Denied Dental Claim – How to Deal with a Denied Claim



low cost dental implantsFaced with a denied dental claim? A denial on a dental insurance claim can be a heavy blow to your well-planned budget. Since you got your dental procedure believing that your dental insurance plan will cover most of the expenses you incurred, finding out that you will have to shoulder the whole cost of the procedure can mess up your budget. Not only that, but having a denied claim means your dental insurance turns out to be useless just when you need it the most. And thinking about all the dental insurance premiums you have been paying endlessly can be even more frustrating because now, all those payments do not pay off after all.

But don’t worry about such things yet. If you have received your denied dental claim, there are some things you can do about it before you even begin panicking about your budget. You can send in an appeal to have your claim request be re-evaluated. Here’s a step by step guide on how to appeal a denied dental claim.

How to Appeal a Denied Dental Claim: Step by Step Guide


  • Examine the reasons for the denial
  • Collect data to support your appeal
  • Send in a letter of appeal

1. Examine the reasons for the denial


Before anything else, you have to understand why your original claim was denied by your insurance company. Keep the letter stating the denial securely so you can refer back to it when necessary. You will also need it when you want to appeal your denied dental claim. Read it carefully and understand the reason why your claim was denied. This will help you come up with a counter argument to support your appeal. If there is something you do not understand regarding the denied claim, you can call the customer service system of your dental insurance company. While you’re at it, inquire about the process of filing a claim appeal.

Some denied claims are only denied because there were some omissions in the information and documents you provided when you requested for a claim. If you don’t bother to examine the reason for the denied claim, you might waste the chance to receive a claim, especially if the reason for the denial is very minor and can be easily remedied.

2. Collect data to support your appeal


Once you have examined the reason behind the denied claim, you can start building a case so you can make an appeal. Some dental claims get denied because there are inaccuracies in your dental or medical records. If the reason is as such, correct the errors and send in supporting documents along with your appeal to show that you have corrected the said errors.

3. Send in a letter of appeal

Once you have a strong counter argument and sufficient documents to back it up, prepare an appeal letter stating your intention to appeal your denied dental claim and stating the reason why you should be given the claims you are asking for. State what actions you have done to correct any problems, if any.

Don’t forget to put in your contact details when you write your appeal letter. This way, your dental insurance company can easily get in touch with you regarding the said appeal. According to dental insurance appeal laws, dental insurance providers should send in a response to an appeal within 30 days upon their receipt of the appeal letter.

Facing A Second Denied Dental Claim?


If your appeal is once again responded to with a denied dental claim, you have yet another chance to fight for the just coverage of your dental expenses. Upon second denial, you can contact your dental insurance provider to get info on a re-evaluation process. The state and federal laws on dental insurance also states that the case can be turned into a civil case. The government, through the American Dental Association, offers various ways to support you using government appeal processes.

If you want to pursue a higher appeal on a denied dental claim, take note of the time limit on making an appeal so you can file your appeal within that period.