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Searching: insurance denials
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Page 6 of 46
Message Board (2268)
Message Board
Views: 23 | Replies: 1
I think one of the biggest issues with the Dental Software programs I've used (Dentrix and EagleSoft) is their inability to flag specific frequency or coverage issues per insurance plan. I'm unsure if any of the Cloud-based softwares do this, but if so please let me know! We have to rely too much
December 18, 2025
Software Discussions
Message Board
Views: 104 | Replies: 4
Just wondering in which States Delta Dental Insurance checks go straight to the patients, and in which States Delta Dental Insurance checks can go directly to the office ? I think it's all over the map. It may even depend on the employer or at least that is what DD will tell you. We stopped trying
September 03, 2025
Practice Management & Administrative Forum
Message Board
Views: 106 | Replies: 5
I'm so sick and tired of these insurance companies leasing each other's networks. It is creating havoc for my office, requiring a lot of phone calls and follow-up. MetLife leasing Sunlife network cost me so much money as Sunlife has a pathetic fee schedule. I opted out and terminated Sunlife
March 18, 2026
Claims Processing
Message Board
Views: 64 | Replies: 2
Is it legal to bill your spouses dental insurance for work you perform on them? Anyone have input on this? Thanks! Depends on your contract, some specifically say you cannot bill for working on family. If you are OON, you don't have that restriction HOWEVER, it is fraud to bill insurance for a patient you are not intending to collect money from if insurance does not pay, so keep that in mind.
January 12, 2026
Billing
Message Board
Views: 11866 | Replies: 318
for the insurance company is we can get people in very quickly and many of our patients called "their dentist" when they broke a tooth but he couldn't see them for a week so we do the BU/crown today for them. WIN WIN they can have them back for the 5 dollar prophy if they want I just dropped all
March 17, 2026
Ideas To Make Your Practice Grow
Message Board
Views: 34078 | Replies: 2116
when getting on Medicare. Advantage plans have serious drawbacks vs the G and N Gap plans. The G and N plans have monthly premiums and you have to purchase a separate drug plan but there are no networks and generally no denial like the advantage plans and I think the yearly max out of pocket is like
November 07, 2025
Personal Finance
Message Board
Views: 838 | Replies: 31
Hi Has anyone used the Insurance Verification service from Over Jet AI? What has your experience been? We are currently doing everything via phone and fax, we have Vyne and they do automated breakdowns but its kind of clunky. Overjet is telling me that they are directly connected with payors
October 31, 2025
Claims Processing
Message Board
Views: 265 | Replies: 10
I need some input on a pt going through a divorce. I see both her ex-husband and her as pts in my practice. Per their agreement, she was supposed to be under his insurance through the end of 2025 but we checked delta in December and it said she was terminated. We informed pt prior to completing any
February 28, 2026
Legal Issues
Message Board
Views: 69 | Replies: 1
If you have practiced long enough, you know every dental insurance plan eventually shows up in your schedule. The patient walks in smiling and says, 'Good news, I have insurance.' You smile back and think, 'Define good.' Physicians Mutual Dental is one of those plans that sounds fantastic at first
February 28, 2026
PPOs and HMOs
Message Board
Views: 34078 | Replies: 2116
isn't the only thing that matters in life and cities are where it is better to make connections, meet your spouse, grow as an individual, etc. Especially if you are a young single person nice! Being a dentist is California, you will be paid less by insurance face more competition, staff wages thru
October 23, 2025
Personal Finance
Message Board
Views: 168 | Replies: 7
I have a front desk employee who I love. She was formerly chairside and we have transitioned her to the front for various reasons. She's doing great with the 'basics'. We have another employee who is handling the higher end stuff regarding insurance, billing, etc. The other employee is also doing
January 27, 2026
Claims Processing
Message Board
Views: 190 | Replies: 8
3 of 7 Compensation should be based on: I can't control how well the office collects. She be paid on adjusted production If you work for a long time in an office, isn't adjusted production based compensation is basically like collection based compensation ? What insurance did not pay
March 02, 2026
Associates Corner
