How to Dispute a Charge from Your Dental Insurance

How to Dispute a Charge from Your Dental Insurance


How to Dispute a Charge from Your Dental Insurance. If your dental insurance provider refuses
to pay a claim, you have the option of disputing the decision. Here’s how. You will need Paperwork and a statement of
benefits Appeal Internet access Decision External appeal Correspondence (optional) and phone
conversation notes (optional). Step 1. Review your paperwork and carefully examine
your statement of benefits. Step 2. Contact your insurance company’s customer
or member services department for help resolving the issue, or for a clarification of your
benefits. Keep copies of all correspondence and relevant
documents, as well as detailed notes from any phone conversations. Step 3. Familiarize yourself with your insurance company’s
requirements for filing a first-step appeal, also known as a grievance, if the member services
representative does not provide a satisfactory resolution to your issue. Step 4. Write an appeal letter to your insurance company. If the dispute is over a “usual and customary”
or out-of-network denial, address the methodologies used to calculate usual and customary fees,
and any extenuating circumstances that would justify a higher payment. Consider purchasing an appeal letter if you
are not comfortable writing your own. Some websites offer health insurance appeal
letters for a fee. Step 5. Wait for a decision from the insurance company. If your appeal is denied, you may have the
option of further appeals. Check your benefits statement. Step 6. Apply for an external appeal once all of your
internal appeals are exhausted. You may be able to request an independent
review of your dispute from your state’s insurance commissioner — note that rules vary from
state to state. Keep trying until your options are exhausted
— or until your insurance agrees to cover the charge. Did you know Dental insurance had its beginnings
in the 1970s.

Author: Kevin Mason

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