A lot of people purchase dental insurance to receive time-to-time dental treatment. However, many of them are unaware of the process to claim dental insurance. Generally, dental service providers submit claims to dental insurance companies on behalf of their patients. And a dental insurance company pays a claim as per the patient’s insurance plan. Patients should be aware of the claim process to understand what payments they are liable for.
From the moment a patient is enrolled for dental treatment until the final payments are made, dental claims processing goes through multiple steps. Dental insurance claims can be made both on paper and online. The article will explain the step-by-step process of claiming dental insurance.
Procedure to claim dental insurance
Filing of claim: The first stage is to file a claim to the dental insurance company. After you’ve given your dentist all of the information he or she needs about your dental insurance, the practice may handle filing the claim for you.
Your dentist might file a claim using either traditional mail or an electronic filing system. Many dentists prefer the electronic option since it is more convenient and efficient, however, the kind of submission you choose may be determined by your insurance provider’s criteria.
Along with the claim form, you may be required to provide copies of your x-rays and other documentation. If you have services such as a crown, bridge, or implant, your dentist may be obliged to provide the insurance company – x-rays.
Adjudication: This is the process of verifying the accuracy of the details submitted in a claim. A professional claims processor examines the claim to check its accuracy and compares it to the insurance policy to know whether the services provided are covered by the insurance policy.
If the services are covered, the insurance company will pay the claim as per the coverages available. Depending on your plan, the insurance company may pay the whole claim in full; or you will be liable to pay the remaining amount after your insurer pays for the services you received.
EOB: Explanation of Benefits or EOBs aren’t the same as dental claims. It has all the details related to the services rendered, how much your dental insurance plan has covered, how much your provider has paid, and the remaining balance (if any) that you would need to pay. You need to verify all the details mentioned in the EOB carefully. You can even ask your dentist to understand it.
Settling the claim: If applicable, a final bill will be given to the patient for payment. Before settling the claim, the patient should examine the EOB and final bill to confirm that everything is proper. A mismatched process code or other clerical error might cause balances to misalign. Claims can be modified and corrected without incurring any penalties.
Dental service providers need to coordinate the benefits if a patient is covered by more than one insurance plan. The primary carrier will be one insurance firm, and benefits from that plan will be paid first. The secondary carrier will then calculate the benefits that will be paid toward the outstanding debt. The coordination of benefits will lengthen the time it takes to process a claim.