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Searching: insurance denials
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Page 1 of 22
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Views: 591 | Replies: 14
overhead to pay. Then give a list of free clinics nearby. Send her a certified letter includes a dismissal letter and a copy of insurance denial letter. You only did 1 exam and have not done any treatment. You are not actually her dentist. I'm pretty sure she gave hell to the other dentist
December 01, 2014
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Message Board
Views: 114 | Replies: 2
Hey everyone, looking for some advice from those who've navigated insurance decisions as a practice owner. I recently took over a dental practice and inherited a bit of a complicated insurance situation. The office is currently in-network with Delta Dental PPO (previous owner was Premier) and out
May 29, 2026
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Views: 1552 | Replies: 65
-payment 2. insurance denial 3. insurance bundling, downgrade/alternative benefit KISS rule.You should use the full fee schedule if you are paying me a % of production for my services. Otherwise..use what you are actually charging..which is the PPO or other fee schedule. That's how we did it anyway
November 20, 2017
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Views: 119 | Replies: 3
I am a dental provider for CSEA Insurance for many years. CSEA in the past has covered Fixed Bridgework replacement for missing teeth for many years. CSEA is now down coding any 3 unit bridge I to replace a missing tooth when the abutment teeth have no issues such as any decay or when they have
March 18, 2015
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Views: 2716 | Replies: 111
the door without paying their copay and without letting insurance denials rot in a folder while AR grow and grow. They'll self manage the problems to a large degree, only bringing the really tough ones to your attention. If they're just paid hourly, they'll happily clock out for a nice stress
December 07, 2014
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Views: 275 | Replies: 6
mail addressed to me. 3. Trash, including advertising, etc. I take all insurance and patient related envelopes, open them, and separate contents into two piles: 1. Payments 2. Denials, pre-auths, and insurance newsletter that keep the front updated on whatever the content is. I take 1. Payments
November 07, 2017
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Message Board
Views: 1201 | Replies: 36
. Thinking about selling it and practicing in a more rural area. Just tired of the PPO denials and dual insurance crap.Do you have alot of nurses as patients ? I feel for you :) Not to hijack the thread but i hear this sort of statement a lot. Just wondering, exactly how rural do you have
November 12, 2016
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Message Board
Views: 131 | Replies: 4
agains the plan limitations (like annual maximum, or frequency limits, or non covered benefit) you will also get denials that can not be overturned. Another denial might be due to out of network provider where the insurance does not pay anything to the out of network provider. Int hat case the claim
June 12, 2019
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Views: 553 | Replies: 29
hours that would be about right: Insurance prophy + exam (and then you have the ones who decline x-rays) I have the same problem as you doc. Hygienist producing only about 50% of their pay. We are in a saturated southern cal area. Our hygienist is still seeing 8 patients a day, Slowly adding laser
April 29, 2026
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Message Board
Views: 1246 | Replies: 58
At the end of the day, unless you are Ok to write off the balance due from the insurance in case of denial or encounter any adverse event regarding the case . Patient you treated as a CUSTOMER will revert back to the patient and you become the Dentist or provider again I have never seen a Malpractice
October 24, 2015
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Message Board
Views: 1523 | Replies: 91
are usually the most insurance conscious and most practices will have the most attrition when dropping Delta. This is due to a number of reasons with most of them out of your control including non-assignment of benefits, Delta letters to patients, and the general demographic that usually has Delta
April 25, 2026
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Message Board
Views: 50 | Replies: 4
and not just hemorrhage money based on asymmetric information which is available to the insurance companies but not to us. (Candidly, I hate that this just adds another ~$1,000/month "middle-man" into the process, which siphons more money away from providers and patients. But I would rather pay a PPO
April 15, 2026
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Views: 327 | Replies: 21
adjustments) 2. If you bill out PPO fees, are they using the correct fee schedule. If they are, are the fee schedule up to date? 3 Are adjustments reasons correctly categorized. Was it because of insurance fees adjustment or was it due to non-coverage or was it a down-grade? I took over a practice which
April 13, 2026
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Views: 131 | Replies: 4
it in the education area of our website (click the logo). It's not about limiting new patients, it's more about replacing the number of patients represented by the plan FIRST, then calling the insurance company and cancelling your contract with them. But there's a lot more to doing it right, so grab the guide
February 22, 2021
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Message Board
Views: 30341 | Replies: 503
(considering monthly premiums, wait periods, low minimums, treatment denials, etc) this would be a far superior plan to have. This is not a PPO plan. This is a plan that for the first time doesn't solely benefit the insurance company. Considering I'm married to a dentist, we own a dental practice, and I
August 31, 2018
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Views: 377 | Replies: 15
Is any one having problems with dental insurance denying claims requesting dental radiographs when services have been pre approved? Prior to rendering services we send an estimate of benefits to the insurance companies along with radiographs and the services are approved. After the service
August 12, 2014
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Views: 1003 | Replies: 82
and sent in my termination letters to all insurances. I didn't want to deal with denials, copays, benefits, etc. I just wanted to do good dentistry and get paid fairly for it. So I made my decision to go completely fee for service that day and deal with the consequences. I had already trained my staff
September 04, 2025
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Views: 778 | Replies: 24
