You did the work. You submitted the claim. And then... nothing.

Every dental office has experienced the pain of unpaid insurance claims. Days turn into weeks, and weeks into months. Your accounts receivable keeps growing—and so does your frustration.

Chapter 11 of Understanding Dental Insurance by Dr. Travis Campbell offers a refreshingly practical roadmap to getting paid. But if the insurance world already feels overwhelming, his style can be a little dense. So here’s a simpler, clearer breakdown of what every dentist and team should know about navigating unpaid claims.

Step 1: Know the Timeline

Most insurance companies are required to respond to claims within 30 days. That doesn’t mean they’ll pay in 30 days—but they need to take some action.

• If they need more information, they’ll request it.

• If there’s an issue, they’ll deny or delay.

• Ideally, they pay.

Your job? Follow up no later than day 31 if you haven’t received a response.

Pro Tip: Run your aging claims report weekly. Highlight any claims over 30 days and start following up immediately.

Step 2: Use Your Scripts and Track Everything

Dr. Campbell suggests having a go-to script when calling insurance. Keep it short, polite, and firm:

“Hi, I’m calling about claim number [XYZ] for patient [Name]. The date of service was [Date]. It’s been over 30 days, and we haven’t received a payment or response. Can you give me the current status?”

Take detailed notes on:

• Who you spoke to

• What they said

• Any reference number

• The next steps

This becomes your record in case you need to escalate.

Step 3: Understand the Common Excuses

Insurance companies are notorious for vague delays. Here are the usual suspects—and how to respond:

1. “We never received the claim.”
   → Resubmit electronically or by mail, and get a confirmation.

2. “We need additional information.”
   → Find out exactly what’s missing. Was it X-rays? Narrative? Charting?

3. “The claim is under review.”
   → Ask for a time frame. Then call back if it’s not resolved by then.

Don’t accept vague answers like “we’re working on it.” Always get specifics.

Step 4: Resubmit with Confidence

If a claim has been lost, delayed, or denied due to missing documents, don’t panic. Just resubmit—but do it strategically:

• Include all supporting documents (X-rays, narratives, periodontal charting, etc.).

• Add a cover letter briefly explaining why you’re resubmitting and what’s included.

• Always include the original claim number if it’s a resubmission.

Document everything.

Step 5: Know When to Escalate

If you’ve followed up and still aren’t seeing progress, escalate:

• Ask for a supervisor or claims manager.

• If needed, submit a formal appeal.

• You can even contact your state insurance commissioner if it gets really bad.

Insurance companies have rules. If they’re not following them, you’re allowed to push back professionally.

Step 6: Don’t Let the Patient Off the Hook Too Soon

Here’s the reality: sometimes insurance just doesn’t pay. That doesn’t mean you’re out of luck.

If the denial is valid (not a mistake), the patient is responsible. Make sure your financial policies clearly state this.

“We’ll work with your insurance to collect payment, but ultimately, any unpaid balance is your responsibility.”

Put it in writing. Review it during the first visit. Avoid surprises.

Step 7: Build a System (So You Don’t Go Crazy)

Handling unpaid claims should not be a one-off project. Dr. Campbell recommends creating a clear office system, including:

• A weekly report to track unpaid claims

• A standard follow-up process (phone, email, documentation)

• Regular training for your admin team

• Accountability—make sure someone owns this task

Final Thought: You Deserve to Get Paid

You worked hard for that crown, filling, or scaling and root planing. You took care of the patient. You did your part.

Chasing insurance payments can feel soul-sucking. But with a structured approach and a little persistence, you can take back control. As Dr. Campbell emphasizes, this is a business skill that can be mastered—not a mystery to be feared.

So take a deep breath, organize your process, and remember: insurance companies count on dental offices giving up. But not you.

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