3 Simple Ways Insurance Companies Deny Claims (And How to Avoid Them) | Dental City Blog

We’re pretty sure there are few things in life less enjoyable than dealing with the mysterious world that is insurance companies. With regulations and red tape galore, even submitting the simplest claim for your patients can lead to headaches and—even worse—denied payment for the claim.

After all, insurance companies are for profit businesses. This means that following proper procedures and being diligent any time a claim is submitted is essential to getting the maximum payment for your practice and patients.

While there are any number of ways insurance companies deny dental claims submitted to them, we’re breaking down three of the most common and including helpful tips on how to avoid them.

  1. Lack Of Required or Incorrect Information
    When submitting a claim it’s imperative that you submit correct and required information. If the insurance company receives a claim without either it will be sent back with “approval pending” until the needed information is provided. To avoid returned claims do your due diligence before sending it in to ensure you have included everything necessary to the best of your knowledge. And if you do receive a claim back follow up with the additional support material as soon as possible to keep the process moving along.
  2. Missing the Filing Deadline
    Most dental practices are pretty efficient at filing claims and do so as soon as they can after an appointment is completed. But it’s inevitable that one or two claims may slip through the cracks and end up not getting submitted for months or even longer after the initial service. This is one of the easiest ways for insurance companies to deny claims. Most have a required filing period (typically a year but for certain insurance groups as low as 90 days) and if a claim is submitted outside the period it can be immediately denied. Make sure you have at least one person in charge of ensuring your claims are filed in a timely manner to avoid this issue all together.
  3. Fine Print (Limitations and Exclusions)
    When and how your claims are processed and payments received is often out of your practice’s control (even when you file everything correctly). The details of a particular patient’s insurance plan will typically have certain measures in place to minimize what the insurance company pays out. For example, insurance plans can limit the number of procedures they’ll reimburse a patient and practice for in a given year. Or they can down-code procedures if they think a simpler alternative to what your practice provided could have been sufficient, resulting in a lower reimbursement than expected. To help avoid this as much as possible request a breakdown of benefits before performing a procedure so you have as much knowledge as possible. This will make your patient’s and your life much easier come time to follow a claim.

The mysteries of dental insurance are seemingly never ending, but picking up a few strategies along the way can help you and your patients get the reimbursement you deserve. Understanding these three common causes of claim denial can help your practice stay ahead of the insurance game and be positive advocates for your patients.