Dental Insurance Denials Denting your Day?

Not again, another stone wall from a denied claim and the games begin.  Filing dental claims in today’s volatile healthcare environment can look like a Hunger Games movie as you try to figure out what to do to survive and get paid for your time and services.

Dental benefit plans are required by law to notify providers of its dispute resolution process and the procedures for obtaining forms and instructions for filing a challenge.  Failure to provide such notification is a violation of California Code of Regulations Section 1300.71.38(b).  This is usually found on the back page of the EOB or explanation of benefits related to the claim.  If the challenge has been submitted properly and the “unfair” policies persist, the complaint should be made to a relevant state agency for possible investigation and enforcement.  The Department of Insurance for the particular state is usually where this begins.  In California that site is insurance.ca.gov.

Many dental practices do not have the manpower or the time to pursue unpaid claims of a small nature, say under $200.00 and this is often referred back to the patient in the form of a statement with the denial attached.  In general consumers today want better answers and when they call the insurance company they hear that the claim was denied for the practice failure to submit the requested information the patient then calls to complain.

As a client of eAssist, your claims will be appealed until paid and if letters need to be sent in the dispute process, eAssist will do that for you.

This is what eAssist does:

1.       Contact the dental plan to make an informal inquiry into the reason for the payment decision or policy.  eAssist will call and find out why the claim was not paid or adjusted. They will file the proper documentation.  If this doesn’t solve the problem and the claim is still denied:
2.       File a formal challenge to the payment decision through the dental plan’s resolution process.
3.       File a formal complaint through the Department of Insurance per state laws.

eAssist has the manpower and the time to solve your unpaid claim issues professionally and timely.