If you’ve ever been in a fender-bender or had wind or hail damage your home, you’ve probably filed an insurance claim.

You may be less familiar with the claims process for dental insurance. After at all, it can be a bit confusing — often, your dentist’s office will file the claim on your behalf, so you never even have to think about it. But depending on the type of dental plan you have, and the type of care you receive, the responsibility for filing claims may fall on you.

Taking care of your teeth is important, not just for your oral health but for your health overall. Periodontal disease is one of the most common illnesses, and it can correlate with systemic issues like diabetes and heart disease¹ .

Making the most of your dental insurance, which may include having to go through the claims process, is critical for your health and wellbeing, and that of your family.

Introduction to dental insurance and claims

Dental insurance is a type of insurance, separate from your health plan, that covers care for your oral health.

Here’s how dental insurance typically works (if you have a dental plan, be sure to check your plan documents to see what’s covered):

• Preventive care is covered in full. For example, you may get two cleanings, one set of X-rays, and one exam per year at no cost to you.
• You’ll pay for dental work beyond the basics via cost-sharing like coinsurance. For example, maybe you pay 20% and your insurance pays 80% for a filling or extraction.
• The more complex the care, the more you’ll likely pay out-of-pocket.²

Dental insurance can help you stay on top of your dental health, so you can avoid having minor issues become more complicated – and expensive – over time.³

What is a dental claim, and how do claims work?

A claim is how your insurance company learns that you’ve received dental care, and it prompts them to pay the provider for that care. Essentially, the claims process allows you to access and use your dental insurance benefits. The claim will include a list of the services you received, when and where you received them, and what each one cost.⁴

Often, your dentist’s office will file claims with your insurance company on your behalf. But certain types of plans, like dental indemnity plans, require you to pay for your dental care upfront and then submit a claim to your insurance company for reimbursement. You also may need to submit a claim yourself if you visit a dental care provider outside of your plan’s network.

If you are responsible for filing a dental insurance claim, it’s in your best interest to file your claim as soon as possible after your provider treats you. If you wait too long to file your claim, it may be immediately denied, even if the care would have otherwise been covered.

This deadline, known as the timely filing deadline, varies depending on your insurer and plan. Check your plan documents to find out how long you have to file a claim after receiving care.

In addition to filing your claim on time, you want to make sure you fill out all claim paperwork accurately to avoid denials or delays in reimbursement. Common claim mistakes include:

• Mistakes in personal information (name, address, etc.)
• Missing attachments, like X-ray images⁶
• Incorrect billing codes

Understanding dental insurance plans

The type of dental plan you’ll choose for yourself and your family will depend on a few different factors:

• Your budget for out-of-pocket expenses
• Whether you can keep going to your current dentist, if you want to
• Whether you, your partner, or your kids will need orthodontic care
• Whether your live in an area with a lot of dental care options

A few of the of the most common types of dental insurance include:

• Dental PPO: This plan allows you to visit any dentist you like, but you may save money by choosing an in-network provider. You’ll likely have to pay costs such as a copay, coinsurance, and a deductible before the plan kicks in to pay for care.⁵
• Dental HMO: This plan only covers care by in-network dentists. You may need to a choose a primary care dentist who will refer you to specialists as needed. This plan type usually has the most affordable premium, and there’s no deductible to meet before coverage begins.
• Dental indemnity plan: This plan is set up where an insurance company pays a particular percentage per procedure, and you pay the rest.⁷

How much does dental insurance typically cost?

If you purchase dental insurance on your own, you can expect to pay a monthly premium of around $14 for an individual for a dental HMO plan and around $35 for a dental PPO plan.²

If you get your dental insurance through an employer, your premium may look like:

• Around $17 a month for a dental HMO
• Around $29 a month for a dental PPO
• Around $36 a month for a dental indemnity plan²

If you’re worried about the cost of dental care for yourself and your family, there are ways to reduce expenses in addition to using your dental insurance:

