Dental Claims Denied

Dental Insurance Denied Claim? What to Do and Know

Have you gotten a dental treatment done that your insurance has denied covering? Don’t worry; we are here to help. Keep in mind dental practices don’t work for insurance nor are they obliged to send appeals on behalf of patients. Most dental practices offer assistance in sending appeals as a service so if they do, use their services to get your dental claim appealed and processed soon.  

Become familiarized with your policy and coverage will be advantageous everytime you go to your dentist for a routine check-up or treatment procedures. It will help you avoid dental claims being denied and any worry you might have of how your dental benefits work. Below you will find three ways which can help prevent claims being rejected.

Review Information

We highly recommend you review your information at least every year with your employer or insurance company for your records and our own. You always want to verify with your employer or insurance company your information such as group and coverage number and to avoid delays in processes and to get dental claims denied. Most common reasons they deny claims are incomplete and inaccurate claims. When you are filling out a dental claim provide all the information it requires.

Legible Documentations

Legibility is a must! When filling a claim ensure your handwriting is legible to understand. This can include other documentation you might have to provide to process the application. The most common documentation that needs clarification is x-rays and charts! X-rays and charts are difficult to read which is why if these documents are required ensure you send in a form narrating the reason for treatment. Sending documents without a clear interpretation or narration that explains why you need dental treatment.

Beware of Limitations

We always say this, and we mean it for emphasis, review and understand your policies. Always ask for a copy of your plan, dental contract, and a list what your insurance covers. Having all these documentations with you can help you better understand how much the insurance will pay and how much you will have to pay out-of-pocket. Dental policies have many restrictions based on age and frequency.

Age limit restriction can prevent you from getting a dental procedure because of your age often being younger. Frequency limitations usually restrict the number of dental services you’re allowed to exercise in a year. For example, you can have restrictions on how many times you can have cleanings and x-rays. Knowing the specifics of your policy to see what is included and excluded will help you understand what will be denied by your insurance.

Even if you have looked over your dental contracts and coverage and still get a dental treatment denied, we are here to assist you! We will help you with the proper documentation your claim needs and send appeals on your behalf. Our account managers are here to answer questions and concerns you might have. Don’t hesitate to ask our managers.

If you don’t understand why your claim got denied call your insurance to inquire about the reason(s) your claim got rejected and what you might need to get the application processed. Remember the more you’re aware of your insurance, what it covers for your and the eligibility for your family, the smoother the process of getting the dental treatment you need will be.

If you need some assists with appealing a denied claim or require medical documentation along with a narration of why we are more than happy to provide you with the information you need. Please don’t hesitate to call our account managers at 801-505-7125.   

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