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Searching: insurance denials
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Message Board
Views: 319 | Replies: 2
Has anyone had an experience with being denied disability insurance benefits? What happened? What steps to take? Contact the company to learn their appeal process. I did for a knee replacement... It was a ADA policy with Great Western... I hire an Attorney and file an appeal in the state of origin.. And lost that one too. Stay healthy doug
May 07, 2014
Anesthesiology
Message Board
Views: 124 | Replies: 1
Greetings, I was just wondering what the general consensus is on Dental Coding and Billing versus a contracted insurance company's interpretation of CDT. Who wins when you have coded the case correctly but the insurance company says that it was billed incorrectly (because it's a Non Covered
November 18, 2014
Anesthesiology
Message Board
Views: 370 | Replies: 13
? Located in Ohio by the way if that helps with the legal aspect. Just call up the admin office of her med school and ask what legal terms are in place for student rotations. Maybe also call your malpractice insurance and get their take on it if she will be under your license. Finally I would make an extra
November 21, 2024
Anesthesiology
Message Board
Views: 295 | Replies: 12
Not sure if this is a new trend, but an insurance company just refused my 3rd unit of IV sedation and I was told that they Rounded Down to the nearest unit of anesthesia. So I provided 34min of sedation, they reimbursed for two 15min increments. I advised them that this is just not how it works
October 18, 2022
Anesthesiology
Message Board
Views: 708 | Replies: 17
I am about 50 percent in network with insurances. I did a start up from scratch about 2 years ago. I have taken multiple short term ortho courses. I am frustrated because there are a lot of insurances saying thatthey cover the limited ortho code. A lot of the allowable PPO fees are around 2000
November 24, 2015
Anesthesiology
Message Board
Views: 374 | Replies: 10
Got my first case ready to roll but BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA basically wants to know why an ORAL SLEEP APPLIANCE is better than a CPAP. Do you have an insurance narrative or can you find one that states why the CPAP is contraindicated for my patient or the OSA has been shown
June 28, 2016
Anesthesiology
Message Board
Views: 246 | Replies: 5
conscious sedation as opposed to minimal sedation. This is almost never covered by insurance. So set your fee knowing there will be $0 coverage from insurance companies. There are many different opinions on what your fee should be. I would suggest you look at the value of the dentistry you intend
December 16, 2022
Anesthesiology
Message Board
Views: 225 | Replies: 1
Does anyone have experience with successfully coding and billing for D9612? I was taught to always document what you do and to code for what you do. I was recently told by an insurance company that D9612 was included in the IV sedation codes D9241 and D9242 - even though these codes only include
November 16, 2014
Anesthesiology
Message Board
Views: 735 | Replies: 35
minutes would be $100, between 30-45 minutes would be $300. As soon as you hit 16 minutes, then you are into the 2nd 15 minutes. Bigger problem I have run into is that some insurance companies want each D9223 listed separately, and others want it once with a multiplier for the number of units
December 08, 2019
Anesthesiology
Message Board
Views: 340 | Replies: 1
are D9243 and D9223 for all 15 minute increments). Not a big deal for longer cases but definitely relevant for single tooth extractions or shorter procedures. Dang I hope the insurances adjust accordingly. Our first 30 is more than3.5 timesthan a single 15 min rembursement. Not a big deal but I'd rather the extra 15 be in my pocket and not the insurances.
