You’ve put aside your apprehension, and gotten your dental work taken care of. Now, you find out that your insurance company is refusing to pay for it. You need to know how to make an appeal, and this article will give you the easy-to-follow steps. Generally, it’s recommended to file your appeal as soon as possible after you get the denial of coverage letter.
Make sure you save the letter of denial, put it somewhere safe, because you will need to refer to it later. Contact the insurance company’s customer service department. Be prepared, because you’ll need to provide the representative with your policy and group numbers, as well as some other information.
Ask the customer service agent why the claim was denied. Write down the reason or reasons you’re given. If the claim was denied due to a clerical error on your part, usually you can correct it quickly, and sometimes it can even be done over the phone.
Check the coding to make sure it’s accurate. Incorrect medical or dental coding is a big reason why claims are denied. It’s silly to have a simple number standing between you and your reimbursement check. Now is the time to ask questions. If necessary, present your side of the story in writing because the insurance company really has no way to document phone contact.
Ensure that your information is up to date. Make certain that the insurance company has your correct telephone number so they can reach you with any concerns or questions. They should already have your address, and if they need to send you another letter, you should get it within thirty days.
If these steps don’t result in the approval of your claim, contact your insurance company’s reevaluation committee. If that doesn’t work, you can go to the ADA to see what steps you need to take in order to file a state-level appeal.
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