When it comes to figuring out why your dental claim was refused, understanding dental insurance billing is quite important. Knowledge is power. Here you will find comprehensive information on dental insurance billing, so read on—Dental Revu has it covered!
Just how does dental coverage function?
To cover all of your dental care costs, you can either get a medical insurance plan that includes some basic dental services or you can get dental insurance separately. Understanding dental billing services is quite important. You’ll have to pay a monthly premium on top of any co-pays, co-insurance, or deductibles associated with your plan to access medical care.
The typical dental insurance payout schedule looks like this: 100%, 80%, and 50%. This means they pay for everything associated with preventative care (including cleanings), pay 80% of the cost of more straightforward procedures, and pay 50% of the cost of more complex ones. Health insurance policies do not cover adult braces used only for cosmetic purposes, such as straightening teeth, because they are not medically necessary.
What is the procedure for billing?
Due to the fact that dental billing is much more complicated than medical billing, dentists often hire outside help from dental billing specialists. These are the ones whose job it is to read over your dentist’s notes and figure out which dental codes to use on your insurance claim forms. Once your insurance has decided how much it will pay, a dental billing specialist will send you a bill for the rest.
What Exactly Is Dental Coding?
Dental coding can be thought of as the language spoken between your dentist’s office and your insurance company. Every visit to the dentist results in a dental code, which is a series of letters and numbers that correspond to the specific service, procedure, or diagnosis you received. Experts in dental billing will use these numbers when submitting a claim to your insurance company.
These dental codes are used by your insurance company when they receive claims to evaluate the necessity of treatment. The percentage of your dental payment that will be covered by insurance will be determined by comparing the dental code to your explanation of benefits if the service is covered by your dental plan.
The challenge with dental coding is that various dentists may utilize different sets of codes. The insurance company will have a much easier time processing your claims if you use dental diagnosis codes to explain why they’re necessary. Then there are the CDT (Current Dental Terminology) codes, which represent specific dental operations like getting a crown or having your wisdom teeth out.
Why Do So Many Dentists Make Insurance Claims-Related Errors?
Billing mistakes in the dental industry are unfortunately widespread due to the following factors:
There are often abrupt shifts in the way dentists report their patients’ procedures. Similarly to the way medical practices continue to change, dental practices undergo annual updates and additions to the corresponding dental code. understanding dental insurance billing makes it easier to understand why it is imperative that your dentist is up-to-date on all dental codes to avoid dental claim denial.
Applying for Medical Insurance and Dental Care Plans. As dental care sometimes encompasses medical procedures as well, dentists need to be familiar with both the CPT and CDT coding systems and know when to file claims with medical or dental insurance. That’s a lot of wiggle room for mistakes!
Specifics Are Needed for Dental Insurance For dental insurance companies to have a clear picture of what’s going on and decide whether or not to cover a service, the dental billing system is detailed and intricate. Dental coding that shows treatments covered by your dental plan and detailed diagnoses that explain the need for costly procedures are what your insurance company is searching for. Your dental insurance claim could be wrongly denied if your dentist doesn’t utilize enough dental codes or doesn’t provide a clear explanation, or “narrative,” that completely explains the circumstance and procedure. Dental reviews confirm that the procedure is a hassle for hassle-free patients.
What Consequences Might We Foresee From Improper Dental Billing?
If your dentist’s practice submits a bill to your insurance carrier with inaccurate dental coding, your claim may be denied, and you may be ordered to pay any remaining balance out of pocket. You may receive a claim denial without knowing exactly where the mistake was made since you do not understand dental coding language or have any say in the dental billing process.
What Should You Do If Your Dental Claim is Rejected?
A dental claim denial can be devastating, especially if it leaves you with a hefty debt and you’re not sure how you’ll handle the costs. One essential point to remember is that a denied dental claim is not necessarily the end of the journey. If your insurance claim is denied, you have the right to get an explanation for the decision and to file an appeal.
What Options Do You Have If Your Dental Claim is Rejected?
If your dental claim is rejected, you can take one of several courses of action. As a first option, you can decide to engage in warfare against them personally. First, you need to contact your insurance company to find out why your claim was denied. Next, you should contact your dentist’s office to see if they can sway the insurance company’s decision. Finally, you may want to file an appeal with your insurance company to have them reconsider their original decision.
Still, if a dental coding error causes a patient’s dental claim to be denied, it might be hard for them to understand what their options are. There is little you can do if your dental practice doesn’t grasp dental code or makes a mistake without realizing it.
Because dental billing is more complicated than medical billing, dentists are more likely to make mistakes that cost them money. Because of this, it is very important to have an expert on your side during the investigation, appeal, and negotiation of your dental bill.
Dental Revu is here to help!
If your dental claim was turned down at first, you can count on the experts at Dental Revu to help you win but understanding dental insurance billing is equally important. Just takes over the conversations about your dental bills, using their deep knowledge of the dental code and billing systems.
In order to help our clients’, make educated decisions about treatment plans and insurance claims, our team of seasoned professionals works closely with dental clinics to collect accurate patient insurance information.
Our company provides claims management services in addition to insurance verification to guarantee timely and accurate claim submission. To avoid claim denials and delays in reimbursement, we work with insurance companies to fix any problems that arise. Additionally, our reporting and analysis tools give our clients a leg up on revenue cycle performance and optimization.