dental care

Dental Insurance Appeal Law
How to appeal your denied detal claim request

The dental insurance appeal law is what keeps people denied for their claims hoping for the just compensation that they deserve.

Although dental insurance promises a whole lot of coverage to its planholders, not every planholder is able to get the promised benefits when they need it.

Before you can make a claim from your dental insurance provider, you first have to make a claims request, and the claims process can be long since your claim will have to go through a strict evaluation procedure wherein your need for the claim will be screened and evaluated.

If, however, your claim is rejected by your dental insurance provider, the dental insurance appeal law can help protect you from unfair rejections by giving you the chance to make an appeal for that decision.

Although the claims process followed by a lengthy appeals process can be rather frustrating, if you really deserve the compensation, then you should definitely fight for your right to the monetary coverage you were initially promised.

This is, of course, a case to case basis since dental insurance providers do have their own reasons for rejecting claims.

This is why you have to know exactly how making an appeal works.

Steps to Get Compensation

  • Build your case
  • Present your case
  • Making a second appeal

1. Build your case

dental insurance appeal lawThe first step in using the dental insurance appeal law as your weapon against a rejected claims request is to build your case.

Your dental insurance provider must have sent you a letter outlining the reason why your claims request was denied.

Keep this letter and understand exactly what went wrong with your original request for a claim. Then build your case or counter argument to whatever reason led to your denied claim.

Building your case is not just about coming up with a good counter argument. You also have to find proof to support your appeal. Gather documents or information that may help convince the dental insurance provider that you do deserve the claim you are asking for.

2. Present your case

Sometimes, the results of a claims request may be affected by the way you present your case. You should follow the appeal requirements written in the dental insurance appeal law. T

he appeal should be formally made in writing, and the letter should contain the request for the appeal plus the reason why you think your case should be re-evaluated for a claim.

Make sure to send in this letter within 240 days from the day you received your claims denial letter as this is the only time window given to you by the dental insurance appeal law.

3. Making a second appeal

The dental insurance appeal law states that you have the right to make two appeals when your claims request is denied.

The second appeal, however, will already be considered as a civil case. You can file a second appeal after 60 days following your first appeal. This amount of time is called by law as a cooling off period, after which you can file another appeal.

The Results of an Appeal

The most frustrating part of making an appeal is to wait for the results.

The results should reach you within 60 days of your sending the request for an appeal. This is once again stated in the appeal law. In the event that more time is needed in considering your case, then the company should still send you a letter within 60 days to inform you that they will need an extension. Dental insurance providers can only extend the appeal review period twice or for two 60-day periods.

If it is your second appeal, you and the dental insurance company has up to a maximum of 5 years to settle the problem.

Whatever the result of your appeal may be, it should once again come to you in writing and should properly explain the real reason why your appeal was once again denied.This is just how dental insurance appeal law works, and knowing this may mean the difference between getting cheated or getting the benefits that you deserve.

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