You’ve submitted a clean claim. X-rays attached. Narrative included. CDT codes on point. Your billing coordinator even burned sage and offered up a prayer to the insurance gods.

And then… crickets.

Weeks go by. The only response is a cryptic EOB that says “under review,” “missing information,” or—our personal favorite—“not medically necessary,” despite a molar looking like it lost a bar fight.

Welcome to the slow-motion circus that is dental insurance claims processing—where the only thing moving slower than payments is the accountability of the insurance companies themselves.

But here’s the kicker: delayed payments aren’t just a hassle—they’re a business model.

Let’s peel back the curtain, cite the laws, and take a well-deserved jab at the insurance industry while we’re at it.

Delay Tactic #1: The ‘Oops, We Need More Info’ Game

Here’s how it works:
You submit a claim with everything—radiographs, chart notes, intraoral photos, CDT codes, a detailed narrative written like a Pulitzer submission.

Then—bam—you get a request for… exactly what you already sent.

This "we didn’t receive it" or "we need more information" strategy is a classic delay tactic.

Translation: “We’re just going to pretend we didn’t see the X-ray so we can buy ourselves another 30 days. Cool? Cool.”

Delay Tactic #2: The ‘We Sent It to a Different Department’ Shuffle

Ever tried calling to check the status of a claim, only to be transferred more times than a football in the Super Bowl?

“We’re checking with our clinical review team…”
“That’s with our processing center…”
“This department handles that plan… but only on Tuesdays during a full moon.”

You’re on hold for 45 minutes just to be told, “We’ll call you back.” (Spoiler: they won’t.)

But Why the Delay? Follow the Money.

Every day that a claim goes unpaid, guess who’s earning interest on that money?

Not you. Not your patient. Definitely not your team who stayed late to chase down coverage verifications.

Nope—the insurance company.

They call it “float.” And in the financial world, float refers to the money held (but not paid out) that earns interest or is invested until it legally must be released. The longer they delay payments, the longer they hold onto that money—and yes, it’s profitable.

In fact, some major insurers make more money on float than they do on actual underwriting.

“We deny your D2740 for insufficient documentation. Also, thanks for the interest income on that crown you didn’t get paid for.”

What the Law Says About Claim Delays

Now let’s bring in the big guns.

Federal Regulations:

ERISA (Employee Retirement Income Security Act)

Most dental plans provided through employers fall under ERISA. While it was designed to protect employees, it also gives insurers a lot of flexibility. However…

ERISA does require timely processing of claims, typically within 30 days for health-related claims (though many dental plans conveniently skirt this).

BUT—if your claim is delayed, denied, or ignored, you have the right to appeal, and insurance companies are required to respond to those appeals within specific timelines.

State Laws:

Most states have prompt payment laws that apply to fully-insured plans (not self-funded ones—thanks again, ERISA loopholes ). Let’s look at a few examples:

• California: Claims must be processed within 30 business days, or the insurance company may be penalized.

• Texas: Carriers must pay within 30 calendar days of receiving a clean claim—or pay interest on the unpaid amount.

• New York: Insurers must pay within 45 days, or again, interest is owed.

Every state defines a “clean claim” differently, but if your documentation meets their criteria and they still don’t pay—you’ve got grounds to escalate.

How to Fight Back (Without Losing Your Sanity)

Step 1: Know Your State’s Prompt Pay Law

Look up your state insurance department's regulations. Know the deadlines and cite them in your follow-ups. Nothing gets Cheryl in claims processing moving like a polite threat of legal recourse.

Step 2: Document Everything

Use email over phone when possible. If you must call, log names, call times, and reference numbers like your practice's profitability depends on it—because it does.

Step 3: Send a “Final Demand” Letter

If a claim is unjustly delayed, send a written notice referencing state/federal law, stating:

“According to [insert statute], this claim is now overdue. Please remit payment within 10 business days to avoid regulatory complaint.”

They’ll get the message. Or you file a complaint. And yes, those do work.

Step 4: Escalate With a Smile (and an Advocate)

Still no resolution? This is where the pros come in.

VeritasDentalResources.com can help you escalate claims disputes, appeal denials, and train your team to prevent delays in the first place.

Because let’s face it: you didn’t sign up to be a part-time insurance attorney.

Fun Fact: They’re Banking on Your Burnout

Insurance companies know that most offices won’t chase a $400 claim for too long. They know you’re tired. Busy. Short-staffed. Distracted.

And that’s where they win.

But not you. Not anymore.

Final Thought: Claim What’s Yours

If you’ve made it this far in the article, congrats—you’re now better informed than most insurance reps.

So next time your claim is delayed because “we didn’t receive the X-ray,” feel free to send them a copy again, along with a printed copy of your state's prompt pay law, your appeal letter, and maybe a glitter bomb (kidding… kind of).

Insurance may play the long game, but you know the rules now. And armed with knowledge, sarcasm, and a partner like Veritas, you don’t have to let delay tactics dictate your bottom line.

Because the only thing that should take 60 days in your office… is your own personal vacation.

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