Why Dental Advocacy Is Essential in Today’s Healthcare System
At the National Dental Advocacy Program®, our Board-Certified Patient Advocates (BCPAs) work directly with patients navigating some of the most complex intersections of dental and medical care.
Over the last several years, we have supported individuals who are
In active dental pain
Confused about insurance coverage
Referred from specialist to specialist
Facing unexplained denials
Attempting medical reimbursement for dental procedures
Overwhelmed by insurance portals and conflicting information
And what we consistently see is this:
Patients are expected to navigate a system that was not designed for laypeople.
What We See on the Front Lines
As healthcare advocates, we have experience operating in both clinical and insurance-facing environments. We review treatment plans. We interpret EOBs. We communicate with provider offices. We speak directly with insurance carriers — on both member and provider lines.
Here is what we have observed:
Member Lines Often Provide Incomplete or Inaccurate Information
When patients call their insurance plans directly, they are frequently connected with representatives who are
Reading from scripts
Limited to what appears on their screen
Not trained in medical or dental coding
Unable to interpret nuanced questions
We have encountered situations where:
Benefits were misquoted.
Coverage was described incorrectly.
Representatives misunderstood procedural terminology.
Patients were told “it’s not covered” when it actually required proper submission.
This not only creates confusion — it can damage trust between patient and provider.
Dental-to-Medical Billing Is a Major Gap
A significant portion of our advocacy work involves assisting patients with reimbursement for dental procedures that qualify under medical insurance due to underlying medical conditions.
In these cases, we frequently see:
Dental offices unfamiliar with medical billing protocols.
Patients unsure how to request documentation.
Medical plans requiring diagnosis-driven claim formats.
Denials due to improper coding alignment.
Portals that are difficult to navigate and poorly explained.
Without structured advocacy, these cases often stall.
With structured advocacy, we are able to:
Coordinate documentation between providers.
Ensure diagnoses support procedures.
Clarify submission pathways.
Track claim status.
Escalate appropriately when needed.
We have seen measurable success in helping patients recover reimbursement that may otherwise have been forfeited.
The “Specialist Loop” — A Growing Concern
One of the most distressing patterns we encounter is what we call the “Specialist Loop.”
A patient in pain may be referred from:
General dentist → to oral surgeon → to primary care physician → to ENT → to neurologist → back to dentistry
Each provider focuses on their specialty. But no one coordinates the full picture.
Patients are left acting as intermediaries between professionals who are not communicating directly.
As healthcare advocates, we step in to:
Clarify roles.
Confirm clinical recommendations.
Identify missing diagnostics.
Ensure providers have the necessary documentation.
Create a clear next-step plan.
Advocacy transforms fragmentation into structure.
The Insurance Portal Problem
We routinely review member portals with patients. What we see includes:
Vague claim statuses.
Confusing remark codes.
Technical language without explanation.
Inconsistent terminology between plans.
Lack of transparency around appeal rights.
Explanation of Benefits (EOB) forms often assume industry knowledge. Patients are expected to understand:
Allowed amounts
Contractual adjustments
Coordination of benefits
Medical necessity determinations
Appeal timelines
As trained advocates, we interpret these details and translate them into clear, actionable guidance
When Patients Feel Intimidated by the System
In some cases, patients report feeling:
Dismissed by representatives.
Overwhelmed by documentation requests.
Unsure how to respond to denial letters.
Pressured by timelines they do not understand.
As BCPAs & healthcare advocates, we recognize procedural patterns. We understand how claims systems function. We know that:
Formatting matters.
Terminology matters.
Sequencing matters.
Documentation structure matters.
Advocacy introduces strategic clarity into a highly procedural environment.
Why Advocacy Creates Accountability
When an advocate is formally involved:
Communications are documented.
Timelines are tracked.
Inconsistent information is escalated.
Providers receive clear summaries.
Insurance representatives recognize structured representation.
This changes the trajectory of a case.
