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Why Certain Insurance Companies Deny Claims

Healthcare claimsInsurance companies make sure that their profits increase by collecting monthly premiums from their members (who happen to be your dental patients) and then they deny as many claims as they can. Denying payment of these claims results in decreased payouts, which means increased profits for the insurance company.

Excuses for Denying Dental Claims

Below are a few of the most common excuses for denying dental claims and how to avoid these situations:

  • Lack of information – Around half of dental claims will be put on ‘pending’ status and sent back to your office, citing a lack of information. Because of this, it’s important that you send all the relevant information the first time around. This includes periodontal, endodontic, orthodontic, and any other minor or major services.
  • Not filing on time – We recommend that claims should be submitted immediately upon completion of services. Submitting claims too late is a very convenient excuse for insurance companies to deny the claim. Different insurance companies have different deadlines, but always err on the side of caution and send your claims as quickly as possible.
  • Exclusions, limitations, frequencies – All dental plans are different, and each has limitations, exclusions, and frequency cutoffs. Limitations include annual or lifetime maximums, frequencies make sure that patients are only covered for certain procedures a few times a year, and exclusions mean that certain procedures are excluded altogether. Instead, the insurance company will cover similar, but less expensive procedures instead.

Here at Pro Dental Designs, we know that insurance companies are in the business of making sure that they have higher profits and increased quarterly earnings. Insurance companies are more interested in making money than what may be best for your patients. This is why it’s important for you to anticipate the above excuses, so you can better protect your patients.

Posted on Jun 4, 2019
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