October 10, 2015
Anesthesiology
Message Board
Views: 746 | Replies: 16
that to insurance or Medicaid, and it was denied. Its the insurance company. Don't argue with me, fight it with the insurance company....Okay, that's important info. So that means it becomes a Non Covered Service (NCS)and the patient's financial responsibility. You can look at your insurance
December 23, 2014
Anesthesiology
Message Board
Views: 612 | Replies: 16
called unbundling fees. In Washington State insurance companies have filed complaits with DQAC against dentists for unbundling ........ Also phycians fees are global, as are ours. All parts of the procedure are included in the global fee. Charge a rush lab fee for same day. We do our own denture repair
April 24, 2016
Anesthesiology
Message Board
Views: 308 | Replies: 7
Does anyone have a narrative for N2O that will help pt get coverage? Thanks, Linda Please expand on what exactly you are looking for. Thanks. I have done insurance reviews for 20 years for 5 different third party administrators, a multi state insurance company and about 30 different union
January 12, 2016
Anesthesiology
Message Board
Views: 389 | Replies: 5
Question: If my new associate is licensed and certified to do IV sedation(we are in Florida), is there any increased liability for my practice and/or my building? He states the liability is on his malpractice insurance etc, but wanted to get more clarity on that. I have one business entity
February 03, 2023
Anesthesiology
Message Board
Views: 608 | Replies: 26
and I thought is was good academically. A little side question. Im in Florida too. How much more do you have to pay for liability insurance? Any other recurring fees that you are aware of? Thank you. The UAB class is no more. Make sure your state will accept any class you are interested in before you
June 29, 2024
Anesthesiology
Message Board
Views: 3821 | Replies: 127
any time there is an issue. This is a cost cutting measure thanks to poor insurance reimbursements...thanks obama care So what happens if there are 2 emergencies simultaneously? Not sure I would blame Obama for this. Nurse anything to me is like dental offices having the expanded duty assistants
October 17, 2017
Anesthesiology
Message Board
Views: 1949 | Replies: 85
but insurance reimburses like 19 dollars so I dont offer it really. we charge $300+ and it is worth it. I only use it a few dozen times a year. Do your insurance plans pay for nitrous? If they don't its a noncovered service and you should be able to charge your office fee and not submit to insurance
August 28, 2025
Anesthesiology
Message Board
Views: 616 | Replies: 3
anesthesia is where it is headed. We are at the mercy of the malpractice insurance companies and the state boards. I am personally more concerned with the malpractice carriers. Not too long ago, they weren't even insuring GA in the office. I pay $10k a year for insurance. Some recent high profile cases
March 26, 2018
Anesthesiology
Message Board
Views: 104 | Replies: 2
about oraqix but, I just never found a specific use case to trigger a purchase. I think with insurance patients, it is recommended to give local otherwise risk non-coverage in the event of an audit. For regular prophies, my hygienists have always had success with topical.
January 03, 2024
Anesthesiology
Message Board
Views: 127 | Replies: 4
said to ask the board. The nurse anesthetist said they are practicing under their own license and as I'm not the one pushing or monitoring I'm ok.Now I'm confused.Please advise,Josh I don't know the rules of CO but I would consult your liability insurance company and tell them you are thinking about
July 18, 2019
Anesthesiology
Message Board
Views: 836 | Replies: 20
;>>> There are not many people who do it in my area>>> SO practice builder indeed >>>>Working as an associate, I can go to the other practices of my employer and make (may be ) more money every year >>>What impact it usually has on my Malpractice Insurance. I
March 08, 2015
Anesthesiology
Message Board
Views: 328 | Replies: 2
... They don't have to play the insurance game by doing it that way like they do in the hospital. They can get 5 or six hundred a case with little over head by going to a dental office. Line up a few cases in one morning at a dental office and it can add up for them. Plus they don't have to worry about
September 22, 2016
Anesthesiology
Message Board
Views: 416 | Replies: 4
What do you all charge for nitrous? I charge private insurances and self pay patients $65. However, I mainly use in on Medicaid kids and it only pays $20. I am LOSING money by offering nitrous! Of course on a lot of kids I wouldn't even attempt treatment without it, but I can't be losing money
June 23, 2014
Anesthesiology
Message Board
Views: 899 | Replies: 31
I don't know about anyone else, but here in my town it is expensive to use nitrous. I estimated one time that it costs me about $50-$60 every time I use it. Insurance never pays that much, especially Medicaid which only pays $20!!! I really don't use it that much, however I do like to use
February 04, 2015
Anesthesiology
Message Board
Views: 62 | Replies: 0
Does anyone know the requirement to be able to charge out this code, as for as insurances go? Is there a certain level of sedation that is required that must be documented? What about monitoring? I'm guessing monitoring varies state to state.
