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How To Properly Appeal Dental Insurance Denials?

Dental Insurance denials are very common in the medical billing process. For the health service provider, it becomes so frustrating and they try their best to avoid denial rate as much as possible. nnSimilarly, the dental service provider faces equivalent kinds of issues. In some cases, the insurance company decided to deny the coverage to the patient. nnAt that point, the dental care handled this situation in a different manner by submitting an appeal. But first, we need to have a quick look at the reasons behind the dental denial rates.n

Top Reasons Behind the Dental Insurance Denials

nGetting a full reimbursement for the services you rendered is sometimes very frustrating but if we know the exact reason behind the lower reimbursement rate then we can better manage our revenue cycle management. nnThere might be many reasons behind the insurance denial rates but if we closely observe in the perspective of dental denial then there are various other reasons behind it. nnIn this article, we will try to explain some of the main reasons behind the denials in dental insurance.n

Eligibility Issue

nFor any dental service provider, the verification eligibility of the patient for the insurance should be the topmost priority. In many cases, patients are not aware of the insurance coverage of their plans and they might take the services and treatment that might not be part of their insurance coverage.nnOn the other hand, the insurance regulation plans are not constant throughout the year. So when a patient came for the services you need to take the essential documentation on the first interaction. nnYour front desk staff can note the following information carefully the patient’s name a brief detail of his primary insurance, social security number, insurance carrier details, identification number, etc. It will help you to verify all the necessary details first hand and it will also minimize the chances of error later.n

Root Planning or Periodontal Scaling Coverage

nIn Dental Practices, Root Planning and Periodontal scaling are supposed to get higher denial rates compared to any other treatments. For insurance purposes, they required a special documentation list that includes some clinical indicators and evidence.nnThe periodontal chart required a pocket depth and full mouth radiographs and digital images.nnThis documentation should be embedded with the patient record first hand.nnOn the other side, the correct use of CPT and CDT codes is also essential in this stage. Many a time Insurance companies fail to present guidelines for the relevant purpose and codes.nnIn SRP claims you can make your case even stronger by giving them additional documentation of periodontal charting description of the procedures that are used during the treatment and some radiographic evidence of bone loss.n

Core Build-up Procedure

nThe core build-up procedure is applied to maintain the crown retention in the internal anatomy of the tooth. The purpose of this procedure is to completely replace the missing tooth structure and make a proper symmetry to protect the integrity of the tooth. Usually, this procedure is denied with the statement of no benefits or low benefits.nnThere are multiple complexities in this procedure like when the dentist conducts this treatment then they have to further remove the irregularity and all the existing filling from the tooth and use the material to fill these irregularities.  nnThis procedure is pretty much similar to the D2950 build-up. It is the same procedure but for different purposes so it might create some mess.nnLet it be very clear with your patient about the lack of benefit in doing this procedure. Use radiographic evidence to get reimbursement from the insurance company while performing this kind of treatment.n

How To Deal With Dental Insurance Denials?

nDental insurance denials can be managed in various ways. Here are some of the ways in which you can minimize your insurance denials. n

Prepare an Appeal Letter

nAn appeal letter is an essential step for getting reimbursement for your dental services from the insurance payer. In this letter you need to fulfill all the essential details required by the insurance provider this information consists of;n


  • Complete details of the patient like his name, policy number, contact information, and information about the policyholder.
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  • In this letter, you should also mention the complete details about the denial rate.
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  • Like you have to mention that what was the reason behind the denials, the date of the denial and also specified some main reason which leads to this.
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  • Lastly, mention the details of the dentist who performed the whole treatment for the patient.
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nThe purpose of this detailed appeal letter is to tell the insurance company to have a look at the case as soon as possible and your practice is strongly eligible for reimbursement.n

Make a Template of Appeal Letter

nFor your convenience, you can also prepare a template appeal letter in case you are filling multiple appeal letters. In this template, you can add a similar process and treatment and you just need to switch the name and claim number and relevant information associated with each patient. nnThis template will eventually not only save you time but also increase the efficiency and productivity of your practice.n

Proper Coding 

nTo get a maximum reimbursement the proper coding is an essential part to be done.nnMake sure that your practice has a team of professional coding experts who are aware of the proper CPT coding or dental terminologies coding CDT by the American dental association.nnNow you are pretty much aware of how you can effectively make an appeal for your dental insurance claims and what is the real reason behind the increasing denial rates and how you can manage it by following steps like appropriate coding practices, understanding the agreement of different insurance companies creating awareness about lack of benefits among the patient and preparing proper documentation of all the required procedures. To avoid hassles you can also take assistance from a medical billing service provider.nnMed-Miles is one of the most prominent names in medical billing services. We have been serving our clients for more than 8 years and our professional team is pretty much aware of the challenges dental health service providers face. We have the best billing solution for your practice call us at 8885 989 181 for the services.

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