dental care

Denied Dental Claim
What You Need to Find Out about A Denied Dental Claim

A denied dental claim can be a tough decision to face.

After all, you may have been relying on that dental claim in order to recover from a heavy blow on your finances courtesy of your dental problems.

Since you’ve already spent the money to pay for the dental care service you availed of, you can’t get it back any other way but to receive your claim from your dental insurance company. Without that claim, you are also forced to deal with your dental expenses on your own.

So if you’ve just received a disappointing letter informing you about a denied dental claim request, you should set to work immediately in order to make an appeal.

By law, you are still entitled to one chance to make an appeal so that your claim will be evaluated again.

But making an appeal is not as easy as you think. Since you’ve already been disapproved once, you should definitely try to be more convincing with your case.

In order to do this, you have to know some things first.

Key Info That Can Help You Appeal A Denied Claim

  • Why were you denied?
  • What other support do you need?
  • Send in a letter of appeal

1. Why were you denied?

denied dental claimThe first thing you have to know is why your dental claim was denied in the first place.

Your dental insurance company will inform you about the denied claim through a letter. Make sure not to misplace this letter as it will be your only point of reference as to the real reason why your claim was denied.

Examine the reasons stated in the letter since these will be the one to lead you to the right solution to your problem.

For example, if you failed to present some information pertinent to making your claim, then you can easily remedy the situation by presenting the missing information. If you don’t know the reason and it is not clearly explained, you should contact your dental insurance provider for more details.

2. What other support do you need?

Whatever that reason may be, you have to come up with an argument as to why you should still be given your claim. Be prepared to present documents or records that will prove your argument.

A lot of denied dental claim instances are related to incomplete documents or inaccurate information in the said documents. Sometimes, the reason may send you looking for missing information, so be prepared to spend time looking for what your dental insurance company needs in making a decision.

3. Does dental claims processing services work?

Some individuals and organizations have started offering dental claims processing services for a fee. These service providers act as the main liaison between you and the dental insurance company.

The dental claims processing service begins with reviewing the claim and the consumer’s policy, evaluating the result of the claim, investigating the real reason for the denied dental claim, and helping the consumer make an appeal and try again.

Although these services are not exactly necessary, your need for it may depend on how complicated your situation is.

These denied claim consultants are experts in what they do so they can speed up the process and increase your chances of getting approved. But if the reason for your denial is very minor, then you don’t need to spend money on dental claims processing services anymore.

How to Avoid a Dental Claim

The best way around a denied dental claim is to avoid it in the first place. The first thing to remember is that you can’t make a successful claim if the policy you paid for does not cover the dental service you availed of.

Make sure that your policy unquestionably states that it will cover the specific dental procedure that you had done. Some people are not sure about the exclusions of their plans and end up with the wrong expectations.

Aside from that, in making your first dental claim, make sure to meet all requirements of the dental insurance company in making claims. Make sure to follow all claims instructions to the letter. If you don’t follow the instructions carefully, the more likely it is that you’ll end up with a denied dental claim.


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