June 18, 2017
Anesthesiology
Message Board
Views: 1872 | Replies: 43
this certainly is within the standard of care, so not malpractice, if plaintiff attorneys in these scenarios can't get a settlement they will go the trial so they can put the plaintiff on the stand in front of a jury and have her smile. Case closed. It's always is cheaper for the defendant's insurance
November 06, 2015
Anesthesiology
Message Board
Views: 5207 | Replies: 165
playing devil's advocate- in general dentistry, when you take PPO insurance (which most OS do), you cut costs by using cheaper labs. Minimal Risk. In Oral Surgery, when you take PPOs, you cut costs by not using Dental Anesthetist/anesthesiologist during surgery on healthy 17 yo who most likely
December 16, 2024
Anesthesiology
Message Board
Views: 184 | Replies: 2
Does anyone know or have any idea how to get IV sedation covered by medical insurance for crown and bridge/implant/extraction cases. I know they usually cover impacted teeth. Any codes I should be aware of. Chances are it will not be covered. I have been doing IV for 11 years and have only seen 2-3 cases that were...Same as he said - been doing for many years. We just have them pay (and pay for dentistry up front).
July 25, 2014
Anesthesiology
Message Board
Views: 278 | Replies: 6
the insurance company decide if they will cover it or not. As not all patient outcomes can be predicted. My issue is MCNA has it as a bundled service so if no treatment is completed its not paid. Also in the rules for sedation it is billing as just sedation there is not an ADA code for actual
November 13, 2017
Anesthesiology
Message Board
Views: 450 | Replies: 9
So the ADA has changed IV sedation codes to 9243 for moderate sedation in 15 minute increments. Not that insurance covers IV sedation very often but how are others using this code. Do you charge out the code multiple times for a longer procedure? I'm interested in other people's thoughts
May 28, 2016
Anesthesiology
Message Board
Views: 217 | Replies: 5
for the safety of your patients then you probably shouldn't be sedating in your officeSorry Maxilla...but cut us a break please.....I have patients paying the periodontist $30,000 for extractions and implants, but they balk at $750 for the sedation to do it because their insurance won't cover
June 04, 2018
Anesthesiology
Message Board
Views: 195 | Replies: 2
So I am filling out a renewal for malpractice insurance. There is a section on concious sedation. I looked up the term and found many different definitions including one that said if I am using nitrous, an IV line is mandatory? Another one listed some very heavy drugs like propofol, ketamine etc
March 07, 2020
Anesthesiology
Message Board
Views: 1592 | Replies: 57
whole life working towards isnt ruined...Never saturated that low - but had several very healthy ASA 1 patients desat on induction or spasm. positive pressure every time worked fine.I hate that Texas does not have reasonable GA hospital coverage for dental wirh ppo insurance. Its just criminal that we
October 20, 2020
Anesthesiology
Message Board
Views: 394 | Replies: 10
rate is or how others handle... What do you think of letting the CRNA/anesthesiologist get paid directly by the patient and not have to involve you at all? I think your liability insurance will love...Would they? Why? I would think i am liable for anything that is done in my office regardless who gets
February 04, 2014
Anesthesiology
Message Board
Views: 627 | Replies: 11
? Usually only makes sense in cases where patient's medical insurance does not cover GA in a hospital setting, or patient has high deductible and can save money by paying the anesthesiologist out of pocket and avoid facility charges. Spinpedojane, in your experience, how much do patients pay to go
September 08, 2014
Anesthesiology
Message Board
Views: 78 | Replies: 2
is the cost. Goodrx has 5 sprix bottles (5 day dosing) costing near $1,000. My insurance flat out denies it since its not on formulary. An IM vial of torodol cost me about 3 bucks.
