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Medical necessity claim denials and Ohio's external review process law

by Christopher Moore, MA - ODA Director of Dental Services
ODA Today

The Ohio Dental Association at times receives calls from member dentists concerned about insurance company claim denials because the carrier determined the work the dentist provided was not medically necessary. If appealing the denial does not provide a satisfactory resolution to the matter, then the dentist and patient may want to consider utilizing Ohio’s external review law.

The Ohio Department of Insurance (ODI) reports that “all health plan issuers must (among other things) provide a…

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