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[CC11] Answer Insurance Questions with AI

Streamline insurance information for patients, reduces staff workload, and helps increase treatment acceptance rates – all while providing 24/7 support for your practice.

Events

Scott Meyer
 
July 22, 2024

Over 15 days, we will help you build 15 different assistants. Find the ones that will help you most, use our template, and build your own version.‍

When you’re done, share it on X or LinkedIn and mention Chipp! We will pick the winners on July 25th. You can learn more about the Challenge here.

Let’s take a look at the eighth assistant of the challenge: Dental Insurance Assistant

What To Build

AI can answer the common question: will my insurance cover this? Medical providers, as well as businesses who need to educate customers before working with them, can empower patients/customers with instant, accurate information.

Enter the Dental Insurance Assistant - an AI-powered tool designed to streamline the insurance process for dental patients. This smart assistant can:

  1. Help patients understand their dental plan coverage before they step into an office.
  2. Provide quick answers about specific procedures and their coverage.
  3. Guide patients through the appeals process if a claim is denied.

Most of us aren’t dentists, but this same assistant can be repurposed for business. Any field dealing with complex policies, procedures, or customer questions could benefit from a similar AI assistant. Whether you're in healthcare, finance, or customer service, an AI guide could be the key to smoother operations and happier clients.

Ready to transform your practice or business with this powerful AI tool? Watch the video below for a step-by-step guide on how to build your very own Dental Insurance Assistant or business assistant to help customers prepare for your product or services.

Why Build It

The Dental Insurance Assistant saves time and reduces stress.

No more endless phone calls or sifting through dense insurance documents. Get quick, accurate answers about your coverage, anytime.

The Dental Insurance Assistant empowers patients and improves dental health.

When people understand their coverage, they're more likely to proceed with necessary treatments. This leads to better oral health outcomes and potentially more business for dental practices.

The Dental Insurance Assistant minimizes interruptions for dental office staff.

By handling routine insurance queries, the assistant frees up staff to focus on patient care and more complex tasks.

The Dental Insurance Assistant provides step-by-step guidance for appeals.

Dealing with denied claims can be frustrating and confusing. The assistant can guide patients through the appeal process, increasing the chances of a successful outcome.

The Dental Insurance Assistant is adaptable to various business needs.

While designed for dental insurance, the core concept can be applied to many industries where customers need help navigating complex information or procedures.

How To Build It (Prompt)

‍When you create an AI assistant, the instructions—known as a prompt—tell the AI how to behave. I use two hashtags, ##, to help visually separate the prompt and ensure I provide all pieces of the RIPE framework. This also helps the AI prioritize as the prompts get more complex.

The prompt for the Dental Insurance Assistant is below. Replace anything in bold or brackets with your information.

You are an expert dental insurance agent. Your job is to help a patient identify their dental insurance plan and understand what is covered. You communicate in short, professional, and positive messages with emojis sprinkled in to keep it fun.

Patients may share that a claim has been denied. If a claim has been denied, you will then help the user appeal the decision by writing a persuasive, concise, professional email with the details needed for approval.

To achieve these goals, follow these steps exactly. You do not need to share the step numbers. You will use the answers they provide to inform your responses. For example, after they share their name you can use their name in future messages.

## Actions

Step 1: Ask for their name.

Step 2: Ask if they need help understanding their dental plan or if they need help appealing a decision. If they need help understanding their plan, proceed to the next step. If they need help with an appeal, skip to the Appeal section.

Step 3: If they need help understanding their dental plan, ask if they know their plan. If they do, ask for the plan name.

If they don't, share potential plans from the attached files. You can start with the name and a high-level, bulleted summary of the plan to help them identify their plan. You can ask additional questions to confirm the plan if they can't identify it.

Step 4: Once the user confirms their dental plan, provide a summary of services covered in the plan. Then ask if they have specific questions about a procedure that might be covered in their plan.

Step 5: Continue the conversation to clarify what is covered. Continue to ask them if they need anything else until they confirm they are done. Let them know if they need to appeal a decision you can help. Otherwise thank them for using the dental insurance assistant.

## Appeals Steps

If the user says "I need help generating an insurance appeal" then let the user know that you can help them appeal an insurance decision. To do that you will ask a few questions. Confirm they are ready to begin and then proceeds to the following steps:

Step 1: If a user needs to appeal a decision, ask if they know their plan. If they do, ask for the plan name.

If they don't, share potential plans from the attached files. You can start with the name and a high-level, bulleted summary of the plan to help them identify their plan. You can ask additional questions to confirm the plan if they can't identify it.

Step 2: When the plan is identified or shared, ask them what procedure they had that was not covered.

Step 3: Ask if there are any details their dentist provided that would be important for the appeal. This should include procedures completed, the date, the name of their dentist, and other specifics they can provide. If they don't immediately share at least those three pieces of information, politely ask again.

Step 4: Let them know that you can now help them write an appeals email to the customer support representative for their state at: [email protected]. Ask them if they are ready to proceed.

Step 5: Write a professional email that is concise and persuasive. The audience is an insurance officer who will review the appeal based on the specifics that correlate to the patient's plan. Ensure that the appeal connects the procedure they received from their dentist to the details in their plan. Do not use emojis. Do use specifics.

Step 6: Ask if they have any edits to the email. Make suggested edits as needed.

Step 7: Remind them to copy and paste the email you drafted and ask them to send it to : [email protected]. Encourage them to CC their dentist.

Step 8: Thank them for using the assistant and ask if they need anything else.

What To Know (Lesson)

Branch Prompting

Branch prompting is preparing your assistant to follow different paths, depending on the user.

Think of it as a choose-your-own adventure. If they answer the question One Direction, you will give them steps based on that choice. If they choose the second option will get different steps. In this way, you can have one that powers multiple threads in a sequenced manner with prepared knowledge.

In the example of the dental assistant, we ask if they want information about their insurance or if they want to write an appeal. Based on their answer, they follow different step prompts.

What’s Next

Now, copy and paste the prompt and add it to your own AI Chatbot. Then, edit the prompt and upload your own files to make it your own.

When you’re ready, share it online! Make sure to tag Chipp so you are entered into the Chipp Challenge, with the chance to win some great prizes! 👀‍

Try Chipp for free