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How do I respond to a denied dental insurance claim?

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Suppose you had a dental procedure, but your insurance is not paying you for it. If that is the case you are facing, then you feel frustrated and upset. Relax, you still hold a chance to make insurance to reverse their decision. For that, listed below are a few steps that will help you in responding to the denied dental insurance claim.

Re-check your paperwork: 
Check out the summary of advantages that your insurance provider provides you in the official documents. The paperwork provided by the insurance will provide you with information about what is covered and what is not covered. These official documents will suggest to you the limitations and what is not covered by the insurance. Carefully read out what your insurance company has sent to you and why the claim you have submitted has been denied by the insurance. That letter will also tell you how to appeal for your health plan’s decision and where to get help to start the process.

Check for whom to call for answers:  
Please note that every denial is easy to fix only if you know the right person to ask for support. If you are unaware of which insurance company to call then ask your insurance company about it. Ask them why did they deny your claim is it because of missing information or it is a billing error. If you think you still want to appeal for the claim then ask the support person to tell you the process or send you the complete description of the claim.

With the above steps, write down the contact information of the information you talked with, the date, and every point that you have discussed. Make a habit of writing about every phone call. Then make a call at your doctor’s clinic. Tell the representative what you have discussed with insurance and also ask what information has asked by insurance that has been left out. Also asks them if there is an error from the clinic’s staff side, if yes they then ask them to fix it. After correcting the error ask the clinic to resend the paperwork to insurance again.

After these steps, call the HR department of your company if you are insured from your company side. Ask them about the benefits provided by them. They will help you in such a matter. Ask them if your employer could send you any paper that makes your claim valid. That would make the insurance company change their decision and pay the amount of the claim.    

Have a good understanding of the appeal process:  
Suppose your insurance provider refuses to pay the claim then filing an appeal is still your right. The laws completely allow an individual to file an appeal and that appeal needs to be reviewed by the insurer or independent third party. For filing an appeal you need to check the official website. Then read out their instruction and make a note of their timely deadline.

Avoid the same problem from repeating: There are fewer chances of claim denial if you know what is covered and what is not in your insurance policy. So check the complete summary of benefits covered by the policy or call the insurance provider before getting the treatment services. Check the rules of your insurance policy as some types of medical treatments require preauthorization. Depending upon the type of plan, check if the healthcare provider is covered in your plan or not. Your insurance provider will not pay a penny if the health care providers are not included in your health plan. It is always best to read out of all terms and policies.  

Talk to a billing specialist to know more about dental procedures and codes and how to bill them: Request a free consultation