Dental insurance companies are businesses set up to make a profit. They are not grandma and grandpa. Many dental patients feel that their dental insurance company should pay for everything they need.

          A dental insurance company is only required to pay for what the dental insurance company agrees to in its contract with you. Many patients are wrong in what they expect.

          However, many dental insurance companies set up their dental insurance contracts so that the dental insurance company can deny patients what patients deserve. One way that a dental insurance company reduces payments is limiting the Usual, Customary, and Reasonable fee that it pays.

          Basically, the dental insurance company pays what it wants.

          A dental patient has the right to challenge her dental insurance company!

          To do this, a dental patient must keep detailed notes of every time the dental insurance company was called. These notes must include the name of the person who spoke with you and what was said. Keep all of the letters that your dental insurance set you with your notes. Keep all the details together in one place.

          Next write a detailed letter explaining why your dental insurance company should pay for your services and send it to the dental insurance company. It must be sent return receipt registered. This officially keeps track of the date you sent it and the date that the dental insurance company received it. There are laws in the State of Georgia which require a dental insurance company to respond in a limited amount of time. Keep a copy of this letter with the official post office receipts stapled to it and keep the copy with your notes and insurance letters.

          Follow up by calling the same person at the dental insurance company that you have been speaking with ten days after sending the letter. Ask her what the dental insurance company is going to do.

          If you receive a letter denying you treatment or denying you better payment of for your services, make an appointment with the Health and Human Services Director at your company. If the Director is not in your city, write a detailed letter to the Director. The Health and Human Services Director negotiates with the dental insurance company every year and can cancel this dental insurance in favor of a better plan. Your dental insurance company will be much more responsive to an inquiry from the Director than you.

          Next write a letter to the State Insurance Commissioner. In Georgia, his web address is: http://www.gainsurance.org/

          You can also make a complaint to the Better Business Bureau.

            Outline of the dental insurance denial procedure