Message Board
Views: 179 | Replies: 6
, collected ~$230 from the pt via cc. SL paid their amount too. In mid February, her mom (whom I've never met) reaches out (and is irate) and says she has a new BCBS insurance and we need to submit through it. We put it in our system and filed claims with it for her Feb appt. Last week, mom calls
March 05, 2026
Claims Processing
Message Board
Views: 156 | Replies: 4
Hello, Has anyone had any experience with Insurance companies continuing to pay based on fee schedule even though the contract termination date has passed? Unicare (Wellpoint) has agreed that my participation terminated in a 30 day period as my contract stated, yet they are allowing the fee
July 20, 2025
Going Out of Network
Message Board
Views: 107 | Replies: 4
I wonder if anyone can tell me how to generate a report for production/collection per insurance in Dentrix. I had done it years ago but just can't remember how anymore. Thinking about dropping couple of them and wanna not doing blind. Thx! Bobby Any Dentrix users that can help out Bobby
October 09, 2025
PPOs and HMOs
Message Board
Views: 236 | Replies: 11
. They also need honesty when complications happen. Overfills, separated instruments, missed anatomy, and post op surprises are not improved by evasive language. The profession has learned, sometimes expensively, that technical mistakes become legal disasters when they are wrapped in denial. The funniest
March 13, 2026
Endodontics
Message Board
Views: 230 | Replies: 10
Just sent a desist letter to Aetna's Equian group. They were going back to a filling from years ago and claiming overpayment and sending threatening letters. I sent them an email letting them know Arizona has a 1-year limit on insurance companies pursuing overpayments and that I would be referring
November 27, 2025
Going Out of Network
Message Board
Views: 227 | Replies: 6
into how many instrument sets are waiting, how long they've waited, and whether your capacity is keeping pace. 4. Staffing flexibility matters. Rigid policies that disallow external help (temps, float pool) can turn a bottleneck into a crisis. 5. Don't let pride or denial hamper response. When problems
October 16, 2025
Infection Control
Message Board
Views: 603 | Replies: 22
All of these teeth are class III or IV mobility. Pt does not want immediate dentures and just want the teeth out first, then dentures later. Her insurance is paying $60 for each simple extraction, $118 for each surgical extraction but obviously all of these teeth will have to be coded as simple
March 09, 2026
Oral & Maxillofacial Surgery
Message Board
Views: 358 | Replies: 18
Is this legal? I gave a 90 days notice to an Insurance company to terminate the PPO contract and they said I cannot terminate the contract for 2 years from the date, They negotiated for a fee increase in JAN after 11 years but because of their recent bullying I send a termination letter, I received
October 05, 2025
PPOs and HMOs
Message Board
Views: 2392 | Replies: 106
to work lower volume and keep a bigger piece of the pie. Having just dropped my last insurance, I understand. It's partially a final decision, partially not. Edit This could very well could make your practice sell easier if you're barely breaking even on hygiene. From a strictly selling standpoint
December 16, 2025
Staff Management Issues
Message Board
Views: 57 | Replies: 2
the more restrictions there are, the less chance the patient will use that maximum. Keep in mind insurance knows the stats. So to give you some simple basics: 50% of patients don't use the policy at all in a year 25% use hygiene only 20% use more than just hygiene, but do not max out 4-5% max out
February 26, 2026
Dental Insurance for Dentists
Message Board
Views: 315 | Replies: 3
I just acquired a practice last month that is heavy PPO. I am looking at increasing my fees as well as looking into better insurance reimbursements as they appear very low. I contacted Unlock the PPO but they do not deal with transitions - therefore, does anyone have any other recommendations? Do I
June 30, 2025
PPOs and HMOs
Message Board
Views: 785 | Replies: 51
Is anyone else noticing how chaotic the Obamacare Marketplace is getting for 2026? What is everyone doing for their offices? I have a hygienist considering going to a DSO just so she can get health insurance. She said her policy is going from $100 a month with the subsidies to $1750 a month next
November 18, 2025
Medical / Health Insurance
Message Board
Views: 189 | Replies: 9
insurance. Not sure if that works with DD. To get technical, most insurance contracts require you accept their patients. Now, what are they going to possibly do if you breach this and Delta cares? Drop you from the network....oh darn, sounds like that is the path you are on anyway. Now, from a practice
