How Insurance Denial impact Dental Practices

Insurance Verification is the initial step in the dental billing process. It holds the key to the billing process, as dentists will only receive reimbursement if they verify the insurance coverage properly. Any shortcomings in the verification process will result in a denied claim. The facility is then left with only one option: to appeal the denial. According to data from a large insurance company, about 8% of claims are denied and are followed by the appeal process. However, with insurance denial being the most fundamental, reimbursement upon appeal is seldom received. Therefore, you need to be accurate in the first place. This article will discuss the reasons for insurance denial and its impacts on a dental facility.

Reasons for Insurance Denial in Dental Practices

As insurance involves many technicalities, it can be denied due to various reasons. Some of these might even be unheard of for seasoned dental practices. These are as follows

• Missing or Incomplete Information:
• Non-Covered Services
• Preauthorization Requirements
• Coding Errors
• Timely Filing Limitations
• Policy Changes
• Duplicate Claims
• Benefit Exhaustion
• Coordination of Benefits (COB) Issues
• Policy Exclusions

Impacts of Insurance Denials on Dental Practices

In this section we will discuss the repercussion of insurance denials on a dental practice

Financial Loss

Insurance denials can significantly impact a dental practice's financial health. When an insurance provider refuses to pay the coverage sum for services rendered to a patient, the practice can face a severe financial strain. This is where the crucial role of insurance verification specialists comes in. They ensure you receive the expected income from insurance reimbursements, preventing potential economic crises. To illustrate, consider a hypothetical scenario where a patient presents with a missing tooth. An insurance verification specialist, well-versed in the implications of missing tooth clauses, would handle this situation effectively.
Conversely, a dentist's limited insurance knowledge can lead to unfavorable outcomes. They might proceed with a procedure despite a binding clause, resulting in a denial. This directly leads to a loss of money and can incur additional costs for the dental practice in terms of filing appeals. Such situations can impede the growth and sustainability of a dental facility, highlighting the necessity of insurance verification specialists.

Increased Administrative Burden

The hiked administrative burden due to insurance claim denials is another challenge for dental practices, especially when the subject service is as specialized as a root canal. When a claim for a root canal is denied, it triggers a cascade of additional tasks. Staff must invest time and effort into re-submitting the claim, providing supplementary documentation to support its validity, and potentially appealing the decision. All these procedures necessitates focus as claims submitted for expensive procedures such as root canal without coverage may be seen as potential malpractice by the payer. Not hiring dental insurance verification specialists and leaving the tedious task to your frontdesk staff will only tamper with the efficiency of a practice. The unnecessary administrative burden on your staff will only drain your resources out as they will not be able to give their best in their areas of expertise.

Patient Dissatisfaction

A person who is already suffering from a deteriorated health, when they find out that their claim is denied that was meant to be covered, frustration often ensues. The dissatisfaction can greatly impact patient retention and reduce their trust in a provider. Patients may feel that they have been played with especially in cases where the communication between the providers and them was minimal. Moreover, denied insurance claims can lead to unexpected financial burdens for patients. Sometimes a patient might visit an in-network provider and the insurance verification specialist also recognizes their coverage and decides to proceed. But still due to issues such as pre authorization or coverage limitations, their claim gets denied. The patient most probably will not opt for visiting the same dentist again.

Negative Impact on Reputation

Consistent insurance denials means problems for a dental practice. Not only their financial position weakens, patients get dissatisfied and administrative burden increases,, but their position among their competitors gets compromised. A dental facility that struggles due to insurance claim denials would be the last that an ailing patient might prefer to go to. It also reflects the lack of expertise of insurance verification specialists of such a facility. The persistent denials may also lead to legal complications that will further tarnish the reputation of a dental facility.

Experience A Seamless Insurance Verification Process with MedsDental

Are you struggling with denied claims due to inadequate insurance verification procedures? Leave this tedious task to our seasoned insurance verification specialist who is attentive to details. They all have legal backgrounds and experience in the dental billing industry allowing them to steer clear through all ins and outs of the industry. They not only give you a clearer picture but also communicate with the patient helping you avoid any conflicts. Overall, MedsDental has a flawless record when it comes to insurance verification and can help you stand out among a pool of dental practices.