3 Reasons Why Insurance Companies May Deny Dental Claims

The best way for insurance companies to make sure profits increase is to collect monthly premiums from their members (who are your dental patients) and then deny as many dental claims as they possibly can. These insurance companies will refer back to the literature in your patients’ insurance contracts, including exclusions, limitations, and frequency provisions. Denying payment of these claims will result in decreased payouts for you and increased profits for the insurance companies!

3 Reasons Why Insurance Companies Deny Claims

Below are 3 of the most common reasons why an insurance company would deny a dental claim, and how to best avoid these situations:

1. Lack of information from the provider – Up to half of all dental claims will be placed on ‘pending’ status and sent back to your office, requiring additional information. Because of this, make sure to send all the information the first time around.
2. Not filing on time – Claims should be submitted immediately after services have been completed. Submitting claims too late is a very easy excuse for an insurance company to deny a claim. Most plans require claims to be submitted within the year, but others stipulate a 90-day filing deadline. Err on the side of caution and send claims sooner rather than later.
3. Limitations, exclusions, and frequency provisions – Lastly, limitations such as lifetime or annual maximums ensure control over how much is paid on a dental policy. Frequency provisions keep insurance costs down by making sure that patients are only covered for certain procedures a few times a year or less. Lastly, some insurance companies will refuse to pay for certain procedures, requesting similar, less expensive procedures instead.

Insurance companies are in the business of making sure that their earnings increase and will tend to make decisions based more on making money than what’s best for the health of the patient. This is why it’s important for you to do all you can to avoid the above problems and better protect your dental patients.

For help dealing with insurance companies, please contact Dental Insurance Credentialing today!