Reviewed by a licensed dentistTopic: Denied claimQuestion: Documentation
My claim was denied for missing X-rays or documentation
The short answer
For some treatments, like crowns, deep cleanings, and gum surgery, insurers want to see the evidence: X-rays, photos, or gum measurements. Your dentist's office sends these, so this isn't homework for you.
Two different kinds of denial
- “We didn't get the records.” This is a paperwork gap, not a judgment about your treatment; nobody has reviewed your case yet. Once the office sends them, the claim can be reviewed again.
- “The records don't meet our criteria.” The insurer reviewed them and decided this case doesn't meet its rules for payment. That's a different situation, with its own page: My treatment didn't meet the plan's criteria.
Questions to ask
- Did you send X-rays or other records with this claim?
- Can you resubmit the claim with the missing records?
- What reason did the insurer give?