I grew up in Western Pennsylvania and returned here to practice dentistry. For the past 16 years, I’ve cared for patients across the region after taking the reins of a long-established local practice.
Recently, a patient came in for a routine cleaning and checkup. During that exam, I identified a problem that required immediate attention and referred the patient to a local oral surgeon, who evaluated and treated it the same day. From a patient-care standpoint, everything worked exactly as it should.
Then the insurance denial arrived.
Because the surgeon’s paperwork was handled first, the insurance company refused to pay for the exam that identified the problem — even stating that the patient could not be billed for it.
The patient reasonably expected that a routine exam would be covered. I reasonably expected that a standard diagnostic service would be covered. This was not a second opinion or an elective visit. It was necessary care delivered promptly.
Instead, payment was denied over paperwork.
Across our region, dental offices are facing more frequent denials, slow payments and growing red tape. Some have stepped away from insurance plans after years of trying to make it work.
Patients deserve clarity. If your dental insurance comes through your employer, ask your HR department to evaluate whether the plan being offered is one local providers can reasonably accept and trust — and to consult with community dental offices when selecting coverage. Insurance should support early diagnosis and coordinated care, not complicate it.
Patients deserve better.
Dr. Michael Chapman
Lower Burrell