It reduces confusion. It increases clarity. It creates accountability across all parties.
The Core Issue
Healthcare systems — both dental and medical — are increasingly complex.
Premiums rise. Benefits narrow. Documentation requirements increase. Language becomes more technical.
Yet patients are still expected to navigate independently.
At the National Dental Advocacy Program, we believe:
Patients deserve:
Transparent explanations.
Coordinated care.
Accurate benefit interpretation.
Strategic claim navigation.
Relief from unnecessary administrative burden.
Advocacy is not about confrontation. It is about coordination. It is about clarity. It is about empowering patients to make informed decisions.
Our Commitment as BCPAs & as YOUR Dental Advocate
As Board-Certified Patient Advocates, we are guided by professional standards that prioritize:
Ethical representation
Confidentiality
Neutral facilitation
Accurate interpretation of information
Patient-centered decision support
We do not replace providers. We do not replace insurance plans.
We bridge the gap between them.
And in doing so, we help patients:
Get answers.
Understand their options.
Navigate appeals.
Coordinate specialists.
Seek reimbursement appropriately.
Move forward with care — instead of remaining stuck in confusion.
How Advocacy Services May Be Covered — And How We Help Patients Move Forward
At the National Dental Advocacy Program, our Board-Certified Patient Advocates (BCPAs) not only guide patients through complex systems — we also work to ensure advocacy itself is accessible.
One of the most important conversations we are having right now is this:
Advocacy services may be covered under certain health plans and reimbursement accounts.
Many patients simply don’t know this.
Let’s break it down clearly.
Medicare, Medicaid & Medicare Advantage
There are qualifying situations where advocacy services may be covered or coordinated under:
Medicare
Medicaid
Medicare Advantage Plans
Coverage depends on:
The specific plan structure
Medical necessity criteria
Care coordination benefits included in the policy
Case management eligibility
Supplemental plan features
Every plan is different. We do not assume coverage — we verify it.
If a patient is interested in exploring whether their advocacy services qualify under their plan, we coordinate this process through our partnership with:
This collaboration allows us to:
✔ Assess plan eligibility
✔ Identify qualifying factors
✔ Coordinate proper documentation
✔ Determine if services may be reimbursable or covered
✔ Ensure compliance with plan requirements
We are incredibly excited about this expansion because it allows us to reach more patients — especially seniors and individuals with complex medical needs.
HSA & FSA Accounts May Cover Advocacy Services
Another important benefit patients often overlook:
Health Savings Accounts (HSA) Flexible Spending Accounts (FSA)
In many cases, advocacy services can qualify as reimbursable healthcare-related expenses.
However:
It depends on the employer’s plan design.
It depends on how the account is structured.
Some plans require a Letter of Medical Necessity.
Some require itemized invoices.
Some require specific service descriptions.
We cannot assume coverage — but there is absolutely a possibility.
When patients reach out to us, we can:
✔ Provide documentation needed for reimbursement
✔ Clarify service descriptions
✔ Assist with submission requirements
✔ Help determine next steps
It always comes down to the individual plan — and that’s where advocacy becomes powerful.
We ask the right questions.
Advocacy Is More Than Insurance Navigation
While insurance navigation is a large part of what we do, advocacy also includes:
Resource Identification
We help patients locate:
Local charitable dental programs
Sliding-scale clinics
Senior care resources
Community-based funding options
Dental school clinics
State-based assistance programs
Foundation grants
Specialty referral programs
Many patients do not know these resources exist.
And often, providers do not have the time or capacity to research them.
Advocates bridge that gap.
Closing Thoughts
From our direct experience, one thing is clear:
The system is complex. But patients should not have to face it alone.
Advocacy provides structure in chaos. It creates pathways where there were none. And most importantly, it helps patients get out of pain — physically, financially, and emotionally.
This is why we do this work.
— The National Dental Advocacy Program® YOUR Dental Advocate