June 22, 2018
Anesthesiology
Message Board
Views: 414 | Replies: 9
spoke Spanish, Chinese, Vietnamese, Japanese, Korean, 2 Filipino languages, and a couple of others. Of the 12 folks who worked there it was rare to have more than 2 of us who were white. 95% of patients had insurance 60% had double insurance. We did not do a lot of big bridges almost no aesthetic
November 09, 2020
Anesthesiology
Message Board
Views: 433 | Replies: 15
numbing protocol just for her. Move on and help the next person.Remember this was prior to advertising. I depended on referrals from other dentists and the dental association. I never got to the point of doing more IV sedations than 50 a year. To do IV sedation the malpractice insurance was +$6,000
October 05, 2017
Anesthesiology
Message Board
Views: 456 | Replies: 8
was $470. Holy heck....Anyone know of another source, or acceptable substitute drug? What if you wrote a script for one of your assistants with rx coverage and had them get it and you paid for it. Any thoughts and legality of that?It's not really an insurance issue, it's only like $40 for a vial
February 01, 2016
Anesthesiology
Message Board
Views: 354 | Replies: 5
to comply with NFPA 2018. The Dentist Advantage malpractice insurance company sent out a letter to their insured essentially stating that if you are not compliant, you are not insured. Look for more of the same in the future and it will get the point where you will be required to go to a surgery
October 17, 2018
Anesthesiology
Message Board
Views: 351 | Replies: 5
calculus and associated periodontal disease. And of course I must be careful not to throw the other office under the bus because as always I only have half the info. He has been in limbo while we fight his insurance and his lack of motivation to get involved. He will not pay for new SRP and I'm
July 21, 2014
Anesthesiology
Message Board
Views: 520 | Replies: 10
to an OMF after I've offered them IV sedation (as opposed to when I did oral/nitrous). 2. Most insurances will cover IV. Only in rare cases will there be coverage for oral. 3. IV sedation is WAY more predictable than oral. 4. Hygiene checks - I am assuming you'll have hygiene running during your cases
March 01, 2018
Anesthesiology
Message Board
Views: 1233 | Replies: 20
... is not covered by insurance?????Access to care only matters if its a need. When its a want people will find a way. I am always amazed at the patients with cosmetic enhancements that won't pony up $200 to get out of pain. The one that really makes me laugh are the people with untreated dental
December 28, 2015
Anesthesiology
Message Board
Views: 305 | Replies: 3
to pay our $15 per carpule fee to inject the OraVerse into the same site as the mandibular block, and have the numbness gone by the time they get back to work. When they are told that the anesthetic effect can be dissipated in half the time, they often inquire if insurance covers it, generally agree
November 02, 2014
Anesthesiology
Message Board
Views: 298 | Replies: 7
for to avoid complications. Not really their fault; hard to have experience doing something you rarely do when we do it several times per day. At the end of the day it's my license, liability, and goodwill under the gun. In my area. hygienists have liability insurance but guaranteed I'm getting thrown
July 23, 2021
Anesthesiology
Message Board
Views: 579 | Replies: 8
A. When I finished the GPR in 2012 I worked at a Clinic (all insurances and Medicaid) and did 1-2 IV sedations a day. I love doing it but it is very stressful. Realistically, you place all your own IVs, you deliver the drugs, and do the dentistry, so it does get overwhelming sometimes. I am currently
June 05, 2014
Anesthesiology
Message Board
Views: 294 | Replies: 6
it, especially in Texas. And Cali is so confusing with GA rates....goes down, goes up. It isn't pegged to the price of diprivan unfortunately. Ah that would make sense. Are da rates higher than gp or oms ? The same way other codes are higher for specialists ? Not higher at all. With any insurance
April 11, 2020
Anesthesiology
Message Board
Views: 544 | Replies: 3
another Obamacare patient who hasn't been to the dentist in 20 years because he had no insurance. He will get the free dentures in 6 weeks, but he wanted sympathy. I am glad the patient released the dentist to discuss the case publicly so he could defend himself, and I think most of us could decipher
April 17, 2016
Anesthesiology
Message Board
Views: 216 | Replies: 5
only use 2% Lidocaine no matter what Crazy story the patient tells me.These patients are a great revenue stream if you are a cash office and can charge double for your time. Insurance or Medicaid I suggest you refer.Just a normal crazy day in my crazy officeAs time has gone on I have lost patience
June 07, 2019
Anesthesiology
Message Board
Views: 1221 | Replies: 23
and the ability to advertise. However, I know a hope of a specialty status in Dental Anesthesiology is to make inroads with insurance companies to increase reimbursement for the patients who require GA (special needs/pediatrics lacking the ability to cooperate). Also I believe another hope is that by being
May 20, 2014
Anesthesiology
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