5 Tips to Win Dental Health Insurance Appeals

Tip 1: Give the health insurance company all the information you have for a specific medical claim

When trying to avoid the need to make medical appeals, give the health insurance company as much information for a medical claim as possible. This will cut down on denials.

However, medical claims may still be denied due to lack of evidence. There are times when an x-ray and narrative aren’t enough. X-rays can’t see what the naked eyes can. Use detailed narratives and intraoral photos to give as much evidence as possible as to why the procedure was necessary.

Tip 2: Having a list of appeal information for each health insurance company

Every health insurance company is a bit different regarding their appeals process. This, of course, is another way to make appeals more difficult and for offices not to follow through with the process.

For example, some health insurance companies want a new medical claim with additional information. Some want the original Explanation of Benefits (EOB) accompanied with additional information. Some want the new medical claim and/or original EOB sent to a different address than where initial medical claims are sent.

Some want them sent directly through their web portal.

Gathering this information for each health insurance company and cataloging it will shorten the time needed to submit each appeal.

Tip 3: Having an appeal template ready for submission

Many of the same procedures are denied or downgraded. Have an appeal template for each type of procedure ready and on deck to save time and be efficient. Switching out a patient’s name and medical claim number and providing additional information specific to that patient is easy if your template is already in place.

Tip 4: Don’t accept “no” for an answer

The majority of offices don’t follow through on medical claim research and will accept from health insurance what they are given. Most of the time, the first appeal will overturn the original decision and benefits or in some cases additional benefits will be paid out.

When working through denials, saying “no” pays big dividends, and your health insurance aging report, if you don’t agree with the decision, appeal it!

Do not let health insurance companies dictate your dentistry.

Tip 5: Make sure you have your patients’ best interests at heart

For patient retention, professionalism and image, it’s always best to collect as much as possible from health insurance and leave as much as possible in your patient’s pocket without hurting your own. Patients recognize when an office or dental billing company is fighting for them and keeping their best interests at heart.

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