How do I fight a denied dental claim?

Advice on How to Appeal a Denied Claim

1. Follow the appeal protocol of the insurance company that denied the claim.
2. Construct a formal letter on your letterhead.
3. Don’t skip the details on the letter.
4. Stick to the clinical facts that support the procedure.

What happens when a dental claim is denied?

What can happen if I close out a denied dental insurance claim and recreate it? Once you figure out the reason the claim is being denied, you have truly two options: You can close the claim and bill the patient. You can leave the claim open and appeal it.

What is a dental appeal?

As you know, an appeal is a request for reconsideration and reprocessing of a claim that has already been processed by the insurance company. Dental claim appeals are necessary if a claim is denied from insurance that you feel should have paid, or if a plan paid less than what you feel it should have.

Why would a dental insurance company deny a claim?

Untimely filing Failing to submit the claim on time is an easy reason for the insurance company to deny the dental claim. Most PPO plans require the claim be submitted within one year from the date of service. There are also some local union plans that have even shorter timely filing periods, such as 90 days.

How do I write a letter of appeal for a denied claim?

Your appeal letter should include these things:

1. Opening Statement. State why you are writing and what service, treatment, or therapy was denied. Include the reason for the denial.
2. Explain Your Health Condition. Outline your medical history and health problems.
3. Get a Doctor to Support You. You need a doctor’s note.

Why would a insurance claim be denied?

Insurance claims are often denied if there is a dispute as to fault or liability. Claims may also be denied if there’s evidence to show that the policyholder isn’t entirely to blame for an accident. In California, anyone who contributes to an accident can be held responsible for resulting injuries.

How do you get paid for a denied insurance claim?

To get paid you must put in time and accuracy to get results. Follow the appeal protocol of the insurance company that denied the claim. Each company has its rules for appeals. Available from their website or there is usually information on the denial EOB on the bottom of the page. Construct a formal letter on your letterhead.

Do I need an appeal for a dental claim?

Dental claim appeals are necessary if a claim is denied from insurance that you feel should have paid, or if a plan paid less than what you feel it should have. The most important thing about appeals is that they are inevitable, yet they are necessary.

When do I need to submit a dental insurance claim?

Dental claims should be submitted upon completion of the services provided. Failing to submit the claim on time is an easy excuse for the insurance company to deny the claim. Most PPO plans require that the claim to be submitted within one year from the date of service.

How can I avoid getting denied for a car accident claim?

When trying to avoid the need to make appeals, give the insurance company as much info for a claim as possible. This will cut down on denials. However, claims may still be denied due to lack of evidence. There are times when an x-ray and narrative aren’t enough.