My Job as the Insurance Coordinator can sometimes be a little interesting/ challenging, and I’ll explain why in two words: Insurance Companies.

Insurance companies can make it difficult sometimes to get payment for dental services.   I send the service that was provided by the dentist, and most of the time, the insurance company seem to find a reason not to pay.  This can be frustrating, because the patient trusts what the dentist is diagnosing and when the Insurance Company denies a claim, stating procedure was not deemed necessary, that can sometimes cause the patient to lose confidence in us.

Some reasons why dental insurance claims are rejected

• Insurance companies say we never sent dental  x-ray along with claim for services
• For some of the major services like; crowns, core build-up, and onlays, the insurance company states there is not enough evidence supported with documents provided
• Waiting periods: This is a period of time that a policy must be in affect before benefits/coverage begins.  Some waiting periods can range from 6-12 months, this is more for major services and not routine dental care.

Some of the ways I am working on our patient’s behalf

• Post payments to their account
• Post insurance payment to patients account
• Submit claims to primary and secondary insurance with requested information such as dental x-rays, narratives, gum charting and patient diagnosis.
• Taking necessary steps to get patients claims paid when rejected
• Verify insurance coverage for patients via internet or telephone
• Follow up on overdue and rejected claims and resubmit necessary information

When insurance claims get rejected for a second time, I start the appeal process.  This step requires a much more detailed narrative from the dentist.  It then goes to a “higher” person to get the dental claim approved.

There are also patient appeal letters that I attach along with the dentist’s  narrative which explains from a patient’s stand point,” what right does the insurance company have not to pay for a service that my dentist deems necessary.”

It boggles my mind that insurance companies think that they should have so much control over what dental services should be considered necessary.  Patient’s pay the premiums and count on the services to be covered.   They are given an annual maximum amount to be covered for the year and should be allowed to use that on dental services that the dentist deems necessary.

An average annual maximum is $1500.00 and instead of letting you just use your insurance to pay until it is gone, they pay in percentages.

Here is a breakdown of the percentage categories that are the most common

• 100% coverage for Preventative; cleaning , exams, x-rays, gum screenings, oral cancer screenings
• 80% coverage for Basic; fillings, oral surgery, root canal
• 50% coverage for Major; crowns, bridges, dentures, implants

Your plans percentage is determined by what your employer has selected to offer you.

All in all I am here every day fighting for the benefits that insurance companies rightfully owe to you, our patients.

It is a busy, hectic, and sometimes frustrating job, but the reward of helping our patient’s through a confusing process is what makes my job worth it!!

Have additional questions about dental insurance claims? Don’t hesitate to Contact Us or leave a reply below and we will be happy to try and answer them for you!