How to File a Dental Insurance Claims Appeal

Whether you have been denied dental insurance claims or medical insurance claims, the appeals process is relatively similar.

Step 1: Do not pay the bill

You will not likely get the payment back. Do not pay until the issue is fixed.

Step 2: Ask for a Reason for Denial

Your insurance company is required by law to tell you why you were denied coverage. Often, you will find out the dentist simply misfiled the paperwork or other clerical error. Finding this out in the beginning will save you a lot of hassle.

Step 3: Fix Clerical Errors

If there was an administrative or clerical error, start there. Have your dentist re-file the claim. The dentist cannot seek to collect payment from you if you have requested the claim be refilled. Make sure you document, in writing, the request for a re-file to protect yourself from collections attempts.

Step 4: Rectify Other Errors

You may have found out a certain procedure was not covered by your insurance company. First, check your plan to make sure this is accurate. Next, speak with your dentist about the problem, since the dentist should have explained this to you before you elected the procedure. The dentist may have a recommendation that would get the claim covered, such as a referral or other examination.

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