Denial of Claim

Denial of Claim is when a dental insurance claim is made by a customer and denied by the Insurance Company. This can happen if the application for insurance claims is late and the financial responsibility is then fully shifted to the customer. It can also occur if the insurer feels that the dental work performed was not necessary to the customer's well being or due to pre-existing conditions. It can frequently happen if an employer offers group dental insurance to their employee's and then changes the Dental Insurance Company after the benefit period. Issues can then occur where an employee has work done under the coverage of the first insurance company, but needs follow up work done under the coverage of the second insurance company. The first company no longer covers the employee and the second company can claim it was a pre-existing condition not covered under their insurance and the employee is then left out of pocket.

Proper documentation needs to be kept and many claim denials are resolved eventually. Anyone who has had a claim denied can make an appeal. Appeals can be made internally and externally. Internal appeals involve contacting the insurance company and asking them to reconsider the denial. External appeals involve consulting a governing body.

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