If you’ve ever logged into an insurance portal and seen a claim sitting in “pending” purgatory for months, congratulations, you’re officially part of a very large, very frustrated club.

I get calls from dentists every single week saying things like:

• “We haven’t been paid in 11 months.”

• “They keep asking for the same documents over and over.”

• “They say it’s under review… again.”

And the worst part?
Many insurance plans are counting on your exhaustion.

Let’s be clear right out of the gate:

Delaying claims is not an accident. It’s a strategy.

The Two Types of Claims Delay (And Why Both Are Dangerous)

1. The Extreme Delay (6–11+ Months)
   This is the nuclear option.
   The plan simply does not pay, does not deny, and does not resolve.

Why it happens:

• The plan hopes the office writes it off

• The patient stops calling

• The claim quietly expires or becomes too old to appeal

• Your team gives up because “it’s not worth the time”

This is not inefficiency.
This is intentional financial pressure.

2. The “Polite” Delay (30–90 Days)
   This one is sneakier and far more common.

Here’s how it works:

• Claim received ✔️

• Status marked as “in process” ✔️

• Random request for records ✔️

• Another “review” ✔️

• Another 30 days ✔️

• Another internal transfer ✔️

No denial.
No payment.
Just time.

Multiply that by hundreds of claims, and suddenly:

• Cash flow tightens

• Staff time is wasted

• Doctors question whether it’s worth billing correctly

That’s not coincidence.
That’s leverage.

Why Insurance Plans Love Delay Tactics

Insurance companies understand three things very well:

• Dental offices are busy

• Staff turnover disrupts follow-up

• Most offices don’t escalate legally

So instead of outright denying claims, which triggers appeals, complaints, and scrutiny, many plans choose the quieter option.

Delay until the provider gives up.

And yes, this happens to in-network and out-of-network dentists alike.

The Legal Reality Insurance Plans Hope You Don’t Know

Here’s the part where insurance companies get uncomfortable.

Most states have prompt-pay laws requiring carriers to:

• Acknowledge claims within a specific timeframe

• Pay or deny clean claims within a defined number of days

• Provide written justification for delays

Federal law also comes into play for many employer-sponsored plans.

Delaying a claim indefinitely without resolution is not allowed, no matter how many times a plan says:

• “It’s under review”

• “We’re waiting on internal processing”

• “Please allow additional time”

Translation:
“We’re hoping you won’t push back.”

Why Demand Letters Work (When Done Correctly)

This is where many offices hesitate and where most insurance plans fold.

A proper demand letter:

• Cites specific state and federal law

• Documents the claim history and timeline

• Establishes a clear deadline

• Signals willingness to escalate to regulators or legal counsel

Once a plan realizes:

• You understand the law

• You’re documenting everything

• You’re no longer playing nice

Payments suddenly appear.
Funny how that works.

The Most Expensive Mistake Dentists Make

The biggest error I see?

Treating delayed claims like a customer-service issue instead of a legal one.

Calling the same 800 number for the 12th time is not a strategy.
Waiting another 30 days “just in case” is not patience, it’s exposure.

Delayed claims:

• Distort your AR

• Hide under-reimbursement

• Create compliance and audit risk

• Train insurance plans to keep pushing boundaries

Silence is interpreted as consent.

A Final (Very Honest) Thought

You run a dental practice, not a bank for insurance companies.

You fulfilled your contractual obligation:

• You treated the patient

• You documented appropriately

• You submitted the claim

At that point, payment is not a favor, it’s a legal requirement.

Insurance companies are sophisticated organizations with legal departments, compliance teams, and algorithms designed to protect their cash flow.

You’re allowed to protect yours too.

And if an insurance plan is delaying claims for months on end?

They’re not confused.
They’re not overwhelmed.
They’re testing you.

The good news?
Once you push back the right way, most of them blink first.

And if you want more clarity, strategy, and occasional sarcasm on how to deal with this nonsense?

Stick around.
There’s plenty more where this came from.

Benjamin Tuinei
Founder – Veritas Dental Resources, LLC
📞 888-808-4513
Services: PPO Fee Negotiators, PPO Fee Negotiating, Insurance Fee Negotiating, Insurance Credentialing, Insurance Verifications
Websites: www.VeritasDentalResources.com, www.VerusDental.com