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Here's why dental insurance claims are so hard to get reimbursed in 2023

November 7th, 2023 | 5 min. read

Here's why dental insurance claims are so hard to get reimbursed in 2023 Blog Feature

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In 2023, denied dental insurance claims continue to be an increasingly frustrating and complex aspect of running a dental practice.

According to the Academy of General Dentistry—

“The largest single payer of dental treatment is private insurance. Direct payments from these insurance carriers make up 50% of all payments made to private practice dental offices, according to 2020 Health Policy Institute data.”

That’s why these claim denials are so frustrating. Insurance claims likely make up half of your overall revenue, and every time payers deny your claim, they delay your income.

But you need every dollar you’ve earned to run your business, and:

  • Pay your employees
  • Pay your utility bills and office lease
  • Pay for updates and repairs of your clinical and administrative equipment
  • Pay yourself

Why dental insurance companies hold your claims revenue hostage is a rabbit hole we’ve gone down, so you don’t have to.

Let’s explore why it feels impossible to receive quick and easy reimbursement on all your dental insurance claims in 2023 — hint: it feels impossible because it is impossible. 

We know that sounds a little hopeless, but we promise we wouldn’t delve into the dark side of insurance companies without offering a practical solution. Let’s get started.

Insurance companies profit from denying claims

One of the central reasons your dental insurance claims are hard to get reimbursed lies in the profit-driven tactics of insurance companies.

Insurance claim denials are a standard operating procedure with most dental insurance companies. It is called ‘stall as long as you can’. There are only two things that can happen with that game. The dentist gives up on collecting the money he earned and cuts his losses. Or the insurance company gets to keep his earned money a little longer to invest it somewhere else.” —Custom Dental

That’s right: Payers hold onto your money because that’s how they make their money. Have you noticed that insurance company buildings are some of the tallest towers in a city? It’s because they’re built with denied claims. 

Related: 4 things your dental insurance claim needs for reimbursement

That’s why they constantly change the requirements needed for your insurance claims to receive reimbursement. Let’s dive deeper into this…

Insurance companies make it hard to submit clean claims — and appeal imperfect ones

The intricacies of dental insurance policies further complicate the reimbursement process.

Every dental insurance provider requires different information on a claim. And if you’re in-network with multiple insurance providers, you have to know the varied requirements for all of them. 

It can be a lot to keep up with. Dental Economics explains—

“Chasing down reimbursements; understanding the intricacies of exclusions, waiting periods, and preapprovals; submitting appropriate documentation; and filing claims for reimbursement are just a few of the many responsibilities required for each patient visit. As cumbersome as these processes are, if any are not attended to, your office runs the risk of not being compensated for its services.” 

Not to mention, vague or misleading policy wording only adds to the confusion. And if this is your responsibility at the dental office in addition to other assignments? It can feel like an overwhelming amount of work. 

Because not only do you want to submit accurate insurance claims for quick reimbursement, but you also want to ensure you remain compliant in your claims process to avoid any legal messes.

The idea of fighting a huge insurance company’s legal team with your one business lawyer sounds like a losing battle, but you don’t have to stay at a disadvantage. 

   Need more income? Schedule a call →  

David vs Goliath: What can you do to combat the reimbursement crisis when insurance companies hold all the power?

In the face of insurance giants, it’s up to you to look for ways to fight back — and dental Revenue Cycle Management (RCM) services emerge as a crucial resource.

Expert RCM services excel at reducing claim denials by improving accuracy, streamlining claim submissions, and handling appeals effectively.

One of our customers at DCS explains her experience with our RCM services—

“The amount of knowledge and help I receive from Onnie at DCS on a weekly basis is beyond generous. As we all know, dealing with insurance and everything else that comes with it is a job of its own, a stressful job at that. She handles struggles and frustration with patience yet passion, as if she was here in person.”

When you partner with RCM experts like the ones at DCS, you’re working with seasoned dental professionals who have years of experience working on dental insurance claims submissions. These experts have learned how to sling the best strategies and practices to receive fast reimbursement from payers. 

Our team keeps up with the ever-changing insurance claim requirements and regulations so that your team doesn’t have to. 

With our RCM experts supporting your dental team, you’ll see: 

  • Increased revenue collected
  • More resources for protection and growth
  • More positive patient relationships and experiences
  • Greater efficiency and accuracy in the claims process
  • Smoother patient billing processes that increase revenue

Read more: Dental providers thrive with outsourced revenue cycle management: 5 key benefits you’ll see

Are you ready to win back the revenue you’ve earned?

While you can't dictate insurance company practices, you can choose to maximize your reimbursement potential. When you utilize dental RCM services, you empower your practice to navigate today’s challenges and secure the financial future it deserves.

As a dental business owner, it’s your job to adapt to the dynamic landscape of dental insurance and claims reimbursement. And as it becomes more and more difficult to receive claim reimbursements, solutions that offer your team support must be explored, selected, and acted on.

RCM services will be a new weapon added to your arsenal for winning back your claims revenue. With our expert support, you won’t have to face insurance head-on: We’ll fight for you

Win back what you’ve earned with DCS’ full-service revenue cycle management: Schedule a call.

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