How to File Dental Insurance Claim?

Dental Insurance is a tool to minimize the expenses on the dental treatment and remedies. Insurance providers pay on behalf of the patient to the consultants. There are many dental insurance plans available with distinct benefits like Fee for Service Plan, Managed Care Plans, DHMO (Dental Health maintenance Organization), Indemnity Plans, PPO (Preferred Provider Organization), Discount Dental Plan, Vision Plans, Dental Plans for Kids and many other customized dental insurance plans.

These plans help in many ways to the users and the patients at the time of casualty and emergency. Although there are several things that are important at the time of putting a claim and one needs to be very careful and pay attention to the small details so that the maximum benefits can be reaped .Generally at the time of buying the insurance plans it is advisable to read the terms and conditions mentioned in the claim procedure column .If there is any misappropriation or non clarity user must get the clarity on the same. There may be some modification and alteration during the term of the policy and many of such information is available online over the website of the insurance provider company. One can post his or her query and get the required information. There are separate claim process turnaround time which ranges from 2 week to 5 week depending on the type of insurance policy taken, insurance company, criticality of the case, amount of the claim and any other relevant clause as specified between the policy holder and the policy provider. Apart from this it is also important to check about what all things are covered under the dental insurance policy. Here are some key claim points to be checked:

All the services covered in the plan

  • How much the insurance plan can pay
  • The status of the claim
  • Claim and Reimbursement ratio of the firm
  • Explanation of Benefits(EOBs) for the claims
  • Reimbursements one has received in the previous time
  • List of the people who are covered in the insurance plan
  • Time frame in which one can claim for the amount

Let us understand and learn some tips to get the claims in the right and appropriate manner. In the dental insurance claims the user must check the following details.

Eligibility: Before claiming for the expenses incurred in dental treatments one must check with eligibility as whether the disease and amount is in the permissible limits. It can be discussed with the insurance carrier or many of such information are available on the back of the policy bond or policy documents. It is also called Insurance Call reference Guide which is issued by the insurance provider or government departments. By proper checking on these terms about the documentation and proper coding one can avoid the rejection.

Record and Maintain Appointment:For claiming the reimbursement one must maintain the records of the appointments and meeting done with the listed dentists. The supporting bills, prescription, pathology details, pharmacy expenses and other slips and receipts must be procured and kept safe so that it should be presented at the time of the claims. It ensures that there will be no hassles and discrepancies in the details of the claims.

Submissions: Dental insurance plans offer comprehensive benefits to the patients and his or her family members. In many plans the patient need to submit the bills and documents to the insurance provider. There is specified time period and one must present the document within the tenure to get the maximum benefits. It helps in presenting the claim in legal manner and getting it in stipulate time frame as specifies in the policy document. Many insurance plans offer cashless claims where one need to show the health card that is being issued at the time of policy purchase and he or she need not to pay any money and against the advance premiums paid it is adjusted and reimbursed.

Reimbursement: Every plan has a distinct feature and benefits associated with it. The insurance providers decide as when one can put for the claim and what will be the reimbursement time periods. Some companies clear the claims in 2 weeks time and some have longer clearance procedures. One must check with this at the time of purchasing the dental insurance plans. If there is any discrepancy or mismatch in the documents generally the insurance providers recheck and evaluate all the information and details meticulously before settling the claims. If one has taken indemnity or managed with care plan he or she must preserve all the bills and documents policy wise so that reimbursement process will be smooth and seamless.

Documentation and Bills:The policyholder is advisable to get clarity on the plans about the participation ratio between the patient, the dentists and the insurance provider. Some bills are being managed by the dentists and some are preserved by the patients. This way both get the right benefits. Some claims dentists directly get from the insurance company and the patients get the cashless treatments .In other cases the patients are supposed to keep the bills safe and in pristine condition. They later on present them to the company to get the insurance claim. Here is the list of such documents:

  • Policy Bond or Policy Documents
  • Premium Receipts
  • Statement of Premiums
  • Health Cards
  • Prescription of the dentists or consultants
  • Diagnostic tests if asked in the policy
  • Pharmacy and medicine bills
  • Hospitalization details with bills
  • Supporting out of the pocket expenses
  • All the required forms

This way the policy holder should be very vigilant and alert while taking any dental insurance plan. There are many insurance providers and numerous dental insurance available in the market and one should see that which one will be suitable for him or her as per the need and requirements. There should not be any hidden cost involved and the reimbursement process should also be easy and smooth. By checking on the above mentioned points one can get the maximum benefits from the dental insurance policies.

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