Concierge Advocacy for Maximizing Dental Benefit Reimbursement

Background

An Emry Health Concierge client had several dental bills for services they had paid entirely out of pocket. These services, totaling $6,160, were provided by an out-of-network dental office. The client was unaware of their dental benefits and their ability to submit claims for partial reimbursement. Additionally, they were paying for an individual dental policy that was not being utilized effectively, as their provider was out of network.

How We Helped ‍

During the initial kickoff call, we advised the client to share all relevant documentation regarding their insurance and provider interactions before taking any action. Upon reviewing the submitted dental bills, our team identified that the claims had never been submitted to the client’s dental insurance provider.

Claim Submission:

• We contacted the dental office to obtain itemized bills

• Our team prepared and submitted the claims to insurance company on the client’s behalf

Insurance Reimbursement:

• The claims were processed successfully by dental plan, and the client received out-of-network reimbursement up to the maximum benefit allowed, totaling $1,300

Policy Optimization:

• We reviewed the client’s individual dental insurance policy and discovered it was set to auto-renew despite being underutilized due to the out-of-network provider

• The client opted to drop the policy, saving $1,052 annually in premiums

Time Savings:

• By managing the entire process, from contacting the provider to submitting claims and optimizing the insurance policy, we saved the client significant time and effort

Outcomes

• Reimbursement: $1,300 recovered through out-of-network claims

• Policy Savings: $1,052 saved annually by canceling the unused dental policy

• Total Savings: $2,352

• Time Efficiency: Hours of administrative work were saved, allowing the client to focus on other priorities

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