5 simple tips to win the dental insurance claim appeals battle [Free guide]

Appealing dental insurance appeals is like a game — one that many dental professionals hate playing, but it’s necessary to collect all they’re owed. At DCS, our experts love the game, and they’ve shared their top 5 tips for winning at dental insurance claim appeals.

No one loves dealing with dental insurance, but appealing denied insurance claims is an essential part of working at an in-network dental office. What makes it both essential and hard?

As we see it, it’s essential because dental insurance claims account for around half of an in-network office’s revenue, and it’s hard because dental insurance payers will try anything to avoid reimbursing your claims. 

Dentistry IQ shares this insight: 

“One of the most common ways insurance companies ensure that their profits soar is to collect monthly premiums from their members (our patients), then deny as many claims as possible by referring to the literature in a patient’s contract, specifically the exclusions, limitations, or frequency provisions. Exercising their right to deny payment of claims based on this literature ultimately results in decreased payouts and increased profits for the insurance company.” 

So, if the dental insurance company has reimbursement policies designed to work against you — what can you do?

You can come prepared with the correct information, complete documentation, and steely confidence that you are owed for every claim. Even so, the claims appeals process is challenging and time-consuming, even for experienced insurance coordinators.

Members of your office team could be stuck on the phone with an insurance company for an hour — per claim — and unable to tackle other tasks in the meantime. That’s why we’re sharing our billing experts’ 5 tips to win dental insurance claim appeals: To help you gear up for the big game.

We’re also offering a free bonus resource: Our DCS Claim Appeal Letter Template. You’ll get the template in your inbox when you fill out the form below.

Key takeaways about appealing dental insurance claims: 

• Dental insurance assumes you won’t do the work for an appeal — shock them by doing it
• Winning appeals can be a huge improvement for your cash flow and overall revenue
• You can partner with revenue cycle management (RCM) experts who will handle appeals for you, and your team can focus on patient care and the patient experience.

Tip #1: Send the insurance company all the information on hand for the denied claim

To avoid the need for an appeal, give the insurance company as much information as possible with the initial claim submission. This will minimize the number of claim denials and appeals, and also fast-track your cash flow.

A common reason claims are denied is due to lack of evidence. There are times when an X-ray and narrative aren’t enough — X-rays can’t see what the naked eye can.

Include detailed narratives and intraoral photos with your claims to supply as much evidence as possible for why the procedure was necessary, giving payers one less reason to delay or refuse reimbursement.

Read more here: 10 reasons your dental insurance claims are being denied

Tip #2: Keep a list of appeal requirements for each insurance company

Every insurance company handles their appeals process a bit differently. This is another reason why it’s difficult for your team to follow through with appeals.

For example, some insurance companies expect an appeal to be a new claim with additional information, while some want the original Explanation of Benefits (EOB) accompanied by additional information. Some want the new claim or the original EOB, or both, sent to an address different from where initial claims are sent, and yet others only accept appeals through their web portal.

Gathering and cataloging the submission requirements for each insurance company, and also processing them in batches by insurance payer, will shorten the time needed to submit appeals.

Tip #3: Keep appeal templates ready for speedy re-submission

Due to their internal policies, insurance payers will deny or downgrade many of the same procedures, regardless of how well-documented the claim is.

To save time, have an appeal letter template ready and on deck for these particularly problematic procedures. 

For maximum efficiency, have a complete letter that only requires switching out the patient name, claim number, and other patient-specific information. You may never love filing appeals, but you’ll love how much easier it is when a template is already in place!

Read more: 4 must-have details for fast dental insurance claim reimbursement

Tip #4: Get your Yes: Don't accept No for an answer

From what we’ve seen, the majority of office teams don’t follow through on claim research and appeals; they accept every denial insurance sends them.

This is unfortunate, as most of the time, just one appeal will overturn the original decision, and benefits — or in some cases additional benefits — will be paid out right away. Also, unpaid claims push the financial responsibility onto the patient, who is rightfully expecting insurance to cover their costs.

When reviewing denials, no-pays, and your insurance aging report, if you don’t agree with the decision, appeal it and follow-up until it’s paid.

Do not let insurance companies dictate your dentistry.

Tip #5: Have your patients’ best interests in mind — and at heart

For patient retention, as well as your own professionalism and image, it’s always best to collect as much as possible from insurance and leave as much as possible in your patient’s pocket — without hurting your own. 

Patients recognize when an office or dental billing company is fighting for them and keeping their best interests at heart.

Earn their loyalty and referrals through skillful and diligent insurance claim submissions, appeals, and follow-ups.

Read more: How to have a patient-centric dental business: 3 tips (Free guide)

⭐️ Bonus Tip: The easiest way to win dental insurance claim appeals

These 5 tips are great tools for winning insurance claim appeals, but while they’ll help you process appeals faster, they won’t eliminate the time and effort it takes to contact the insurance company and actually get it done.

This time spent on insurance claim appeals takes your team away from your core source of revenue: Your patients.

Our bonus tip to you: Let our RCM experts manage your insurance claim submissions and appeals, so your team can focus on what they do best — caring for your patients and running the dental office. 

When you have experts handling claims, you’ll know they’re being submitted accurately the first time and appealed quickly. Our RCM experts at DCS, for example, know all the best practices and strategies for insurance claims appeals, including specific strategies for each insurance company. They can even appeal multiple claims in a single phone call! 

We have over 100 employees who specialize in dental insurance, and we call this crew of experts the DCS Knowledge Network. If your designated RCM expert has questions about an appeal, there is a massive pool of colleagues they can turn to for answers.

With a designated expert and the entire DCS Knowledge Network on your team, it’s a lot easier to win the game — your claims will be appealed, and your practice will get paid promptly. 

Make it easy: Use our DCS Claim Appeal Letter Template to help you return appeals quickly and accurately

Our DCS Claim Appeal Letter Template is a dental insurance claim appeal letter that gives you a head start on an effective claim appeal. We’ve set up the structure, all you’ll have to do is fill in the blanks with the information for a specific claim.

The DCS Claim Appeal Letter Template as a downloadable PDF that will land in your inbox within just a few minutes when you fill out the form below.

Make it even easier: Let the experts at DCS submit dental insurance claim appeals for you

To recap, here are our RCM experts’ top 5 tips to win dental insurance claim appeals: 

• Tip #1: Send the insurance company all the information on hand for the denied claim
• Tip #2: Keep a list of appeal requirements for each insurance company
• Tip #3: Keep appeal templates ready for speedy re-submission
• Tip #4: Get your Yes: Don't accept No for an answer
• Tip #5: Have your patients’ best interests in mind — and at heart

You can also download our DCS Claim Appeal Letter Template to make your insurance claim appeal process as seamless as possible — or, you can take an even easier route…

Turn to the experts at DCS to manage your insurance claims, and your team will spend their time growing your practice and building relationships with patients, instead of on the phone with insurance companies playing the appeals game.

Take back control of your insurance claims revenue when you partner with DCS: Book a free 30-minute call today.