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3 Common Ways Insurance Companies Deny Dental Claims

3 Common Ways Insurance Companies Deny Dental Claims
by Kyle Summerford

Ever heard of Warren Buffet, the man who made most of his fortune by heavily investing in the insurance industry? Of course, you have. His net worth is said to be somewhere in the area of $100 billion. Understanding the business model of insurance companies, Mr. Buffet took a gamble and came out one of the richest men in history. You see, insurance companies are in the business of making money, not spending it.

One of the most common ways insurance companies ensure that their profits soar is to collect monthly premiums from their members (our patients), then deny as many claims as possible by referring to the literature in a patient’s contract, specifically the exclusions, limitations, or frequency provisions. Exercising their right to deny payment of claims based on this literature ultimately results in decreased payouts and increased profits for the insurance company.

Now that you have a better understanding of the insurance company business model, you need to think like an insurance company. Be sure to dot your i’s and cross your t’s before you send out any dental claims for processing.

Here are three most of the most common ways insurance companies deny dental claims, and some ways in which you can avoid them.

Lack of information from the provider

At least 50% of dental claims for basic and major services will be placed on pending status and sent back to the dental office, which requires you to send additional information in order for the claim to be considered for payment. Most of the time the claim is sent back due to a lack of information.

Be sure to send a recent full-mouth series or periodontal charting from the last six months for claims requiring this information, such as periodontal, endodontic, orthodontic, and other basic and major services. In some cases, the insurance company will delay payment by requesting a detailed narrative with a written explanation of necessity. Always be swift and timely with any requests from the dental insurance company to facilitate claims processing.

Read full article on Dentistry iQ.