Insurance Denials for Fluoride Varnish and Well-Child Visits

The Patient Protection and Affordable Care Act (ACA) required insurers to cover evidence-based preventive services without patient cost-sharing. Despite this mandate, pediatricians report issues with reimbursement for fluoride varnish—a treatment recommended by the US Preventive Services Task Force in 2014 for children 5 years and younger and reaffirmed in December 2021 for children 4 years and younger. Furthermore, claim denials are a problem more broadly. We used all-payer claims data (APCD) to examine claim denials for fluoride varnish applications and well-child medical visits (WCVs) for Medicaid and private insurers in Massachusetts.