How to File a Dental Insurance Claim

Know Before You Go

Whenever you sign up for dental coverage, you’re often given a big folder explaining the insurance policy and benefits. That’s fine if you love required reading and have lots of time to spare. If you don’t, try calling your insurance company’s customer service department and asking a few vital questions that can help you understand the process before you even walk inside your dentist’s office. This includes:

• Are routine dental checkups covered under my plan? Does a dentist have to be in-network for the care to be covered?
• Are there any special procedures not covered? How much money do I have to pay out-of-pocket before my insurance kicks in?
• Do I have any pre-existing notes on my insurance information that won’t be paid? How long will these conditions be listed on my insurance?
• When I go to the dentist, what do I need to receive in order to get my insurance claim filed?
• Do you accept e-claims or must paper claims be submitted only?
• How long does it take to reach a decision or payment on claims?
• What is your policy on claim appeals?

Start With the Forms

Insurance companies are all about dental forms — it gives them a standardized method to review and fulfill claims. Before you head to your dentist’s appointment, visit your dental insurance company’s web site and look for any relevant paperwork that may have to do with your dentist’s visit, such as a checkup or filling. Print out the paperwork and take it to the dentist’s office with you. This way you won’t miss any information and have to make a return trip or call to your dentist’s office.

Get All the Info at the Office

Unless your insurance company specifies otherwise, most insurance claims require a few items of common information. This includes your insurance policy group and number, the date of services rendered, what type of service was provided and an explanation of the service. For example, if your dentist performed a filling, you may specify the location of the filling, materials used, etc. You can ask these questions in your dentist’s office to determine so you can start filling out forms as you are in your dentist’s office. Don’t forget a receipt for charges since that’s how the insurance company will know what to pay.

Remember many insurance companies offer electronic filings on statements. You’ll still need to collect the information at your dentist’s office, but you can then type it out online and hit “send” at the click of a button.

Send It Off

Put your claim in an envelope, attach a stamp and send that claim off in the mail to the appropriate address. Since many insurance organizations have different departments, you may wish to call to ensure your information was sent to the appropriate dental division.

Check In

Your dental company gets lots of insurance claims in the mail each day, but that doesn’t mean yours isn’t important. About a week after you send in your insurance claim, give the company a call to confirm they have received the claim. The company may not have made a decision just yet, but they likely can tell you if the claim has been received.

Follow Up — and Get Paid

If you haven’t heard a verdict on your claim yet, it’s okay to follow up with your insurance company as to the status. Some states have laws related to how fast a claim decision must be made. For example, California requires an insurance company acknowledge your claim within 15 days and accept or deny the claim within 40 days. Every state is different, so it’s a good idea to find out your rights to determine when you can expect a response.