If you’re planning to go out of network in 2025, you’re not alone. More and more practices are making the shift to offer patients better care and financial transparency. One of the biggest challenges in this transition is estimating insurance coverage accurately. Dentrix has tools that can help, but you need to know how to use them effectively. In this article and podcast episode, I’ll walk you through some Dentrix estimating tips that will make this process smoother for your team and your patients.
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Why Estimating Matters When Going Out of Network
I remember when my own dentist went out of network with my insurance plan and I had a significant out of pocket expense to pay for my next visit. It made me think if I was going to stay with the office or try an in-network provider. In the end I chose to stay because of the personalized care I receive and the relationships I had built with the team. When you go out of network, what personalized service are you brining to your patients?
When you’re in-network, Dentrix uses either the fee schedule method or the allowed amount method to calculate patient estimates. But once you go out of network, you need a new approach. You’re still billing insurance and accepting assignment of benefits, but your estimates won’t be as straightforward as before. That’s why understanding Dentrix estimating tips is essential to keeping your patients informed and minimizing billing headaches.
Checking Eligibility and Benefits: Your First Line of Defense
Even though you’re out of network, checking eligibility is still a crucial step. There are three key reasons why:
- Preventing Claim Denials – If a patient’s insurance plan has changed and you don’t catch it before submitting a claim, it will be denied. Checking eligibility in advance helps you avoid this costly mistake.
- Understanding Remaining Benefits – Patients need to know their maximum coverage and whether they’ve met their deductible. Even out of network, these factors play a role in their out-of-pocket expenses.
- Providing Accurate Estimates – Patients expect more transparency when you’re out of network. If you want to retain them, you need to offer the best possible estimate for their treatment.
Updating the Payment Table for Better Estimates
One of the most powerful Dentrix estimating tips is utilizing the payment table. Unlike the allowed amount table, which you no longer need, the payment table can help you fine-tune estimates. Here’s how:
- When posting an insurance EOB, update the payment table with the actual amount the insurance company paid for each procedure.
- For example, if your prophy fee is $100 but insurance pays $80, enter $80 into the payment table. Next time a patient with that plan comes in, Dentrix will automatically estimate $80 instead of guessing.
- This is especially helpful for posterior composite downgrades, where the insurance company may only cover the cost of an amalgam filling.
Adjusting Coverage Percentages for More Accuracy
Out-of-network coverage percentages are usually lower than in-network percentages. If an insurance company used to cover 80% of preventive care, that percentage could now be 65-70%. One of my biggest estimating tips is to err on the conservative side—reduce the estimated coverage so that patients pay slightly more upfront.
I’d much rather refund a patient because the insurance paid more than expected than send a bill after the fact. No one enjoys chasing down unpaid balances, and patients appreciate the proactive approach.
Using Credit Card on File for Financial Security
Because your estimates won’t be as precise as they were in-network, having a credit card on file is a game changer. If a patient owes a small balance after insurance pays, you can charge their card instead of sending statements and waiting for payment. Dentrix Pay makes this process easy and seamless, ensuring that you get paid faster while keeping your accounts receivable low.
Troubleshooting Dentrix Estimations
If an estimate looks off, go into the treatment planner and check how Dentrix is calculating the numbers. Look for hidden fee schedules or old allowed amounts that may still be influencing estimates. Cleaning up these settings will help ensure more accurate numbers moving forward.
Take Your Estimating Skills to the Next Level
Going out of network doesn’t have to mean losing patients or struggling with estimates. By leveraging Dentrix estimating tips like updating the payment table, checking eligibility, adjusting coverage percentages, and using credit cards on file, you can maintain a smooth financial workflow.
If you need a deeper dive into insurance management, our Dental Insurance 101 course inside the Novonee membership covers everything from setting up fee schedules to optimizing Dentrix for out-of-network practices. Book a free discovery call with me to learn how we can help your practice transition seamlessly and keep your schedule full.
I appreciate you spending time with me today. Now go implement these Dentrix estimating tips and continue your journey toward becoming a high-performing dental team!
