Across the health-care spectrum, cost barriers stand in the way of patients accessing care. According to a KFF
analysis1 of a National Health Interview Survey,2 more than one in four adults (some 28% of
those surveyed3) reported delaying or skipping dental, medical, or mental health-care services or
prescription drugs because of costs. As a result, they potentially exposed themselves to leaving serious and
underlying conditions untreated.
Cost hurdles, however, are most severe in dental care. A 2024 ADA Health Policy Institute report4 found 13% of the population faced cost barriers to dental care, compared with just 4%-5% for medical and mental health services, prescription drugs, and eyeglasses.
While a lack of insurance coverage and low Medicaid reimbursement rates are culprits, even insured patients report
avoiding care when facing high out-of-pocket costs and deductibles, as highlighted in a recent KFF Consumer
Survey5 on insurance experiences. Denied claims can further exacerbate the problem, discouraging patients
from seeking or continuing treatment.
Dental practices can position teams to play a proactive role in helping patients navigate these challenges. Here are
four ways practices can help patients overcome barriers to dental care.
Help patients understand their plans
Navigating dental insurance can be a monumental, disheartening task for patients, from figuring out which treatments
are covered and their financial responsibility to finding a dentist. Once a patient enters a practice, however,
providers can alleviate some of this burden by helping them understand their insurance plans and benefits. Dental
providers can cut through red tape and jargon to give patients a simple rundown of their plan, outlining covered
services, annual maximums, deductibles, and copayments.
Taking the time to guide patients through their insurance coverage and offer additional resources can eliminate
financial surprises in dental care. This approach can build trust between patients and providers while boosting
patient confidence and willingness to seek care.
Offer preauthorization assistance
Insurance policies are complex and change year to year, making it difficult and time-consuming for dental providers
to first learn about, and then explain, the terms of individual policies. The preauthorization process that clearly
determines a patient’s coverage makes this feat simpler. Routine and preventive services are generally 100% covered
by insurance, while procedures outside of this scope—including crowns, root canals, gum surgery, dentures, bridges,
extractions, and implant treatments—likely require preauthorization.
When dental providers assist patients with the preauthorization process, they can help prevent treatment delays,
payment obligation surprises, and coverage denials. This isn’t a guarantee; approval delays and denials are still
possible. However, it’s important for patients to have an advocate in their corner, helping navigate the intricacies
of their dental coverage.
Provide cost estimates and payment options
The cost of dental services continues to rise, with the latest Consumer Price Index report6 showing an
increase of approximately 2% over the past year—with projections showing a compounded annual growth rate of
5.33%7 between 2024 and 2033.
Because care has grown more expensive, 92% of respondents in a study by the financial services company
Synchrony8 indicated they would consider holding off on dental treatments. In fact, 17% of those surveyed
said they ignored a recommended procedure, with nearly 44% adding this choice caused additional dental issues. And
of the 29% of respondents who delayed care, 22% indicated that postponing treatment resulted in other oral health
problems.
Providers can help patients avoid treatment delays and potentially more issues by guiding them through coverage
options, offering cost estimates, and providing flexible payment plans. Providing transparency in coverage and costs
can help patients manage their financial expectations. With financing and payment installment options available,
patients can also manage their expenses over time while still receiving the immediate treatments they need.
File an appeal for denied claims
Dental claim denials are an unfortunate reality of the dental health-care system. They’re a shared frustration for
patients and practices that lead to treatment delays and higher costs.
Practices can challenge denials by filing appeals with supporting documentation to justify why a claim should be
covered. For instance, providers often face denials for periodontal scaling and root planing procedures. Despite
being key to treating gum disease, these treatments are often deemed not medically necessary by insurers or
exceeding coverage limits. This is just one example of the disconnect between recommended treatments and insurance
approval.
Other common reasons for claim denials include the need for preauthorization, coding errors, missing information,
policy limitations, and noncovered services. To mitigate the risk of denials, providers should communicate with
patients about their coverage limitations and advocate on their behalf should a claim dispute arise.
As the cost of dental services continues to rise, providers can alleviate stress and confusion by guiding their
patients through their coverage, out-of-pocket costs, and potential claim denials. When providers advocate for their
care, patients are encouraged to seek routine checkups, follow treatment plans, and improve their health—dental and
beyond.