is denial really. So if we accept assignment of benefits, file for our patients and the insurance checks come to our practice that's not taking their insurance?I always tell them no and I explain the reason for why we are not and then they say thank you and leave. From now on I am going to say no and I
December 19, 2017
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Message Board
Views: 622 | Replies: 23
Hi I was hoping to get an opinion about a situation with a pt I dismissed. The background is this pt was upset about an insurance issue--it was something to do with her copay. She was upset and started calling my office manager names and belittling her. My office manager was upset and told me about
August 25, 2023
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Views: 1283 | Replies: 64
I need to be trained in front office systems. I know absolutely nothing-my fault. Not even sure what insurances Im in network with. Im essentially an associate in my own office. I need to learn everything so I can train new people so I can eliminate employees easier and prevent them from having
September 26, 2024
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Views: 1393 | Replies: 36
Surely I'm not the only one with this fantasy: Caller: Do you take my insurance? Me: No I'm so sorry, we no longer accept new patients with dental insurance. We're protesting an industry that is siphoning off gazillions (is it really 1/3???) from our national spending on health care
December 10, 2015
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Message Board
Views: 72 | Replies: 1
Hello Friends, What reports do you pull while you are deciding to drop some insurance plans ? I have Open Dental. Thank you . Your goal is to figure out the demographics of your office and the revenue from each plan so you can get an estimate of how many pts you can lose and still be at the same
October 09, 2024
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Views: 1480 | Replies: 51
we have yet to collect anything above $200K. On average my daily production is around $1400. I currently work 4 days a week cos I started working one day a week at another office. I am OON but think I may be going IN with some insurances. post 2019 only, looking at jan-jun 2020 is useless as its
July 26, 2020
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Views: 1069 | Replies: 38
months unless history of high decay. Insurance companies can word things very creatively. I would question her on the denial if they specifically list once in 6 months and then deny. I would also question the need for 4 BW xrays every 6 month however.I pay my hygienist 33% of her production against
June 09, 2019
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Views: 30341 | Replies: 503
don't have to submit any claims because the insurance company advanced you the money at the start of the month. No admin fights, no back and forth X-rays and narratives, no denials. The idea is like the Price is Right - get as close to zero without going over. So let's say it worked out to the tee
March 11, 2018
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Views: 371 | Replies: 25
unexpectedly) The retiring dentist has been practicing for over 30 years as the second owner. As a result, the office is somewhat outdated in terms of interior, billing systems, and overall workflow-it still relies on paper charts and older dental software for insurance claims. I am looking
March 09, 2026
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Views: 2133 | Replies: 82
far as pts numbers go, I think you need to target about 2000 for the average dentist working 4 days a week with 2 hyg. 1300 pts total probably is not the time to drop a big insurance unless you want to work 3 days a week. There are ways to also look at specific plans with UC. A few of the employers
December 14, 2017
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Views: 442 | Replies: 13
I work in two completely different practices and am wondering what normal is when looking at insurance contracts. Do most all FFS practices bill insurance for their patients? Do most FFS practices require at least some payment day of service and then provide refund checks if the patients insurance
May 14, 2019
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Views: 1016 | Replies: 42
I've been to a course or two that stated you just want to get them in the door. Even if they have Medicare of HMO dental plans that you are not a participant. You are supposed to win them over and then they don't want to use their insurance anymore. I don't want to do that. I want to be honest
December 18, 2014
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Message Board
Views: 579 | Replies: 17
I have a busy PPO driven office. I was wondering if anyone knew of a company that could help me with insurance verification? Thanks I would like someone to explain to me why hiring a company to do this is more efficient than just having the front desk quickly type in the member ID number
December 28, 2018
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Message Board
Views: 116 | Replies: 3
Hi All - I am a newbie dentist who just started a practice with a front desk that has never don't dental claims or billing before - not to mention - I am a in giant cesspool of crap and need people here to help pull me out. I am taking all insurances including NJ Family Care - use open dental
June 29, 2025
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Views: 150 | Replies: 3
Has anyone used or an recommend an Consultant that specializes in running systems for a dental insurance department of a dental practice? We are looking for a consultant to oversee and revamp our current systems in our pediatric practice. We have a feeling that the staff running our insurance
March 01, 2014
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Message Board
Views: 3490 | Replies: 64
I am in network with many PPO. Recently I am getting claim denials,late payments etc a lot.I feel like PPO is my business partner who did not invest in my practice, did not go to school of 8 years or more and take fourty percent of my income and remotely controls my office. They make all
October 12, 2016
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Views: 8224 | Replies: 207
people on a 30k salary need someone that is ethical and takes their insurance. They might have to go online and do some research, but that's what a good parent does. LOL I'm still in denial. TN, Easy, The thing we don't learn from Corp dentistry islocation, capacity(6ops+) marketing(location signage
September 13, 2018
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Views: 77 | Replies: 1
Hi, whats everyone paying for disability?I got a quote from protective for $450/3 months. Im 27/M.Benefits COLA, $9500 a month, and a $1000 increase until I get to 15000/month for income. Lets see if anyone can get you some answers?
