How Are Dental Claims Handled?

Have you ever wondered about how your dental claims are handled after you receive treatment and you have insurance? Below is a quick summary of what your dentist does to ensure proper payment for any procedures that you have undergone, along with a few tips on how to submit a dental claim yourself whenever that’s necessary.

Step 1: Submitting a Claim

After you give your dentist all of the information that he or she needs regarding your dental insurance, the office might take care of submitting the claim on your behalf. Your dentist could submit a claim through regular snail mail or through an electronic filing process. A lot of dentists will choose the electronic option because it’s easier and more efficient, but the type of submission may depend upon your insurance provider’s requirements.

Sometimes copies of your x-rays and other documents will also need to be submitted along with the claim form. For example, if you had a restorative treatment, such as a procedure that involved a crown, a bridge, or an implant, your dentist might be required to show the insurance provider some x-rays.

Keep in mind that your dentist might estimate what your out-of-pocket costs will be before submitting the dental claim. So you may need to pay a portion of the bill up front and then let your insurance cover the rest. Your dentist will reimburse you if you end up overpaying, or he or she will come back to you and ask for another payment if the estimate was incorrect and you owe more.

Step 2: Waiting for Payment

After a claim has been properly submitted, your dental insurance provider will check it to make sure the treatments that you received are covered under your plan. As long as the claim is approved by the insurance company, they will submit the appropriate payment to your dentist for the services that you received. But if you paid the bill up front, the insurance provider will reimburse you instead.

Things could get a bit complicated if a claim is submitted and your insurance provider doesn’t cover part or all of the services within the claim. In this case, your dentist will likely contact you to receive an out-of-pocket payment directly from you. Or you might be contacted by your insurance provider regarding any payment that you’re required to make to your dentist because they don’t cover the full cost of treatment.

Knowing When You Need to Submit a Claim

Your insurance provider might prefer receiving a claim that has been submitted by you, the patient. So rather than your dentist submitting the claim, you may need to pay your dentist upfront and then submit a claim for reimbursement. Some insurance providers might require this step when you visit a dentist who isn’t in-network, as an example. Once the claim has been reviewed and approved, you’ll receive the payment directly from your insurance provider, whether they owe you the full payment or they’re only required to cover a portion of what you paid for the treatments you received.

Often, when you submit a claim yourself, you’ll be required to include information like your contact info, your dental insurance policy number, the date of service, information on your dentist, a description of the services and diagnoses you received, and the itemized costs of the treatments that you were billed for. You may also be required to submit receipts, x-rays, and other information. Basically, everything that your dentist would otherwise do on your behalf, you have to do yourself. But it’s a lot easier than it might seem at first, so don’t worry!

Choosing the Right Plan and Dentist Is Key

Before signing up with any dental insurance company, it’s best to read through a plan’s details carefully. This way, you’ll know if you’re required to submit your insurance claims or if your dentist will be able to do so for you. On top of that, you will know if you are required to pay upfront and then be reimbursed, or if the payment will be submitted directly to your dentist.

In addition to knowing what’s covered and what isn’t covered by your insurance plan, it’s also a great idea to find out if there are any limits on the amount of treatment that you can receive or if there is a waiting period. This information will help you avoid those dreaded declined dental claims. For example, with a Spirit dental plan, there aren’t any waiting periods, you could receive up to three cleanings annually, and you could receive coverage for major services.

A Quick Recap

When it comes to dental claims and how they are handled, it’s pretty straightforward. To sum it all up:

1. You or your dentist will fill out the required claim form and submit all necessary attachments, such as x-rays.
   
   
2. Your claim will be reviewed to verify that all of the necessary information is there. If any information is missing, you or your dentist will be notified. The insurance provider will also make sure that you’re eligible for coverage for the services received, and they’ll check on whether your dentist is in-network or out-of-network.  
   
   
3. Once approved, your claim will typically be processed within a few days and payments will be submitted to you or your dentist. Done and done!

Sources:

• http://www.apexedi.com/dental-claims/things-you-should-know-about-submitting-dental-claims/
• http://www.bcbsm.com/index/health-insurance-help/faqs/topics/claims/claims-faq/submit-a-claim.html
• https://www.deltadentalins.com/individuals/guidance/reimbursement.html
• http://www.affiliateddentists.com/info/dental-insurance-claims-handled/
• http://deltadentalwiblog.com/dental-claims-handled/