Helping patients overcome cost barriers, insurance disputes to access dental care

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.

Editor's note: The article appeared in the February 2025 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Telesford I, Winger A, Rae M. Beyond cost, what barriers to health care do consumers face? Peterson-KFF Health System Tracker. August 22, 2024. https://www.healthsystemtracker.org/chart-collection/beyond-cost-what-barriers-to-health-care-do-consumers-face/
2. 2022 NHIS questionnaires, datasets, and documentation. Centers for Disease Control and Prevention. National Center for Health Statistics. November 20, 2024. https://www.cdc.gov/nchs/nhis/documentation/2022-nhis.html
3. National Health Interview Survey. 2022 survey description. Division of Health Interview Statistics. National Center for Health Statistics. Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. June 2023. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2022/srvydesc-508.pdf
4. National trends in dental care use, dental insurance coverage, and cost barriers. American Dental Association Health Policy Institute. September 2024. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/national_trends_dental_use_benefits_barriers_2024.pdf
5. Wallace R, Long M, Pestaina K. Access to adult dental care gets renewed focus in ACA marketplace proposal. KFF. March 8, 2024. https://www.kff.org/policy-watch/access-to-adult-dental-care-gets-renewed-focus-in-aca-marketplace-proposal/
6. Economic indicators. Moody’s Analytics. Updated November 28, 2023. https://www.economy.com/united-states/cpi-urban-consumer-dental-services
7. Pandey D. U.S. dental services market size, share, and trends 2024 to 2034. Precedence Research. https://www.precedenceresearch.com/us-dental-service-market
8. Your smile is yours to keep – and to give away. Synchrony Bank. https://www.dentallifetimeofcare.com/#page=8