Resources for dental offices
Billing surprises can undo trust in seconds. An unexpected balance can lead to longer collection times, frustrated conversations, and the risk of a negative review. The impact reaches beyond relationships. Cash flow slows, staff lose hours to follow-up calls, and disputed charges can stall production. The upside is that most billing complaints come from a few predictable, preventable issues. With clear processes and upfront communication, you can stop these problems before they start. This article covers the five complaints dental patients report most often and offers practical steps to fix the problem.
Aug 15, 2025
1. Unclear or Unexpected Costs
When a bill is higher than expected, trust takes a hit. These gaps often come from overlooked details such as a deductible not yet met, an annual maximum already exhausted, or a LEAT (least expensive alternative treatment) provision, where the plan pays based on the cost of a less expensive material or procedure, leaving the patient to pay the difference. Dental plans often hide these rules in fine print, so patients assume “insurance covers it” until the explanation of benefits says otherwise.
You cannot change a patient’s policy, but you can close the expectation gap by controlling the information they receive before treatment starts. This means giving them a complete picture of what their plan covers, what it might not, and how their share of the cost is calculated. The following steps make that possible:
Verify benefits before every procedure: Confirm remaining deductible, annual maximum, frequency limits, and whether a LEAT downgrade could apply.
Use clear, written estimates: Present an itemized breakdown in plain language, and note that coverage is an estimate, not a guarantee. A short disclaimer such as, “Your plan may pay less if a downgrade applies,” can prevent the “Why didn’t anyone tell me?” call later.
Set context for costs: Remind patients that many annual maximums barely cover the cost of a single crown, so larger treatment plans may require out-of-pocket payment.
Secure prior authorizations when possible: This is especially important for high-cost or specialist treatments to reduce surprises.
Practices that combine thorough benefit checks with clear communication have fewer disputes, faster collections, and patients who feel informed rather than blindsided.
2. Confusing Explanation of Benefits (EOB)
Patients often find an Explanation of Benefits unreadable. They see unfamiliar codes, write-offs, and balances that seem arbitrary, which can quickly lead to frustration and calls to your front desk. The confusion usually starts when the insurer’s raw document is passed along without any context or translation.
Insurance terms such as “alternate benefit applied” or “bundled service” have no meaning for patients outside of the billing world. Missing claim details, such as an X-ray or narrative, can trigger reductions or denials, followed by cryptic adjustment codes. The ADA lists lost attachments and bundling adjustments among the most common third-party payment issues dentists encounter, and these almost always make an EOB harder for a patient to interpret.
Closing this gap requires a process that translates the payer’s language into patient-friendly information:
Explain before sending: Review the EOB internally and rewrite key lines in plain language before issuing the final statement.
Offer a glossary: Provide a simple reference sheet that defines terms like “deductible,” “downgrade,” “bundling,” and “write-off” in everyday language.
Follow up on complex cases: For larger or more complicated claims, schedule a short call to walk the patient through any differences between the estimate and the final coverage.
Store explanations for reuse: Save these plain-language explanations in your knowledge base so staff can provide consistent answers every time the same code or term appears.
When patients understand what their EOB means and why their balance looks the way it does, they are less likely to dispute charges and more likely to trust your team’s billing process.
3. Charges for Services Patients Thought Were Covered
Unexpected balances often result from plan provisions identified too late in the process. A LEAT (least expensive alternative treatment) clause can reduce payment for a posterior composite to the cost of an amalgam, leaving the patient to pay the difference even though the restoration did not change. Other common factors include frequency limits, age restrictions, and bundling rules; for example, many payers bundle a crown buildup with the crown itself, which lowers or eliminates payment for the buildup.
The best time to address these is during benefit verification, before the patient commits to treatment. Each estimate should include:
Deductibles and remaining annual maximums
LEAT clauses that could apply to planned procedures
Bundling rules that affect common restorative or prosthetic services
Once these details are confirmed, review them with the patient in plain language and connect them to their specific treatment plan. For example: “If your plan processes this white filling as a silver filling, your portion could be about $75 more.” Using a clear, relevant example keeps the conversation focused on what matters to the patient.
Written acknowledgment that coverage is not guaranteed helps avoid misunderstandings later. When these verifications and conversations happen before treatment, most post-treatment balance disputes can be avoided entirely.
4. Delayed or Inaccurate Statements
Late or incorrect statements create doubt and invite billing disputes. The root causes are often avoidable: re-keyed fees entered incorrectly, claims stalled past the filing window, duplicate charges, or outdated fee schedules that no longer match your estimates.
Manual data entry is a frequent source of these errors, and even one typo can trigger a patient complaint. Automation reduces this risk by pulling data directly from scheduling, clinical notes, and claims. When paired with electronic remittance posting, automated systems can generate statements immediately, check for mismatches, and send them by mail or digitally. Platforms such as Vyne Dental or Dentrix with QuickBill Premium can auto-post ERA data, submit clean claims, and deliver digital statements with text-to-pay links, eliminating most re-entry and mailing delays.
Accuracy still needs a human check. Review fee schedules quarterly and sync updates across all ledgers so estimates align with final bills. For high-dollar cases, run a quick audit before releasing the statement. Automation handles the routine work at scale, and a targeted human review catches the exceptions most likely to cause disputes.
5. Difficulty Getting Billing Questions Answered
When patients reach out about a bill, they expect a clear explanation quickly. Delays in responding keep balances unpaid and can weaken confidence in your billing process. The main causes are usually undertrained staff, hard-to-find information, and overburdened phone lines.
Build Skill And Confidence
Staff should be able to explain deductibles, downgrades, or denied claims without relying on a manager. Schedule regular micro-trainings and shadowing sessions so new and existing team members stay fluent in insurance basics and can walk through an EOB in plain language. Training tools such as Front Office Rocks offer targeted modules, but reinforcement comes from consistent, real-world practice.
Centralize The Answers
A searchable, HIPAA-compliant knowledge base saves time and keeps responses consistent. Include fee schedules, payer downgrade policies, and step-by-step appeal instructions. When a common question arises (such as “Why did my crown downgrade?”) staff can reference an approved response instead of digging through binders or old emails. Update the knowledge base whenever a new denial or rule change appears.
Offer More Than Phone Support
Secure email and encrypted texting let patients share EOB screenshots and receive answers without tying up the phones. Many practice management systems already have these features, and enabling them can be as simple as adjusting settings. Use these channels for straightforward questions so phone time is reserved for complex cases.
Combining continuous training, an up-to-date knowledge base, and multiple secure communication options shortens response times, improves accuracy, and helps patients feel heard.
Reduce Staffing Gaps with Teero
Short staffing forces your front desk to rush eligibility checks and claim forms, increasing the chance of errors that become patient balances and missed calls. Clinical shortages compound the problem. If a hygienist calls out, the team scrambles to manage schedule changes, assist chairside, and handle benefit questions, which often delays statements and follow-up. Patients interpret those delays as poor service.
Temporary staffing closes this gap by taking recruitment, vetting, and payroll off your plate, so your attention stays on billing accuracy. Same-day staffing platforms help maintain production while your in-house team handles claims and patient inquiries without the usual disruption.
Teero makes this process seamless. Our network of qualified hygienists keeps operatories running, giving your core staff time to complete detailed verifications, accurate coding, and proactive patient follow-up, the tasks that directly prevent complaints. We manage hiring, onboarding, and payroll so you can keep your focus on patient care and accurate billing. Sign up for Teero today to reduce staffing gaps and prevent billing complaints.