Sometimes, a dental insurance claim might be denied. This can be especially frustrating to deal with, especially if you have to explain it to the patient. Common denial reasons might include missing or inaccurate information, a lack of documentation, or a lack of coverage for the service in the first place. If you properly verify and review a patient’s insurance coverage prior to their treatment, the latter issue should never be the case. However, claims still do get denied for the other reasons listed — and luckily, it’s not the end of the world!
The first step to figuring out why a claim was denied is to review the Explanation of Benefits for the patient. Once the reason for the denial has been identified, gather any additional information or documentation that you need that will support the claim. This could include X-rays, medical records, or a letter of medical necessity from the dentist. After you gather this information, you will submit a letter of appeal to the insurance company.
Submitting an appeal can be a complex process, however, careful attention to detail and following a proficient system will make it possible to handle each appeal smoothly and efficiently. Look below for what the process looks like for submitting an appeal.
As you can see, denials can be appealed with the proper documentation and presentation of the issue. Your role as your patients’ most valuable advocate will truly shine in this scenario! Your dental practice might have their own template for appeal letters. However, to give you a peek at what this might look like, here’s a sample appeal template below:
