Why Insurance Payments Go Missing (And Where to Find Them)

You submitted the claim three months ago. The patient says their insurance paid. Your bank shows nothing. Where did that money go?

The Vanishing Payment Problem

Insurance payments go missing more often than most practices realize. The claim was submitted. The insurance company processed it. Somewhere between approval and your bank account, the payment disappeared.

Sometimes the money is truly lost. More often, it is hiding in plain sight: deposited but unposted, sent to the wrong address, or credited under a different patient name.

Finding these missing payments requires understanding how they get lost in the first place. Once you know the common failure points, you can systematically track them down and, more importantly, prevent them from going missing again.

How Insurance Payments Get Lost

Stage 1: Payment Never Made

Sometimes the payment genuinely was never sent. Reasons include:

Claim denied but nobody noticed. The claim was rejected or denied, but the practice never received or reviewed the notification. The patient account sits waiting for payment that will never come.

Claim still pending. The insurance company has not finished processing. Processing times vary from days to months depending on the payer and claim complexity.

Coordination of benefits issues. When patients have multiple insurance policies, the primary insurer may have denied pending secondary information, or vice versa.

Timely filing deadline missed. Claims must be submitted within a certain timeframe (usually 90 days to one year). Claims submitted late are automatically denied.

Patient termed from coverage. The patient's insurance ended before the date of service, but the practice did not verify eligibility.

How to find it: Check claim status directly with the payer. Log into the payer portal or call the provider line. Get the actual claim status: paid, denied, pending, or never received.

Stage 2: Payment Sent to Wrong Place

The insurance company made a payment, but it went somewhere other than your bank account.

Wrong address on file. If your practice address is incorrect in the payer system, checks get mailed elsewhere.

Wrong EFT information. Bank account or routing numbers might be wrong, causing EFT deposits to fail or go to wrong accounts.

Payment sent to patient. Some plans pay the subscriber directly, especially if the provider is out of network. The insurance company sent money to your patient, not you.

Payment sent to another provider. Referral situations or provider database errors can cause payments to route incorrectly.

How to find it: Contact the payer and ask where payment was sent. Get the trace number for EFTs or check number for paper checks. Verify your demographic information in their system.

Stage 3: Payment Received But Not Recognized

The money arrived at your practice, but it was not identified or recorded.

EFT deposited without ERA. The electronic payment hit your bank, but nobody matched it to specific patient claims. It sits as an unidentified deposit.

Check deposited without posting. A paper check was deposited, but payments were never posted to patient accounts. The check cleared, the bank balance increased, but the PMS shows outstanding balances.

Payment combined with others. Your missing payment is buried inside a larger lump sum deposit covering many patients. Without proper ERA matching, individual payments are invisible.

How to find it: Review bank deposits around the expected payment date. Match deposit amounts to ERA totals. Check for payments that were deposited but not posted.

Stage 4: Payment Received But Misposted

The payment was received and posted, but it was applied incorrectly.

Posted to wrong patient. Similar names, transposed ID numbers, or careless data entry caused the payment to credit the wrong account.

Posted to wrong date of service. The payment was applied to a different visit than the one it was meant for.

Posted to wrong provider. In multi-provider practices, payments sometimes get attributed to the wrong dentist.

Applied as adjustment instead of payment. Someone mistakenly wrote off the balance instead of posting the payment.

How to find it: Search the PMS for the payment amount or check/trace number. Review the ERA and compare to posting records. Look at similar patient names.

Stage 5: Payment Received Then Reversed

The payment arrived, was posted, then was taken back.

Insurance take-back. The payer recouped the payment due to overpayment, audit finding, or coordination of benefits adjustment.

Claim audit or review. The payer conducted a post-payment review and determined the claim should not have been paid.

Patient changed insurance retroactively. Coverage was terminated or changed effective before the service date.

How to find it: Review take-back notifications. Check recent ERAs for negative amounts. Look at the patient account history for reversals.

