People don’t become dentists to spend their time navigating the insurance claims process.
They do it to take care of people.
Unfortunately, the reality of dealing with insurance carriers and their varying claims policies can create headaches not only for dentists and their front-office staff, but for patients as well.
“It can be particularly frustrating when it comes to insurers’ retroactive denials,” said Hope Watson, D.M.D., vice chair of the ADA Council on Dental Benefit Programs.
Insurers typically limit dentists’ window of time to file clean claims, meaning any claim filed after their arbitrary deadline can result in no payment to the dentist. And, with retroactive denials, dental insurers have the ability to review claims after payment has been delivered to the dentist. Even in those instances when the insurer made an error, they can request a refund from the dental office years after the claim was originally paid.
Source: Retroactive denial laws a priority for ADA advocacy / American Dental Association