• Use FSA/HSA funds: If you have a health savings account or flexible spending account, you can use tax-advantaged money.⁸
• Ask your dentist: Some dentists offer discounted care during particular times of year or can set up a zero-interest payment plan for what you owe after insurance pitches in.⁹
• Visit a dental clinic or dental school: If you live near a dental school, you can help student dentists learn to perform care while saving money on treatment. Licensed dentists always supervise the dentists-in-training.¹⁰
• Check out charitable organizations: America’s Dentists Care Foundation hosts events to help people find affordable dental care, and Give Kids a Smile treats kids for free.¹⁰
• Focus on preventive care: Brush and floss twice daily, and stay on top of your routine cleanings and exams — preventive care is much cheaper than more involved dental work.³
• Ask if your dentist accepts special credit cards: Cards like CareCredit allow you to pay for care upfront and pay it off slowly over time at 0% interest.¹⁰

Filing your dental claim: a step-by-step guide

Once your dental care has been completed, if you, and not your provider, need to file a claim, these are the steps you’ll follow:

• Ask your dentist’s office for a detailed list of all services rendered, their costs, and a payment receipt. This is known as an invoice, walkout statement, or superbill.
• Fill out a dental claim form, which may be either paper or electronic. You’ll usually find this on your insurance company’s website.
• Include your primary insurance information, as well as secondary if applicable.
• Make sure to attach any relevant documents, such as X-rays and chart notes from your dentist.
• Review all information for accuracy and completeness, sign, and submit.¹¹

If you’re a MetLife dental PPO customer, you’ll follow this entire process online in the Claim Center on the MyBenefits site.

To ensure your claim is processed and paid as soon as possible, make sure you include all the relevant information and documentation. If something is missing, the insurance company may come back to you asking for more details or deny your claim entirely.

Make sure you include:

• All your personal details
• Your insurance plan details
• An itemized list of completed services that includes the dentist’s contact details and a payment confirmation
• The correct tooth number and tooth surface number for the treatment you received, if applicable
• X-rays, chart notes, and other relevant attachments
• Your signature, plus the signature of whoever is subscribed to the insurance plan if not you
• An explanation of benefits (EOB) from your primary insurer if you’re filing a claim with a secondary insurer
• Dental codes for each procedure, the area of your mouth where you received treatment, your provider’s specialty, your diagnosis, and your place of service¹²

You can check your claim’s status anytime, but one of the benefits of filing a claim digitally is that it could make it easier for you to track its status after it’s been submitted. If you file a claim online through your insurer’s member website or mobile app, you can quickly look up your claim history to see if it has been filed, received, is in process, or if it has been approved, denied, or paid.

Some insurers, like MetLife, will send you updates via text or email as they process your claim. To activate these alerts and stay in the loop in real time, members can log into their MyBenefits account, visit the “Communication Preferences” page, and toggle on email or SMS alerts.

Dealing with dental claim denials

Whether your dentist or you file your claim, after it has been processed, you’ll receive an explanation of benefits, or EOB, which will explain how much the insurance company will pay for a particular claim. It will also let you know how much, if anything, you will be responsible for.¹²

If your insurance company decides that they won’t cover one or more treatments, you’ll see that in the EOB.

If you receive a dental claim denial, you might be wondering why it was denied. The EOB will explain that, but here are some of the most common reasons for a denial:

• Mistakes in personal info
• Plan frequency limitations, like if you got a third cleaning when your insurance plan only covers two per year
• Coding mistakes — the Current Dental Terminology (CDT) code changes over time, so you need to make sure you’re using the current codes
• Some procedures, such as periodontal scaling and root planing, are more likely to be denied¹⁴
• You needed a pre-authorization for the care but did not obtain one
• The care you received is not covered under your plan

Nobody wants to get a claim denied and be forced to pay for dental care out of pocket. Luckily, there are steps you can take to help avoid denied dental claims.

• Get a pre-treatment estimate: Before undergoing dental work, particularly if it’s an expensive procedure, you can have your dentist submit a treatment plan, and in return, your insurance company will send back an estimate of what your benefits will cover.
• Read your policy: Familiarize yourself with what’s covered, exclusions, annual and lifetime coverage limits, and waiting periods.
• Double check the information: Simple errors in your personal info, dental office info, or dental codes can trigger a denial.
• File your claim promptly: If you wait too long after the date of service, your insurer could deny your claim.

