Paid your dentist out of pocket? How to get your dental insurance to reimburse you?

“How do I get my money back from dental insurance?” is one of the most common questions in our office. The answer depends mostly on one thing: whether your dentist is in your PPO’s network. In-network, the office files and gets paid directly. Out-of-network, you usually pay first and then claim the money back yourself.

This guide walks through both, explains the paperwork, and covers what to do when a claim is delayed or denied. It applies to the main PPO plans we work with in Frisco: Aetna, Cigna, Delta Dental, MetLife and UnitedHealthcare.

Quick answer: With an in-network dentist, you do not file anything: the office submits the claim and you pay only your share. With an out-of-network dentist, you pay the bill, send your insurer a claim form with the itemized bill, and the insurer reimburses you based on its allowed amount. Every claim ends with an Explanation of Benefits (EOB).

In-network or out-of-network: who files the claim?

• In-network dentist: the office checks your benefits, sends the claim electronically and is paid by the insurer. Fees are set by the network agreement, so your share is usually smaller.
• Out-of-network dentist: you typically pay in full at the visit. You then file a claim, and the insurer reimburses you according to its allowed amount for the procedure, which may be less than the office charged.

How do you file a dental claim yourself, step by step?

1. Get an itemized bill. It should list each procedure with its dental procedure code, the date, the tooth or area treated and the fee.
2. Download your insurer’s claim form. It is on your insurer’s member site (links below).
3. Fill it in and attach the itemized bill. Include your member ID and group number exactly as they appear on your card.
4. Submit it promptly. Plans set filing deadlines. Many members can upload claims online.
5. Watch for the EOB. It shows what the plan paid and why. Reimbursement usually follows by check or direct deposit.

What should your itemized bill include?

A claim is only as good as the paperwork behind it. Before you leave an out-of-network office, ask for a statement that shows:

• the patient’s name and date of birth, and the subscriber’s member ID and group number;
• the date of service for each procedure;
• the dental procedure code (CDT code) and a plain description;
• the tooth number or area of the mouth;
• the fee for each line and the total paid;
• the dentist’s name, address and license or provider number.

For crowns, bridges, implants and some periodontal treatment, insurers often ask for X-rays or a short narrative as well. Sending them with the first claim avoids a round of back-and-forth.

Have two plans? How coordination of benefits works

If you have dental coverage from two plans, they coordinate: the primary plan pays first and the secondary plan may pay part of the rest. Send the claim to the primary plan first, then send the secondary plan its own claim with a copy of the primary plan’s EOB. For children covered by both parents, the plan of the parent whose birthday falls earlier in the year is usually primary.

How do you read your Explanation of Benefits (EOB)?

The EOB is the insurer’s receipt for a claim. It lists the amount billed, the allowed amount, what the plan paid, and your remaining responsibility. It is not a bill. Compare it with your dentist’s statement: if the numbers do not match, call the office or the insurer before you pay anything extra.

Where is your insurer’s member portal?

• Aetna: Aetna Find a Doctor (dental networks and member sign-in)
• Cigna: myCigna
• Delta Dental: Delta Dental member portal
• MetLife: MetLife MyBenefits
• UnitedHealthcare: myUHC

Are orthodontic and Invisalign claims different?

Orthodontic benefits are usually paid in installments over the length of treatment rather than in one payment, and they count against a separate lifetime orthodontic maximum. A pre-treatment estimate before you start is the best way to know what to expect. Our carrier guides explain it plan by plan:

• Does Cigna cover Invisalign? · Cigna PPO at Coit Dental
• Does Delta Dental cover Invisalign? · Delta Dental PPO at Coit Dental
• Does MetLife cover Invisalign? · MetLife PPO at Coit Dental
• Does UnitedHealthcare cover Invisalign? · UnitedHealthcare PPO at Coit Dental
• Does Aetna cover Invisalign? · Aetna PPO at Coit Dental

What if a claim is delayed or denied?

Most problems come from missing information: a code, a tooth number, X-rays for a crown, or the wrong member ID. Check the reason on your EOB, send what is missing, and keep copies. If you still disagree with the decision, your plan documents describe the appeal process. If we treated you, our team will help with the paperwork.

Coit Dental is in-network with all five plans listed above, so for our patients the claim is our job, not yours. Contact us or call 214-387-8400 if you would like us to check your benefits.

Frequently asked questions

How long does dental insurance reimbursement take?

Many clean claims are processed within a few weeks of being received. Claims with missing information take longer, which is why itemized bills and correct codes matter.

Do I have to file the claim myself?

Not when you see an in-network dentist. In-network offices like Coit Dental file for you, and the insurer pays the office directly. You usually file yourself only when you see an out-of-network dentist.

What is an Explanation of Benefits (EOB)?

A statement from your insurer for each claim. It lists the fee, the allowed amount, what the plan paid and what you owe. It is not a bill.

Is there a deadline to submit a dental claim?

Yes. Plans set a time limit for filing claims, often months rather than years. Check your plan documents and submit as soon as you can.

What if my dental claim is denied?

Read the reason on the EOB. Many denials are fixed by sending missing information. If you disagree, your plan describes how to appeal; your dentist’s office can usually help with the paperwork.

General information only. Coverage and account rules vary by plan and employer; your plan documents and account administrator have the final word.