How Are Dental Claims Handled?
Updated May 2023
Have you ever wondered how your dental claims are handled after you receive treatment and have insurance? Below is a quick summary of what your dentist does to ensure proper payment for any procedures you have undergone, along with a few tips on submitting a dental claim yourself whenever necessary.
How are dental claims processed?
If you have never submitted a dental claim, you may be asking, "How are dental claims processed?" Dental insurance claims processing typically involves two steps.
Step 1: Submitting a claim
After you give your dentist all of the information he or she needs regarding your dental insurance, the office might take care of submitting the dental claim on your behalf. Your dentist could submit a claim through regular snail mail or electronic filing. Many dentists will choose the electronic option because it’s easier and more efficient, but the submission type may depend on your insurance provider’s requirements.
Sometimes copies of your X-rays and other documents will also need to be submitted along with the claim form for dental claims processing. For example, with a Spirit dental plan, there aren’t any waiting periods, you can receive up to three cleanings annually and you can receive dental insurance for major services.
Keep in mind that your dentist might estimate what your out-of-pocket costs will be before submitting the dental claim. So you may need to pay a portion of the bill upfront and let your insurance cover the rest. Your dentist will reimburse you if you end up overpaying, or he or she will come back to you and ask for another payment if the estimate was incorrect and you owe more.
Step 2: Waiting for payment
After a dental claim has been properly submitted, your dental insurance provider will check it to ensure the treatments you received are covered under your plan. As long as the claim is approved by the insurance company, they will submit the appropriate payment to your dentist for the services that you received. But if you paid the bill upfront, the insurance provider will reimburse you instead.
Things could get a bit complicated if a claim is submitted and your insurance provider doesn’t cover part or all of the services within the claim. In this case, your dentist will likely contact you to receive an out-of-pocket payment directly from you. Or you might be contacted by your insurance provider regarding any payment you must make to your dentist because they don’t cover the full cost of treatment.
Knowing when you need to submit a dental claim
Your insurance provider might prefer receiving a claim that has been submitted by you, the patient. So rather than your dentist submitting the claim, you may need to pay your dentist upfront and then submit a claim for reimbursement. For example, some insurance providers might require this step when you visit a dentist who isn’t in-network. Once the dental claim has been reviewed and approved, you’ll receive the payment directly from your insurance provider, whether they owe you the full payment or they’re only required to cover a portion of what you paid for the treatments you received.
Often, when you submit a claim yourself, you’ll be required to include information like your contact info, your dental insurance policy number, the date of service, information on your dentist, a description of the services and diagnoses you received, and the itemized costs of the treatments that you were billed for. You may also be required to submit receipts, X-rays and other information. Basically, everything that your dentist would otherwise do on your behalf, you have to do yourself. But it’s a lot easier than it might seem at first, so don’t worry!
Choosing the right plan and dentist is key
Before signing up with any dental insurance company, it’s best to read through a plan’s details carefully. This way, you’ll know if you’re required to submit your dental insurance claims or if your dentist will be able to do so for you. On top of that, you will know if you are required to pay upfront and then be reimbursed, or if the payment will be submitted directly to your dentist.
In addition to knowing what’s covered and what isn’t covered by your insurance plan, it’s also a great idea to find out if there are any limits on the amount of treatment you can receive or if there is a waiting period. This information will help you avoid those dreaded declined dental claims. For example, with a Spirit dental plan, there aren’t any waiting periods, you can receive up to three cleanings annually and you can receive coverage for major services.
Frequently asked questions about dental claims
If you have questions about dental claims, we have answered a few common questions we hear about dental insurance claims processing below. If you have further questions, please contact us; our experienced team will gladly assist you.
What is the major difference between medical and dental claims?
The major difference between medical and dental claims is the type of services covered and how they are processed. Medical claims typically involve reimbursement for medical services related to illness, injury, or disease, such as doctor visits, hospital stays, surgeries, and prescription medications. Dental claims, on the other hand, involve reimbursement for dental services related to oral health, such as dental exams, cleanings, fillings, crowns, orthodontics and other dental treatments. Dental claims are specific to dental care and are processed separately from medical claims.
What is a dental claim form called?
The dental claim form is typically referred to as a "Dental Claim Form" or "Dental Insurance Claim Form." It is a standardized document used by dental providers to submit a claim for reimbursement to the dental insurance company on behalf of the patient. The dental claim form includes information such as the patient's personal details, policy number, description of services rendered, diagnosis codes and charges for the dental services provided.
How do I finalize an open dental claim?
To finalize an open dental claim, you will typically need to follow these steps:
- Complete the dental claim form accurately and provide all the required information, including details about the dental services provided, diagnosis codes, and charges.
- Attach any supporting documentation, such as dental treatment records, X-rays or invoices, as requested by the dental insurance company.
- Submit the completed dental claim form and supporting documentation to the dental insurance company by mail, fax or electronically, per their instructions.
- Follow up with the dental insurance company to ensure they have received and processed your claim. You may need to provide additional information or documentation if requested.
- Once the dental insurance company has processed the claim, they will typically send you an Explanation of Benefits (EOB) which outlines the coverage, benefits and any patient responsibility, such as deductibles or co-pays.
- Review the EOB carefully and compare it with the original dental claim to ensure accuracy.
- If the dental claim is approved, the dental insurance company will issue reimbursement directly to you or your dental provider, depending on the terms of your policy.
It's important to note that the specific process for finalizing an open dental claim may vary depending on the dental insurance company's requirements and policies, so it's best to refer to their documentation or contact their customer service for detailed instructions.
Trust Spirit Dental for your dental insurance needs
Now that you understand more about how dental claims work, you may be ready to shop for low-cost dental insurance. Spirit Dental has a variety of affordable dental plans for you to choose from that will meet your needs. It's easy to get dental insurance quotes online from Spirit Dental. Discover the difference Spirit Dental can make in your oral health.