If your claim is denied, you can file an appeal to try and get your dental care covered. Be sure to:

• Submit your appeal in writing as soon as possible after you receive the claim denial. Some plans require an appeal to be filed within a few months of the denial.
• Correct any errors that the insurance company flagged and address any reasons they specified for denying the claim.
• Ask your dentist for any additional materials you can include with your appeal to substantiate your case.¹⁵

Maximizing your dental benefits

With a bit of strategic planning, you can ensure that you get as much as possible out of your dental benefits and lessen how much you pay for care out-of-pocket.

• Take advantage of your covered preventive care — if you take great care of your teeth, you’re less likely to develop more complicated and expensive dental problems.
• Use an in-network provider to save money on your care.
• Familiarize yourself with your annual maximum (and when it resets) and, when possible, schedule your care to avoid paying for it all out-of-pocket. Just be sure to consult with your dentist about the timing of the care you need.
• If your insurance requires it, get a pre-authorization to help avoid unexpected expenses. If you need complex and/or expensive care, your dental office can help you file a pre-authorization with your insurance company. The insurance company will review the treatment plan to ensure they deem it “medically necessary” and give you an idea of how much they will pay and how much you will need to cover.¹⁶
• If you have to file a claim yourself, ask your dentist what dental billing codes you should use for the treatment you received. The American Dental Association maintains what’s called a CDT Code that dental professionals use when filing insurance claims, and each code corresponds to a type of treatment. Using the right codes can help make sure your claim gets processed in a timely manner.¹⁷

Digital tools and resources for managing dental claims

You can still submit dental claims to your insurance company on paper. In fact, about 14% of dental claims still arrive at insurance companies via snail mail.¹⁷

But filing a digital claim on your insurer’s website or app has a number of benefits:

• They get processed and paid more quickly.
• The information within the claim, including attached documents, is more easily collected and evaluated.
• You can see all your claims in one place and track their progress.²⁰

If you’re a MetLife member, you can take advantage of their digital tools to file, track, and review dental claims. You can:

• Complete your claim form online in the Claim Center on the MyBenefits site.
• Upload an already completed claim form
• Attach and submit any additional documents
• Sign up for SMS or email updates about the status of your claim

Troubleshooting common dental claims issues

There are multiple moving parts involved in filing a dental claim, so mistakes happen. These are some of the most common dental claim issues, and how to avoid them:

Problem: A claim gets denied due to out-of-date personal info, a typo, or an incorrect billing code.
Solution: Double check your claim form for completeness and accuracy before submitting.

Problem: A claim gets denied for being filed too late after the service was completed.
Solution: File your claim ASAP after you receive the service.

Problem: A claim gets denied due to frequency of service issues.
Solution: Understand your policy and how often you’re allowed to receive a particular treatment.

Problem: A claim gets denied because the treatment isn’t covered
Solution: Check with your insurance company before undergoing treatment, especially when it’s expensive.

If you’re having issues with a dental claim, take action right away. Contact your insurer for more information if they denied your claim and you don’t understand why. Contact your dentist to see if there’s any addition documentation or notes you can submit to back up your claim. Keep all emails, letters, and other correspondence in one place you can easily reference later.

If you’re a MetLife member, and you have questions about a claim, check your MyBenefits portal for details on your explanation of benefits. You can also get more help via the “Contact Us/Support” section.

Filing a dental claim: Key takeaways

Understanding dental claims, how they work, and how to file one can help you and your family:

• Save money. Making sure claims are filed promptly and correctly gives you the best chance of getting reimbursed for all or part of the cost of your dental care.
• Get the most value out of your plan. Understanding claims means understanding annual maximums, frequency rules, and what your plan covers, so you can make sure to take advantage of what’s available to you.

The services available on dental insurers’ sites varies. As an example, on MetLife’s Claim Center, available on the MyBenefits site, you can:

• Upload a claim form
• Fill one out digitally
• Attach any necessary secondary documentation
• Check the status of all your claims in one place
• Set up SMS or email alerts about your claim’s progress

By having a handle on the claims process, keeping your dental information organized, being thorough about accuracy and clarity, and taking advantage of the digital tools at your disposal, you can avoid the pitfalls of the claims process and better take care of your and your family’s dental health.