I want to talk about something critical for any dental practice: the importance of reading and correctly interpreting Explanation of Benefits (EOBs).

Too often, I see practices leaving money on the table because of unnecessary write-offs. This often happens when EOBs aren’t thoroughly reviewed. One of the biggest mistakes is assuming that a denial or reduction means the treatment must be written off, without understanding the reason behind it.

It’s Not Always a Write-Off!

For example, one of the most common denials I still see is for buildups. The insurance might say the buildup is denied because it’s “all-inclusive” with the main treatment, or that their records don’t show 50% tooth structure loss.

In some cases, the solution is simple: one large insurance company (Cigna) just needs the preparation and seat dates in order to reconsider the buildup. Another large insurance company (Aetna) needs an intra-oral photo with buildup in place in order to reprocess. By providing this information, we can get the claim reviewed and paid. It’s all about researching the ‘why’ behind the denial and then following through with the right information via the best channel. I do most of my reconsideration requests online, or by fax.

Other times (with UHC, and some other payers), you may need to appeal by providing more detailed documentation, such as treatment notes, X-rays, or clinical photos, to show the need for the buildup and proving the 50% tooth structure loss.

The point is, by taking the time to fully understand the denial reasons on the EOB and address them directly, you can avoid unnecessary write-offs and ensure your practice is paid for the services provided.

So, don’t just accept denials at face value, especially when something doesn’t feel right! Often, with a little research and the right information, you can get those claims paid. If you’re seeing too many write-offs in your practice, it might be time to take a closer look at those EOBs.

Once you’re familiar with the specific requirements of each insurance company, you can stay ahead of the game by submitting a perfectly tailored claim that avoids “all-inclusive” denials for the most part.