Guest Contributor Introduction from Susan
In consulting, there are colleagues you might cross paths with and then there are the trusted few you confidently refer practices to again and again. Dana is one of those trusted few. A fellow Texan—sometimes a thicker-than-blood distinction—she brings deep expertise in dental insurance, stays current on ever-changing policies, and—most importantly—listens carefully to each practice so she can design solutions tailored to their needs. Nothing cookie cutter, always ethical, and always with compassion. I am grateful to call her both a colleague and a friend.
Now to the article…..By Dana Moss
Insurance verifications have long been one of the most time-consuming parts of running a dental practice. Front desk staff know the drill: hours on hold, chasing down benefit details, and hoping the information received is accurate. Yet verifications are essential for treatment planning, setting financial expectations, and avoiding unpleasant surprises after care. The process, however, consumes valuable time and resources.
Now, artificial intelligence (AI) is stepping into the picture. AI-powered tools promise to automate much of the verification process, lightening the workload and boosting efficiency. The appeal is obvious—faster results, fewer errors, and more time for patient care. But as with any new technology, AI brings both advantages and drawbacks.
Below, we’ll explore the pros and cons of AI in dental insurance verifications, with real-world examples from practices already testing this shift.
The Pros of AI in Dental Insurance Verifications
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Speed and Efficiency
What once took 20–30 minutes on the phone can now be done by AI in just a few minutes. For busy practices—especially those welcoming dozens of new patients each week—that’s a major time saver.
Example: A multi-location practice in Texas adopted an AI verification system that pulled benefit information overnight. By morning, the next day’s patients already had updated eligibility and benefits attached to their charts. The front desk team went from spending 15 hours a week on verifications to just a couple of hours reviewing AI-gathered data.
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24/7 Availability
Unlike staff, AI doesn’t clock out. Many systems can run after business hours, automatically processing verifications in the background. For practices, this means eligibility for the next day’s patients is ready before the first appointment. Teams start the day with accurate information instead of scrambling through hold times.
Example: A Florida practice used AI to run evening verifications, giving their morning huddle a huge boost. Staff could walk in, review confirmed benefits, and start the day focused on patients rather than paperwork.
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Scalability
As practices grow, the volume of verifications rises quickly. AI tools scale with that growth, handling higher volumes without additional staff hours.
Example: A start-up practice in California doubled its patient base in a year. Instead of hiring another coordinator, they invested in AI software, which allowed the existing team to manage demand smoothly.
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Data Insights
Some AI platforms provide reporting that highlights payer trends, such as frequency restrictions or common limitations. These insights can help practices improve financial forecasting and even support negotiations with payers.
Example: A group practice in Florida used its AI reporting to track how often a major carrier denied fluoride treatments due to frequency limits. Armed with data, they adjusted treatment plan conversations with patients and later used the evidence when negotiating reimbursement policies.
The Cons of AI in Dental Insurance Verifications
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Missing the Fine Print
Dental benefits are rarely straightforward. While AI can pull basics like eligibility and coverage percentages, it may miss details buried in policy language—waiting periods, frequency limits, or exclusions.
Example: A North Carolina practice relied on AI to verify benefits for fillings. The system showed 80% coverage but failed to note posterior composites weren’t covered. When the claim paid differently, the patient was frustrated, and the practice had to absorb the fallout.
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Loss of the Human Touch
Insurance coordinators do more than gather numbers—they explain coverage in a way that reassures patients. AI can’t replace the empathy and clarity of a human conversation.
Example: One office went “all in” on AI, but patients grew frustrated when staff couldn’t answer questions beyond what the system displayed. The practice shifted to a hybrid model, letting AI handle data but relying on coordinators for communication.
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Technology Costs
AI systems come with subscription fees, setup costs, and training time. For smaller practices, the expense may outweigh the savings.
Example: A single-doctor office in Ohio trialed AI but canceled after three months when the subscription proved more expensive than hiring a part-time coordinator.
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Integration Challenges
Not all AI platforms integrate smoothly with practice management systems like Dentrix, Eaglesoft, or Open Dental. When systems don’t communicate, staff may end up entering data twice—once into the AI platform and again into their software.
Example: A practice in Arizona discovered their AI tool didn’t sync well with Dentrix. Staff still had to manually copy information into charts, undercutting the efficiency gains.
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Liability Still Falls on the Practice
Even when AI makes the mistake, responsibility for incorrect estimates falls on the practice. If patients owe more than expected, it’s the team—not the software—that must explain and resolve it.
Example: An Arizona practice’s AI tool missed a six-month waiting period for crowns. A patient moved forward with treatment, only to have the claim denied. The oversight left staff scrambling to explain and set up payment arrangements.
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Limited Connectivity with Some Carriers
AI platforms are only as strong as the systems they pull from. Some carriers lack real-time eligibility feeds or maintain outdated portals that don’t integrate with AI.
Example: An Illinois practice found its AI tool worked well with Delta Dental and Cigna but couldn’t connect to smaller regional insurers. Staff still had to make phone calls, creating a hybrid process that sometimes caused confusion.
Finding the Balance: A Hybrid Approach
So, is AI the future of dental insurance verification? The answer likely lies in a middle ground.
The most successful practices adopt a hybrid model:
- AI handles the heavy lifting—overnight verifications, basic eligibility, and coverage details.
- Coordinators provide oversight—reviewing results, catching fine-print exclusions, managing smaller carriers, and communicating with patients.
This approach blends speed and efficiency with the judgment and empathy only humans can provide.
Example: A large group practice in Georgia adopted this model and reported strong results: AI handled 80% of data gathering, while coordinators managed exceptions and patient conversations. Staff stress decreased, and patient complaints about surprise bills went down.
The Bottom Line
AI is reshaping how dental practices manage insurance verifications, offering powerful efficiency gains. But it’s not a magic wand. Without human oversight, details can slip through, and patient trust can suffer.
For most practices, the smartest strategy is to let AI work with the team, not replace it. By pairing technology with skilled coordinators, practices can speed up verifications, reduce errors, and maintain the personal touch that patients value most.
Meet Dana Moss, the PPO Pro
Dana Moss, founder of PPO Dental Consulting, is a PPO business coach with a focus on dental insurance. She is a money finder, PPO practice builder, and team motivator, ready to empower dental practices to increase profitability without sacrificing service-oriented care. Dana has refined the fundamental solutions for developing a patient centered and lucrative practice. Dana has worked as a front office coordinator, insurance specialist, office manager and practice administrator. Her years of experience in leading PPO practices bring firsthand knowledge of what it takes to be profitable in today’s dental insurance world.
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