Why Insurance Companies Deny Dental Claims and How to Avoid This

One of the ways that insurance companies make sure that their profits increase is to collect monthly premiums from their members (your dental patients) and then deny as many claims as possible. These companies refer to the literature in your patients’ insurance contract including the limitations, exclusions, and frequency provisions. Denying payment of these claims results in decreased payouts and increased profits for the insurance company.

Why Insurance Companies Deny Dental Claims

Below are a few of the most common reasons why an insurance company would deny a dental claim and how to avoid these situations:

• Not filing on time – Claims should be submitted immediately upon completion of the services performed. If you submit claims too late, this is a very easy and convenient excuse for an insurance company to deny the claim. While most plans require that a claim is submitted within a year, others require a filing date of 90 days. Always err on the side of caution and send claims earlier rather than later.
• Lack of information from the provider – Around half of all dental claims will be placed on ‘pending’ status and sent back to your office, requiring you to send additional information. Because of this, it’s important to send all the information the first time around including endodontic, periodontal, orthodontic, and any other minor or major services.
• Exclusions, limitations, and frequencies – All dental plans are different. Limitations such as annual or lifetime maximums make sure that there’s control over how much is paid on a dental policy. Frequencies keep insurance costs down by making sure that patients are only covered for certain treatments and procedures a few times a year or every couple of years. Lastly, some insurance companies will exclude certain procedures altogether. Instead, they’ll cover similar, less expensive procedures instead.

Insurance companies are in the business of making sure that their quarterly earnings increase and they make higher profits. Insurance companies tend to make decisions based more on making money than what may be best for the health of the patient. This is why it’s important for you to anticipate these moves to better protect your dental patients.

For help with your insurance issues, including dental insurance credentialing, please contact CTC National today.