September 24, 2025
Delta Dental
Message Board
Views: 406 | Replies: 16
) Purchase Price $515,000 Gross Income $900,000+ Adjusted Net Income $225,000+ Projected Cash Flow ~$ 180,500 after debt service, including $50,000 working capital Number of Active Patients 800+ "Out-of-network" Insurance 50% No Insurance 50% Number of New Patients 5-10 per month on average Hygiene
February 26, 2026
Practice Acquisitions
Message Board
Views: 372 | Replies: 19
Are there easy part time jobs out there with health insurance coverage? My current self-pay premium is $3300/month for us fully retired 55yo couple. I heard Starbucks is only12hrs but haven't verified. Are you a dentist? If you're only 55 and having a difficult time supporting yourself then maybe
December 18, 2025
Personal Finance
Message Board
Views: 57 | Replies: 1
Dentists and dental students rallied at the Alabama State House this week urging the state Legislature to pass dental insurance reform laws. They're backing bills that would require dental insurers to spend a higher percentage of premiums on actual patient care rather than administrative costs
January 29, 2026
Going Out of Network
Message Board
Views: 204138 | Replies: 100186
the exact same crimes as the nazis. Whatever helps you sleep at night. One of the children that's starving has a pre-existing condition and you all pretend that's somehow a win. Even Trump is admitting the obvious. Netanyahu and team genocide still in denial. The World Health Organization said
July 30, 2025
Politics
Message Board
Views: 88 | Replies: 2
Have any of you gotten health insurance thru Gusto the payroll service? any feedback? I'm looking for any and all possibilities given increasing costs. Right now I get them thru some TDA group pricing via Wallace (agency). Yup. Works pretty seamlessly. Not sure how prices compare to your company
November 04, 2025
Practice Management & Administrative Forum
Message Board
Views: 116 | Replies: 3
to the original problem: He is trying to do something that will not work out well. "Patient, I get you want to get the most out of your insurance. Your insurance companies have rules that define which is primary vs secondary. If you try to go around these rules, one of two things will happen: 1
March 02, 2026
Claims Processing
Message Board
Views: 102 | Replies: 3
What is the correct response to insurance when a CBCT screen view is not an accepted x-ray from insurance. (CBCT taken for another reason). Taking x-rays for Insurance is not ALARA. It's such a game and yes - I'm ready to drop our last insurance. That point besides, is there a response we can send
October 21, 2025
Claims Processing
Message Board
Views: 1446 | Replies: 65
disagree with this. This sounds like you're treating the insurance not the patient. So what if the debridement triggers the deductible and is not a covered service. That's the patient's dental benefits. If they need it, then they need it. A prophy means the patient has healthy tissue with an absence
February 11, 2026
Front Office Discussion
Message Board
Views: 1031 | Replies: 43
In Evergreen, Alabama a longtime local dentist, Dr. Douglas P. O'Connor, has been arrested and charged with second-degree arson and first-degree insurance fraud linked to an explosion at his own dental practice. The Alabama State Fire Marshal's Office and the state Attorney General's Office spent
February 04, 2026
Legal Issues
Message Board
Views: 108 | Replies: 3
I know that when buyers purchase a/r there is a format for of percentages to pay depending on the age of receivables. does this include outstanding insurance payments? i know some of my ppo's will take even longer than 90 to pay, or delay asking for different radiographs, etc. does that just get
February 02, 2026
Practice Sales
Message Board
Views: 159 | Replies: 10
Didn't want to hijack the other thread; How is everyone doing the NP scheduling that participates with insurance. We currently go through hygiene first most of the time, and book 90 minutes. The problem is on a lot of them they are coming in with no insurance verified and several are leaving due
February 04, 2026
Front Office Discussion
Message Board
Views: 134 | Replies: 7
I learned some patients of mine have a contracted rate for an after hours service call for a dental 'emergency.' In one specific insurance example the reimbursement rate is $100. Well, guess what, I won't go in for that rate. We all know even to get a plumber after hours we're probably paying
October 06, 2025
Billing
Message Board
Views: 204138 | Replies: 100186
