Let’s be honest: claims denials have become the new national pastime for insurance companies. In-network? Denied. Out-of-network? Denied. Breathed wrong on box 38 of the claim form? Denied with gusto and a cryptic error code for good measure.

It’s a game of “gotcha,” but no one’s laughing—especially not dentists who work tirelessly to provide care, only to have their reimbursement hijacked by some soul-crushing algorithm and a faceless adjuster in a cubicle 3,000 miles away.

But here’s the thing: this isn’t just a dental problem. Oh no. Denial culture has spread like unchecked gingivitis across nearly every sector of healthcare and beyond. So, buckle in, because we’re about to tour the maddening landscape of modern claims denials, the industries suffering with us, and what dentists can actually do about it (besides scream into the void).

The Rise of the Rejection Machine: How Did We Get Here?

Let’s set the stage with some stats:

• According to the Office of Inspector General, Medicare Advantage plans improperly denied 13% of prior authorization requests and 18% of payment denials—many of which met Medicare coverage rules.

• In the private sector, the Kaiser Family Foundation reported that in 2021, ACA-compliant plans denied 17% of all in-network claims—and 99% of the time, patients didn’t appeal.

• In dentistry, multiple consultants report that 10–30% of claims are denied on first submission, many for reasons that are either completely fabricated or so ambiguous you’d need a Rosetta Stone to decode them.

Now let’s add a chilling backdrop: former UnitedHealthcare CEO, Brian Thompson, was shot on the streets of NYC in 2024—an incident still under investigation. While no motive has been officially confirmed, online whispers speculate that this was a direct response to public outrage over UHC’s aggressive cost-cutting and denial practices.

Let’s be clear: violence is never the answer. But the rising frustration? That’s real. And it’s boiling over.

Claims Denials Are an Equal Opportunity Nuisance

Here’s where it gets weird (and oddly comforting): we’re not alone.

Medical doctors? They’re dealing with the same mess. Radiologists report up to 35% denial rates for imaging services—even with prior authorizations. Surgeons? Try battling denials for medically necessary procedures because the patient “should’ve tried physical therapy first” even though they already did.

Pharmacists? Oh, they’ve entered the chat. Denials for life-saving medications are routine. One report from the AMA highlighted multiple instances of insulin denials due to “non-formulary” status—even when no alternative was available.

Mental health professionals? Don’t get them started. Claims for therapy are routinely rejected for “lack of medical necessity”—as if depression or PTSD somehow isn’t real unless it comes with a visible rash.

The Top 5 Ridiculous Reasons Dental Claims Get Denied

1. “Missing tooth clause” on a crown submitted for a tooth that was never missing.

2. "Not a covered benefit"—even when the treatment code is literally listed on the patient’s benefits breakdown.

3. "Lack of preauthorization"—even though the plan doesn’t require preauthorization for that procedure.

4. “Alternate benefit applied”—which is insurer-speak for “we’ll pay for a silver filling from 1982 instead of your composite restoration.”

5. “Timely filing exceeded”—because heaven forbid you submitted the claim 33 days after service instead of 30.

So…What Can Dentists Actually Do About It?

Let’s be clear: fighting denials is part art, part science, and part blind rage. But here are some actual strategies that work (most of the time):

1. Appeal Everything. No, Seriously.

The American Medical Association reports that when patients or providers appeal, denials are overturned up to 40% of the time. That means you’re leaving money on the table if you’re not appealing.

Write strong appeal letters. Cite plan documents. Use clinical notes. And don’t be afraid to use bold formatting when the stupid is just too much to tolerate.

2. Educate Your Patients on the Denial Game

Create a handout (or better yet, a meme-filled flyer) explaining how and why dental claims get denied. Help them understand the difference between insurance decisions and actual clinical needs. You’d be surprised how many patients are willing to fight alongside you when they realize the insurer is playing dirty.

Bonus: show patients how to submit their own complaints to the state insurance commissioner. Nothing says “fix your nonsense” like a flood of angry consumer complaints.

3. Use External Review Rights

Most states allow patients to request an independent review of denied claims. This process is often faster and more successful than internal appeals. And yes, even dental claims can qualify—especially when medically necessary care (think sedation, surgery, systemic conditions) is involved.

4. Track Your Denials and Expose the Patterns

Don’t just fix each denial—track them. Build a spreadsheet. Get your team involved. When you see that 75% of your D4341s are denied by a certain insurance plan, you now have ammunition for collective complaints, negotiation, and public pressure.

Pro tip: Reporting patterns to the National Association of Insurance Commissioners (NAIC) has gotten results in other sectors. Don’t assume no one cares.

5. Phone a Friend—Preferably an Insurance Nerd

Outsource your verification, claims submission, and appeals to a billing expert or consulting firm that lives for these battles. These folks know exactly how to phrase things, how to escalate issues, and which buttons to push. (Like… cough Veritas Dental Resources, cough.)

The Final Word: Be a Denial Disruptor, Not a Doormat

It’s easy to feel powerless in the face of denial culture, but remember: insurance companies are betting you won’t fight back. That’s how they win.

Yes, the system is broken. Yes, it’s soul-crushing at times. But you have power. You have patients who trust you, data that backs you, and legal rights that matter.

So channel your inner Gladiator, sharpen your appeal-writing sword, and remember: the only thing worse than a denied claim… is a dentist who gives up.

You were trained to fix teeth—not play insurance roulette. But if they’re going to turn this into a game, it’s time we start winning.

Quick Recap:

• Denial culture is raging in all corners of healthcare—not just dentistry.

• Appeals work, but you have to be persistent and strategic.

• Patient education is your not-so-secret weapon.

• Data tracking + external reviews = powerful leverage.

• Stay professional, stay relentless, and never stop advocating.

Need help turning your denial chaos into reimbursement wins? Partner with pros who’ve battled this beast and lived to tell the tale. (Cough Veritas Dental Resources cough.)

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com