Fighting a dental claim straight away means that the claim you or your dental service provider submitted to your dental insurance company has been rejected or denied, which means your insurer is not going to pay the claim amount you have asked for. It can be a little bothersome for both you and your dentist but there are valid reasons behind claims denial.
In this blog, you’ll get to know about the major reasons for claims denial and how you can appeal against it to get reimbursed properly.
Top Reasons for Claims Denial
First, you need to figure out why your claim was rejected in the first place. Let’s take a look at the top reasons due to which claims can be denied:
So, it becomes significantly important for you to understand the appeal process in order to fight a dental claim denial.
What’s an Appeal?
Anyone insured by a dental insurance plan has the right to appeal. You have the right to appeal a decision on a dental claim if it is not favorable. Most insurers have many stages of appeal, but you must have a compelling argument to succeed.
Though you have the right to appeal, you are unlikely to succeed in some cases, such as attempting to appeal a claim refused for a service that your plan does not cover. Consult your dentist to determine whether the therapy in issue is medically essential.
Your dental insurance provider will provide at least two levels of appeal, each with its own group of reviewers. You can appeal verbally or in writing.
“An appeal is the process of requesting your insurer to reconsider and reprocess the denied claim. Appeals are usually made when your claim is either rejected or denied or if you have received less than the required claim amount”.
Filing an Appeal