August 03, 2024
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Message Board
Views: 618 | Replies: 8
Hi all! I was listening to Mark Costes' podcasts the other day, and he mentioned there are people out in India or Philippines that helps with insurance verification in a dental office. Are any of you doing that? Can I get some recommendations? Best, Howard We were using a company for insurance
February 01, 2022
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Message Board
Views: 65 | Replies: 2
I have a question about what the requirements are regarding documentation when a patient's insurance coverage is terminated. In our PM system, we can resubmit claims with the new insurance. However, if the month is closed out, we cannot rebill to new insurance through the software if there has
December 03, 2021
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Message Board
Views: 267 | Replies: 4
Hello. Has anyone used a person or service to help decide if/when/how we can go out of network? Were down to two insurance companies but wed really like to be out from under their thumb. Looking for recommendations. Thanks! Build or hold some time in your schedule for the kinds of patients you
September 03, 2020
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Views: 305 | Replies: 3
, I don't know which insurance carrier is prevalent in the area 2) I do not know how to negotiate. Well, at least effectively. Is there someone whom I can hire to negotiate fees (and research which insurance carrier is present in the area?) Thank you. Google this: Unlock The PPO
October 15, 2018
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Message Board
Views: 783 | Replies: 17
. In EVERY office, no matter the state, insurance and the public's expectations creates one of the biggest problems dental offices have. Let me assure you, patients are the same no matter where you live; only the accents are different. This reality prompted me to write the following in my monthly
December 16, 2017
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Views: 682 | Replies: 11
I currently have a business overhead insurance policy for $25K that costs me $3000 annually. I'm wondering if its actually worth it. My practice collects around $70-75K a month. Would a line of credit be a cheaper option to serve as an unofficial insurance policy? Worst case scenario, if I can't
November 08, 2017
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Message Board
Views: 702 | Replies: 11
I'm trying to get all my patients' insurance verified and put into open dental. Does anyone know of someone that does this? Can I outsource this overseas? Breakaway will verify insurance for $12 a pop. Seems a little expensive. Thanks Ben I know nothing about outsourcing insurance verification
September 14, 2017
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Views: 70 | Replies: 0
employees? Second question, can an employee who currently has a private grandfathered health insurance policy cancel and join the office group policy without qualifying reasons or only do it during the sign up period for Obamacare? Thanks
May 08, 2016
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Message Board
Views: 543 | Replies: 25
I'm debating adding PPOs to my office and I'm not really sure what to do or which ones to add? Are there some guidelines that I can use to help in making the decisions for which insurances to add to the office? Currently the office only accepts Delta Premiere (60%) and the remaining patients
April 03, 2017
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Message Board
Views: 80 | Replies: 1
I think I already know the answer...If I am able to get an individual disability policy with prinicple with regular occupation (prinicples name for own occ) to replace my ada great west plan thats a no brainer right?My ada plan hd a small exclusion on it, principle is giving me no exclusions.Just...
February 28, 2020
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Views: 647 | Replies: 26
I have a small private practice that I purchased 6 months ago. Seller dentist was not in any insurance networks and was strictly out of network. I am the same, but I am young and wondering if I should get in-network since I'm not established yet. She did not have a hygienist and the vast majority
August 01, 2019
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Views: 406 | Replies: 10
Is it legal to charge a reduced fee for new cash patients? Then charge a new insurance patient a full array of fees (either PPO or FFS)? I know this subject has been talked about, but the posts I've found are pretty old. No It is insurance fraud Yes I see competitors doing
February 16, 2019
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Message Board
Views: 70 | Replies: 4
Hi everyone, What is the best way to find out who the biggest employers in certain towns are and which insurances their employees have? Could you use a reference librarian? Or is there a nice online source. If I could at least get a list of the major employers then maybe I could ask those
March 30, 2018
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Views: 305 | Replies: 8
I started my practice in 2005. I originally signed on with five PPO plans that I thought would be beneficial based on employers in the area. Around 2009, I added the Connection Dental network as their fees were substantially higher than some of the PPO insurances I started with. I have eliminated
July 07, 2017
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Views: 533 | Replies: 14
Is there a reliable website or system which can give real time eligibility and coverage quickly when patients come in for their appointments? We have tried 2 products, but the number of insurance companies we could check benefits was very limited. What type of software program do you have? We use
February 28, 2017
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