DiscoverThe Dental Billing Podcast3 Things Every Dental Biller Should Know About the Insurance Commissioner
3 Things Every Dental Biller Should Know About the Insurance Commissioner

3 Things Every Dental Biller Should Know About the Insurance Commissioner

Update: 2025-06-25
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Dental insurance companies often deny necessary treatment claims not because they should, but because they can—and we explore how to fight back effectively through appeals and regulatory complaints.

• 59% of denied claims are upheld simply because no appeal is ever filed
• Unreasonable denials occur when patients have benefits but claims are still denied
• State insurance commissioners can investigate denials and prompt payment violations
• Understanding the difference between fully-insured and self-funded (ERISA) plans
• For self-funded plans, complaints must go to the Department of Labor (866-444-3272)
• Gather evidence including denials, submission reports, and clinical notes
• Position your complaint as patient advocacy rather than financial recovery
• Insurance companies cannot dictate treatment or force doctors to work for free

Remember: You're not just a biller—you are the patient advocate and the system of checks and balances they didn't see coming.


Join The Biller Acceleration Mentorship Wait List Here: (Only 5 Spots Left in 2025!!)

https://linktr.ee/dental_billing_coach

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
ericka@dentalbillingdoneright.com

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min


Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)


Delta Dental Locum Tenens Form:

https://www1.deltadentalins.com/content/dam/ddins/en/pdf/dentists/locum-tenens-form.pdf





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3 Things Every Dental Biller Should Know About the Insurance Commissioner

3 Things Every Dental Biller Should Know About the Insurance Commissioner

Ericka Aguilar