When a Dental Insurance Claim Wasn't Filed: Steps for Patients

Discovering that your dentist did not submit your insurance claim can be frustrating and confusing. Whether you’re a patient seeking reimbursement or a dental office team member aiming to improve workflows, understanding the correct steps and best practices is essential. Here’s how to handle the situation professionally and ensure your dental benefits are maximized.

Confirming If a Claim Was Submitted

Before taking any action, it’s important to verify whether your claim was actually filed. Dental offices typically submit claims electronically using CDT codes for each procedure. Ask your dental office for the claim reference number or a copy of the claim submission. You can also contact your dental insurance provider directly to check if a claim for your recent visit is on file. Have your appointment date, provider information, and policy number ready for faster assistance.

Talking to Your Dental Office

If you confirm that the claim was not submitted, approach your dental office calmly and professionally. Sometimes claims are delayed due to missing information, insurance verification issues, or administrative backlogs. Ask to speak with the office manager or billing coordinator. Provide your treatment details and request that the claim be submitted promptly. Successful dental offices will document your request, verify your insurance details, and ensure the claim is sent electronically to minimize further delays. Request a copy of the claim and ask for an estimated timeline for processing.

Filing a Claim Yourself (If Necessary)

If your dental office is unable or unwilling to submit the claim, you may be able to file it directly with your insurance carrier. Obtain an itemized statement from your dentist, including CDT codes and proof of payment. Download your insurance company’s claim form and complete all required sections. Attach the itemized statement and any supporting documentation, then submit via mail or through your insurer’s online portal. Keep copies of everything for your records. After submission, monitor your Explanation of Benefits (EOB) and follow up with your insurer if you do not receive a response within their standard processing time.

Preventing Future Insurance Filing Issues

To minimize future claim submission problems, always verify your insurance information at each visit and ask for confirmation when a claim is filed. Request a copy of the claim or a claim reference number. Many dental offices use practice management software to track Accounts Receivable (AR) and claim status—ask if your office provides patient access to this information. If you receive an EOB before a bill from your dentist, compare the details to ensure accuracy and address discrepancies promptly.

Patient Rights and Dentist Obligations in Claims Submission

Patients have the right to timely and accurate claim submission. Dentists are obligated, under most insurance agreements, to submit claims on behalf of insured patients for covered services. Failure to do so can result in delayed reimbursement or patient dissatisfaction. If you encounter repeated issues, you may consider filing a complaint with your insurance provider or state dental board. Dental offices should have clear protocols for insurance verification, claim submission, and appeals to ensure compliance and patient satisfaction.

In summary: If your dentist did not submit your claim to insurance, take proactive steps to confirm, communicate, and resolve the issue, while understanding your rights and the office’s obligations for a smoother dental billing experience.