By: Yara Zakharia, Esq.
With the ever-increasing cost of dental procedures such as root canals, crowns and bridges, more and more Americans are taking out dental insurance policies. While it is plain for them to see that this decision will benefit their pocketbook, the procedure for filing a dental insurance claim remains a mystery to a good number of them. Since federal and state insurance laws require that dental insurance claims be filed accurately in order to prevent fraud, consumers should follow the standardized steps below that will facilitate the task and enable them to comply with the regulations:
At a patients’ first appointment, he or she furnishes a copy of and signs his/her dental insurance claim form which is kept on file. In the information section of the form, the policyholder must fill in the following information:
1. Presentation of the dental insurance claim form: A dental insurance form is submitted in two instances: 1) to request payment for services rendered or 2) to file for pre-authorization of services to be performed.An insurance agent will usually accept the ADA's (American Dental Association) boilerplate dental insurance claim form.
- Full name and address
- Social security number
- The name and date of birth of the patient receiving the dental services
- The group name and the group number
2. Attachment of supporting documentation: The policyholder should substantiate his/her dental insurance claim expenses by attaching itemized bills and receipts, which contain the following information:
Member identification number
Provider's name and address
Dates that dental care or treatment was provided
Member identification number
Dates that services or treatments were received
Tooth surface(s) and tooth number(s), arch, quadrant
ADA procedure codes
Description of each treatment
Charge for each service
3. Enclosure of a copy of the EOB (explanation of benefits)
4. Signing and dating of the dental insurance form by the insured
5. Making a copy of the dental insurance form and documentation
6. Submission by the dentist of the claim form and processing: After providing the treatment and performing the services, the dentist mails the dental insurance claim to or electronically files it with the insurance company for payment. Electronically-filed dental insurance claims have several advantages over hand-processed claims: They augment cash flow, reduce processing time, and enhance efficiency. They also eliminate the need for storage and paperwork.
Electronically-filed claims are sent to a clearinghouse that forwards the data to a specific insurance company or directly to a claim processing system by way of the internet. This enables the insurance agent to receive the dental insurance claim the same day and speeds up processing and payment. A direct deposit is made into the insurance carrier's bank account, a process that avoids the need to process and mail out paper checks. The insurance carrier then receives proof that the funds have been transferred and payment of the dental insurance claim has been effectuated.
The insured should leave adequate time to file the dental insurance claim. This will ensure that the policyholder does not miss the deadline and, that in the event that he/she files erroneous information, he/she has sufficient time to re-file.
Dental insurance is a valuable health resource to patients in general. Properly filing a dental insurance claim by following a few methodical steps will ensure that the policyholder has one less headache to worry about: finances.