How to Appeal a Denied Dental Claim

You have finally put aside your fears and taken steps to get major dental work done. Now that you committed to and began the work, you find out that the insurance company is going to deny the claim. You need to know how to make an appeal—as soon as you get the denial.

Instructions

Difficulty: Moderately Challenging

Things You’ll Need:

• Dental insurance

1. Put the letter of denial from the insurance company in a safe place. You will refer to it often. Contact the Customer Service Department with your dental insurance plan. Be sure you have the information nearby in order to quote your policy and group numbers when you call.
2. Ask the Customer Service representative the reasons for the denial. Write these down so you can refer back to them as needed. If the reasons are simply omissions on your part, you can take care of this quickly.
3. Check the coding with the insurance company if it is not evident that it is correct. Wrong medical or dental record codes are often the only thing standing between you and the check-writing people at the dental insurance company. This is a particularly good time to ask questions in order to clear up the problems. The best way to present your side is in writing. There is no way for them to file your phone call.
4. Establish that the dental insurance company has your correct telephone number so they can stay in contact with you. They already have your address as evidenced by the letter of denial they sent you. If they send a letter, it will be within 30 days.
5. Handle a second denial of the dental claim by contacting the Reevaluation Committee of your insurance company. Also, check with the American Dental Association to see what is available on the government level of appeals in your state.

Tips & Warnings

• If you are going to have your claim denied, you will hear within 30 days.
• Make your appeal as soon as possible as there is a time limit on when you can appeal the claim (usually 180 days).