A Systematic Search Process

When a payment is missing, work through this checklist:

Step 1: Verify the Claim Was Submitted

Before assuming payment is missing, confirm the claim was actually filed.

Check your PMS for claim submission record
Verify through your clearinghouse that the claim was transmitted
Confirm the payer received it

Claims that were never submitted are not missing payments. They are work that never happened.

Step 2: Check Claim Status With Payer

Log into the payer portal or call the provider services line. Find out:

Was the claim received?
Has it been processed?
If processed, what was the determination?
If paid, when, how much, and where was it sent?

Get specific details. A general "it was paid" is not enough. You need dates, amounts, and delivery method.

Step 3: Trace the Payment Delivery

If the payer says they paid, trace where the payment went:

For EFTs:

Get the trace number
Check your bank deposits for that amount on the expected date
Verify EFT information on file with the payer

For checks:

Get the check number
Ask if the check was cashed (payers can verify this)
If cashed, request a copy of the endorsed check

Step 4: Search Your Records

Look for the payment in your systems:

Bank account:

Search for deposits matching the payment amount
Look at date ranges before and after expected arrival
Check for combined deposits that include the amount

Practice management system:

Search by payment amount
Search by patient name
Search by check or trace number
Review the patient's payment history

Clearinghouse:

Check for ERAs that were received
Look for ERA that matches the payment

Step 5: Investigate Misposting

If money was received but cannot be found:

Review similar patient names
Check other dates of service for the same patient
Look at other patients treated on the same day
Review adjustment reports for the period

Step 6: Document and Resolve

Once you find the payment (or confirm it was never made):

Document what happened and why
Post or correct the payment
Note any process failures that allowed this to happen
Follow up on claims that need resubmission or appeal

Preventing Missing Payments

Verify Eligibility Before Service

Catch coverage issues before they become missing payment issues:

Run eligibility checks the day before appointments
Verify subscriber information matches your records
Confirm the patient is active and coverage applies to planned services

Submit Claims Promptly

File claims within days of service, not weeks:

Same-day or next-day claim submission
Batch billing delays lose money
Track submission confirmations

Monitor Claim Status Proactively

Do not wait for payments to be late. Track claim status actively:

Run weekly aging reports
Follow up on claims not paid within 30 days
Check payer portals for pending claims

Match EFTs to ERAs Daily

Every insurance EFT should be matched to an ERA within 24-48 hours:

Check bank account for new insurance deposits daily
Match each deposit to its ERA immediately
Investigate unmatched deposits right away

Post Payments Accurately

Prevent misposting with careful verification:

Verify patient name and date of service before posting
Double-check amounts
Use auto-posting with review rather than blind trust

Review Unidentified Deposits Weekly

Do not let unidentified deposits age:

Weekly review of all unmatched bank deposits
Escalate deposits unidentified after one week
Resolve or write off by 30 days

When to Write It Off

Some missing payments are genuinely unrecoverable:

Timely filing has expired. If you cannot refile and the payer will not reconsider, the revenue is lost.

Documentation is insufficient. You cannot prove the service was provided or that the claim is valid.

Cost exceeds benefit. If recovering $50 will take hours of staff time, write it off and improve processes.

Payment went to patient. If insurance paid the patient directly, your recourse is with the patient, not the payer.

Document write-offs with the reason. Track write-off patterns to identify systemic issues.

The Cost of Missing Payments

Missing payments are not just inconvenient. They represent real financial loss.

Consider a practice that loses track of just 1% of insurance payments:

$600,000 annual insurance revenue
1% missing = $6,000 per year

That is $6,000 in revenue that was earned but never collected, often because of preventable process failures.

Practices with weak insurance tracking lose far more than 1%. Some lose 3-5% of insurance revenue to missing payments, mispostings, and unworked denials.

Strong practices track every claim from submission to posting. They reconcile daily. They investigate quickly. They recover what is theirs.

Tired of hunting for missing insurance payments? Zeldent automatically matches your bank deposits to expected insurance revenue, flagging payments that should have arrived but did not. Schedule a demo to see proactive payment tracking.