE ADA PRACTICAL GUIDE TO EXPERT BUSINESS STRATEGIES 3 Introduction Changes in reimbursement rates, restructuring of dental plans, ballooning office overhead, and ever-increasing demands on the consumer and their resources are just some of the factors dental professionals must master when working with the insurance companies. The days are long gone where the dentist could hire someone “off the street,” have them submit a claim for reimbursement and expect it to be paid appropriately. Anticipating a positive outcome from a claim submitted by an uninitiated, under-qualified business staff member is foolhardy at best and potentially dangerous. The practice must recognize the benefits of working cooperatively with the insurance industry in order to maximize legitimate reimbursement, decrease risk, and reduce stress. The dental practice must learn to play well with the insurance carriers who receive, process, and pay claims for the patient who received care. Learning Objectives • Differentiate between various types of dental plans • Understand how to effectively work with insurance plans by knowing the basics of insurance administration • Establish and maintain the systems for communication and reporting of the codes • Identify the support materials every office should have at their disposal Chapter 1: The Basics of Working with Insurance Plans By Charles Blair, D.D.S.