Know your dental facts before making decisions

Filing An Insurance Appeal For Dental Health Services Payment

Dental health services may sometimes reject your insurance claim. Here's how to go about filing an appeal.



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So you’re already ahead of the curve having dental health insurance, but then the worst strikes and a claim that should have been paid was not for whatever reason, what do you do? The only alternative to you is to figure out what went wrong, and appeal the decision. But you have a limited amount of time with which to act, so it’s really important that you know the proper channels, and what you can do to file sooner rather than later, to get that claim paid.

Basically there’s a routine that you want to follow, so that you can be sure that you’re able to look at the right things to get the claim taken care of as soon as possible. Insurance filing processes are notoriously complicated and can be a major pain in the neck if you don’t know what you’re doing. That’s why you want to follow these principles to clear the air without having to know too much actual technical knowledge. When you have enough of a grasp on everything concerning what you can and should do to get the claim appealed, you’ll be well on your way to a satisfactory resolution.

1) For starters, really read and then keep the denial letter in a safe place.

You first want to be sure that you’re well read in everything the denial letter had to say, so that you have an idea of why the claim was denied and exactly what happened. Without this knowledge, you’re going to be lost throughout the investigating process, so you have to know what you’re talking about. Moreover, you also want to keep the letter in an extremely safe place. If you’re not able to do so, what you’re going to find is that you can end up losing an appeal just because you don’t have a copy of your denial letter and you can’t acquire a new one fast enough, which you don’t want to happen.

2) Contact your insurance rep.

This is one of the best chances that you’ll have so that you can be sure that you’re able to get an answer to what exactly happened. Plus in many scenarios, and most in fact, you’re able to resolve the problem pretty quickly as they can catch if anything went wrong for you, and immediately point you in the right direction for appealing and then resolving the claim altogether.

3) Check the medical bill coding with your actual dental bill, against the insurance denial letter.

Utilizing the wrong type of record code is actually one of the number one causes of insurance denial, because it’s something that can happen pretty easily. This is something that can literally happen when just one digit is off, and that can be a massive problem. By looking into the dental health services provided by your dentist, you’re able to better assess anything that could have been a red flag on the bill for whatever reason, to better understand why the claim was denied.

4) Sometimes claims can accidentally be denied again.

If you’ve followed the advice of your customer service rep to the letter, and you’ve looked at the bill to see there’s no reason the claim should have been denied yourself, then it’s time to call the Reevaluation Committee. You want to do this quickly, as your time to keep appealing generally runs out pretty quick, and then you can be left with no way out. Ensuring you’re able to contact the RC as quickly as possible, you give yourself the best chance for resolving this and finding out a real reason as to why the claim was actually denied if falsely.

5) Have patience.

While dealing with insurance especially over dental health services bills can be really difficult and emotionally trying, it’s something you have to take with a grain of salt. The arrangement of insurance companies is not designed to deny claims, but rather to prevent fraud which unfortunately dominates the industry these days. Because of those techniques, legitimate claims slip through the cracks and are then denied. Understand this, and be patient because it’s really nobody’s fault, and if your insurance covers the dental health services you had performed, they will be paid in time.

 

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