How to Avoid Insurance Companies Denying Your Dental Claims

Insurance companies are notorious for collecting monthly premiums and then denying as many claims as they possibly can in order to increase profits. These companies will refer to the contract your patient has with them, including exclusions, limitations, and frequency provisions. They’ll use these to deny payment, which will result in decreased payouts and more money for the insurance companies.

Why Insurance Companies Deny Dental Claims

Below are some of the most common reasons why insurance companies deny dental claims and how to avoid these situations:

• Lack of information from the provider – Around half of all dental claims will be sent back to the office due to lack of information from the provider. Because of this, it’s a good idea to send all the pertinent information the first time around. This includes any endodontic, periodontal, orthodontic, or other major or minor services.
• Filing late – To avoid filing late, claims should be submitted immediately after services have been performed. Otherwise, a late claim is an easy and convenient excuse for insurance companies to deny the claim. Some companies require filing within 90 days, so always err on the side of caution and send claims early.
• Limitations, exclusions, and frequencies – All dental plans are different. Meaning that limitations such as lifetime or annual maximums make sure that there’s control over how much money is paid out on a dental policy. Certain plans only cover patients for certain procedures and treatments every year or every couple of years. Some plans won’t cover certain procedures at all, opting to cover less expensive treatments instead.

Insurance companies are in the business of making sure that their profits increase, even over the dental health of your patients. The best way to protect your patients and your practice is to anticipate these moves and avoid them.

For help with dealing with dental insurance companies, please contact CTC Associates today.