Billing Medical Insurance: Claim Disputes & Challenges

When we ask offices why they do not bill medical insurance the reasons range from “it’s too hard” to “I don’t have time.” However, medical billing will help your patients make the most of their benefits and strengthen your practice with a new revenue stream and increased case acceptance. According to a national study, 65% of medical claims are never challenged!

Here are a few tips for billing medical insurance and insurance company policies you need to know.


Claim reconsideration – this takes place prior to a formal appeal.  Issues that would warrant reconsideration are not limited to:

  1. Provider contract issues
  2. Claim payment policies
  3. Processing errors (them thinking this is for dental issues)

Things to remember:

  • Reconsiderations must be filed within 180 days of initial claim submission.
  • A request can be submitted online through
  • A request may also be submitted by phone.

Level 1 – Claim Reconsideration

If you are following up after reconsideration and the decision is not in your favor, a level 1 appeal should be requested either in writing or verbally.

    1. Must be done within 60 calendar days of the reconsideration decision.
    2. Provide medical necessity or additional information for some investigational/experimental criteria.
    3. Additional information was not provided at first submission.

Per Aetna, they must respond within 30 days if no additional information is required for adjudication.  

BCBS of Texas

Level 1 – Claim Dispute

    1. There is a specific claim review form to fill out on their website.
    2. Forms must be submitted within 180 days of receiving the Explanation of Payment (EOP).
    3. BCBSTX will respond with written notification within 45 days.

Level 2 – Claim Dispute

    1. If your decision for level 1 appeal is unfavorable, the 2nd level appeal must be completed within 15 days.
    2. BCBSTX will respond within 30 days of receipt of level 2 appeal.


Level 1 – Provider Reconsideration Request:


Step 1

    1. Contact Cigna representative to request reconsideration.
    2. You will be advised if the representative is unable to help and an appeal must be completed.

Step 2

Complete and mail the request for a health care professional payment review form from their website and/or appeal letter along with all supporting documentation.

Level 2  – Appeal Requests:

This must be received within 180 calendar days from the date of the initial payment or denial decision.  Appeal requests will be handled by a reviewer who was not involved in the initial decision.

  1. Complete the Cigna Appeal form and submit with additional information and any prior information submitted.
  2. Include a copy of the original claim.
  3. Make sure to include a clinical component such as services were denied for no prior authorization, include the operative report and any other documents that support medical necessity.

United Healthcare

Level 1 – Claim Reconsideration

  1. A claim reconsideration request must be submitted within 12 months from the date of the EOB.
  2. Reconsideration may be submitted on or at  Select claims and payments then claim reconsideration.

Level 2 – Claim Appeal

  1. A formal level 2 appeal request must be submitted within 12 months from the date of the EOB.
  2. Attach all supporting materials such as clinical records, the reason for the request or medical necessity supporting documentation (as in articles, medical doctor letter, or website information).

Imagn Medical Billing Service

Due to the complex nature of medical insurance billing, most dental offices are not equipped with the knowledge to properly credential national payers, submit successful claims, or handle aging and appeals. Imagn Medical Billing Service performs the proper credentialing and billing for you, which results in fewer denials and time well saved as you rely on expert help.

One-Time Credential Fee

$795/per dentist

The key to more successful payments

Our experts complete the process so you can start billing medical insurance. Each dentist billing medical insurance needs to be credentialed.

Pay Per Case

Verification of Benefit

$35 per vob

We get your patient’s insurance information so you can set proper expectations with the patient regarding the specific coverage available and any out of pocket fees. This is the most critical step in all of medical billing.

Per Authorization

$40 per auth

All procedures require pre-authorization in order for your practice to get paid. Gaining appropriate authorization can be challenging, let our experts get the job done for you.

Claim Submission

8% of successful claim

You don’t have time to sit on hold. Let us sit on hold and handle the claim submission work for you  We also handle the aging and appeals so you can focus on your practice.

Choose Your Software

Imagn Software is your one stop solution with both medical billing and dental sleep medicine capabilities with world-class support

What most dentist don’t know is that medical billing can increase your case acceptance rate and ensure your patients get the care they need.

Imagn Software

$195 /month

No contract and your satisfaction guaranteed.

Our goal is to give you the best experience. But if you are not satisfied then we will give you a full refund for your software access fee within 30 days of purchase.

Add Imagn Sleep Software

$100 /month

Our software provides everything you need

to give your patient’s the sleep care they deserve.

Patients can no longer afford to have dentists ignore the responsibility of providing care for sleep disorders. Two out of every three Americans report poor sleep; the ability to breathe well is the most important factor in determining a person’s sleep quality. 

Imagn Software Set-up Fee

$399 one-time fee

No contract and your satisfaction guaranteed.

Our goal is to give you the best experience. But if you are not satisfied then we will give you a full refund for your software access fee within 30 days of purchase.

Choose Your Monthly Devdent Support Program

In order for you to succeed, we offer a unique range of customer support solutions including coaching, online resources, implementation programming, and so much more. We keep an eye on the ever changing industry trends so you can focus on your practice

Medical Billing Support

$200 /month

The program to get and keep your staff trained.

Dental Sleep Medicine Support

$200 /month

The program to implement Dental Sleep Medicine into your practice.


$345 /month

Get both of the Medical Billing and Dental Sleep Medicine Support programs at a discount.

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