with Epstein. I'm pretty sure he's still in denial that Israel is doing anything wrong. The networks didn't spend enough to make it work. If only they had given it more time, and spent what was needed. Colbert was close to having a breakout show, but the higher ups had no vision. They need to be forward
July 23, 2025
Politics
Message Board
Views: 3187 | Replies: 110
Is there any "retirement" program in the school ? Thanks for sharing this. I have not seen this before. Have you had any issues with finding providers? No issues with providers, as I am basically a cash paying patient. I tell them to submit to the insurance company, they are not going to pay
February 11, 2026
Dental "Pearls"
Message Board
Views: 223 | Replies: 7
economically free. Imo..only get minimal term type ins one needs and drop it as soon as possible. Don't use ins for any other reason. Full Disclosure: As a Financial Adviser, I help people with life and disability insurance. I believe that your agent is talking about an Accelerated Terminal Illness Rider
September 24, 2025
Personal Finance
Message Board
Views: 234 | Replies: 16
is the insurance companies want to swallow everyone with their own TPA's, but don't want you to be able to strategically pick them up in a higher paying.TPA. They want and get all of the control. At the end of the day, price control should be a free market variable and not controlled by insurance companies. Yes
February 24, 2026
PPOs and HMOs
Message Board
Views: 339 | Replies: 9
Anyone have a good Break up letter to send patients when you are dropping the insurance company that they have? We are dropping being in network? with Metlife/ Aetna because they refuse to raise our fee schedule. Thanks! I would put the bit about still submitting insurance and them still being
June 27, 2025
PPOs and HMOs
Message Board
Views: 204138 | Replies: 100186
typed. Gosh, where would you or Sibs GET these far fetched ideas? Prolly the REAL issue is, you READ what he posted and actually ADDRESSED his point with a COUNTERPOINT that in true Ram fashion gets chased down the rabbit hole of the RamZone of denials. Stand by for further denials with a BP thumbs up
July 01, 2025
Politics
Message Board
Views: 204138 | Replies: 100186
ideologies on the Altar of Liberalism I see. You are smothered in denial. hopeless. No sense talking to a cult member. Of course you guys wont like this so you will deny this. No reason. Just goes against Trumpism and Fox ideology. Fuck you. If Global Warming were happening, then why did
July 07, 2025
Politics
Message Board
Views: 238 | Replies: 12
Does anyone have any tips on how to bill for all on X Restorative portion only? insurance obviously will heavily downgrade fees, so do we need to bill more codes (study models, surgical guide, temp denture, final hybrid, each abutment, etc.) in order to have more billable items to achieve
January 22, 2026
Coding Q&A
Message Board
Views: 46 | Replies: 2
Dear Dental Insurance Guy and fellow practicioners, Received this EOB w/ downgrades from composite fillings to alloy fees. Please advise how you would handle this one. A. Write off the difference between fee of composite and alloy reimbursement. B. Collect the difference from the patient after
February 04, 2026
Claims Processing
Message Board
Views: 118 | Replies: 6
Our office is experiencing a serious address error with Guardian Dental insurance claims. We submit claims through DentalXchange, and all of our office information in DentalXchange is correct. However, for an unknown reason, Guardian processed our claims under a different dental office
January 02, 2026
Claims Processing
Message Board
Views: 577 | Replies: 24
misunderstanding? What's the goal with the membership plan? I have a fair number of seniors and other clients without insurance. This is to keep them loyal to the office Sounds reasonable. They should like that. You may want to consider incorporating a family plan too. If you see kids. That's fair
February 15, 2026
Marketing
Message Board
Views: 7 | Replies: 0
In 1980, the average dental insurance maximum was $1,500. In 2026, the average dental insurance maximum is... $1,500. If insurance had kept up with inflation, that check should be $5,500 today. By letting patients view the "Max" as a limit, we are neglecting their health. The Breakdown: Patients
January 29, 2026
Ideas To Make Your Practice Grow
Message Board
Views: 121 | Replies: 7
will not send us the insurance checks. We will have to rely on having the patients send us the checks. For all other patients, we will just collect 100% up front. But, those with Medicaid as a secondary. I'm not certain what to do. This is more of an emotional conundrum. About 1/2 of our families
February 11, 2026
Delta Dental
Displaying 251-300 of 2268
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