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Searching: insurance denials
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Displaying 1-50 of 1843
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Page 1 of 37
Message Board
Views: 130 | Replies: 5
is okay, but does not show the entire tooth/root. The second x-ray is not even centered. The tooth in question is a no brainer to get paid with good x-rays and photos. Estimate insurance will pay, get better x-rays and photos, and then do the work. Stop asking insurance for permission. The denial isn't
May 05, 2026
Claims Processing
Message Board
Views: 255 | Replies: 12
Add this one to the Why I hate Dental Insurance Companies list..... Recently, we preauthorized a patient for 4 quadrants of scaling and root planing with Delta of Minnesota. We completed treatment and submitted all necessary documents for payment. This claim was denied. Furthermore, the denial
June 26, 2025
Claims Processing
Message Board
Views: 1017 | Replies: 45
Principal Insurance Denied claim for crown on #9/10. Shocker!! We went through the appeal process and got the final denial today. The narrative said, restorations due to attrition, abrasion, and erosion are not a covered benefit. If you look at these photos and radiograph, ask yourself
May 24, 2019
Claims Processing
Message Board
Views: 98 | Replies: 1
insurance we had to submit it anyways to primary. Apparently, according to my FD, it took 3 months to get this formal denial from her primary insurance, and now we are still waiting on the payment from her secondary. 4 months later....!!!! Did my FD just screw up, or it this normal? I call BS
April 13, 2016
Claims Processing
Message Board
Views: 256 | Replies: 5
is cracked and you are feeling it. It needs a crown to fix it, it might even need a root canal in the future. Your insurance company is more concerned with not paying this claim as opposed to doing what is right by you. As I am sure you already know, insurance companies make a lot of money be denying
January 25, 2019
Claims Processing
Message Board
Views: 133 | Replies: 2
I am dealing with an insurance denial for crown pre authorization. I have included documentation of significant tooth structure loss. Despite this, they claim that the amount of damaged tooth structure does not support crown coverage. Any advice on how to strengthen my apparel would be greatly
September 09, 2024
Claims Processing
Message Board
Views: 1156 | Replies: 60
, when you attempted to extract it with forceps and needed to use a handpiece and bill as surgical extraction and you will be less pissed. Even in the OP's insurance Dental Doctor Review denial, there is a section that lays out what they deem is needed to constitute surgical extraction: If the tooth
May 14, 2026
Claims Processing
Message Board
Views: 170 | Replies: 9
to be covered. Obviously if I thought it was going to be denied then I would've told them so....anyways...does anyone have a form that they use for United Concordia for this particular scenarios. I've read elsewhere that our estimate that clearly states that insurance denials are their responsibility doesn't
April 16, 2019
Claims Processing
Message Board
Views: 159 | Replies: 4
, narrative, x-rays, photos, and EOB denial, I might be able to help. Most likely the department of insurance isn't going to be useful for you if the documentation is the problem. Documentation meaning you sent information that allows the insurance company off the hook (the first sentence above
September 17, 2020
Claims Processing
Message Board
Views: 194 | Replies: 3
Restored 8 and 9. Both were very sensitive to any air as she had literally no enamel on about 1/3 of the facial. The mesial facial had what I assumed to be abfractions. Principal insurance denial after a narrative was written No benefit payable: treatment is for attrition, abrasion, abfraction
January 04, 2018
Claims Processing
Message Board
Views: 384 | Replies: 9
that teeth with crown never suffer from bacterial invasion that leads to decay may be an exclusion, but it doesnt mean you have to play by the insurance industries edicts. Good luck in following the insurance denial narrative writing image sending chain of command in the dental insurance game
October 20, 2022
Claims Processing
Message Board
Views: 158 | Replies: 1
. Companies like DentalXChange, Stedi, Zentist, Pearl AI, Overjet, Vyne Dental, DentalRobot, Curve Dental, and Stratus AI are all attacking the same giant problem from different angles: insurance verification, predeterminations, claims scrubbing, attachment management, denial prediction, payment posting
May 10, 2026
Claims Processing
Message Board
Views: 808 | Replies: 26
to schedule a couple of peer to peer reviews when the reviewing doc still questioned necessity but the 2 peer to peers were paid in the end with a 5 minute call with the reviewing doc. Unfortunately, insurances know that a lot of offices won't even respond to the denial appropriately or send an appeal
September 21, 2023
Claims Processing
Message Board
Views: 592 | Replies: 10
Any suggestions for a letter template to fight an insurance denial for SRP? We have a patient who had 2 quads of SRP done with probings in the 4-5+ range and the insurance (MetLife) has denied SRP claims twice now. I don't think we've had an issue with them before. Her radiographs don't exhibit
March 03, 2017
Claims Processing
Message Board
Views: 554 | Replies: 13
point)United Concordia is notorious for denying claims despite sufficient evidence for needed treatment. Collect in full or risk of working for free. Patients nowadays hop from one office to another when they have a balance due to insurance denial or incomplete payment, and they bad mouth
September 08, 2014
Claims Processing
Message Board
Views: 570 | Replies: 7
Recently, I've been getting more denials for SRP's from insurance companies. I send x-rays and pictures, but sometimes the bone and attachment loss isn't obvious on them. Go through the appeal process and they still deny. Has anyone been successful in getting paid for SRP when it's not obvious
October 02, 2014
Claims Processing
Message Board
Views: 754 | Replies: 24
dSLR camera if you don't already have one. Your insurance denial is the reason that 100% of the time I always had a pre-op photo and a intra-op photo of all of my procedures that were much more than a basis sealant. This one got paid. Crown and build up. I accept that its not a great picture
April 13, 2016
Claims Processing
Message Board
Views: 1151 | Replies: 57
case. Guardian denial. They said no noted radiographic bone loss was reason for denial. Any help or direction would be MUCH appreciated. Thanks! I actually agree with the insurance company here-not clinically, but by THEIR definition of what qualifies as 4341/4342. They want to see clear radiographic
September 16, 2025
Claims Processing
Message Board
Views: 1734 | Replies: 28
. But these are different cavities. Remember two things with insurance denials. 1) Most are automatic by the computer, not a human. All they do is look at frequency and coverage, a human never touched the claim. You have to call for these and force a human to look at the claim. 2) Even the humans
May 21, 2018
Claims Processing
Message Board
Views: 691 | Replies: 44
to hopefully avoid more denials like these. Youve got this Doc! Make them pay! Clearly fraud, but honestly not your problem. You didn't force the patient to pay for shitty insurance nor did you cause the tooth to become decayed. Distance yourself from the insurance situation and collect for what
February 14, 2023
Claims Processing
Message Board
Views: 476 | Replies: 10
will appeal once to a patients insurance upon denial but after that the remaining balance must be paid by the patient and they can take the fight to the insco if they wish. My staff doesn't have time to sit on the phone for an hour to try and talk to some overseas call center representative etc, we send
March 30, 2019
Claims Processing
Message Board
Views: 181 | Replies: 10
were sent without issue and accepted -Ensure insurance verification is completed 48 hours out (this gives you time to get updated info from the patient if needed) -Post all payments received and work any denials/appeals received Weekly -Run claim reports to look for any procedures not attached
November 11, 2022
Claims Processing
Message Board
Views: 162 | Replies: 4
Like everyone who has to deal with insurance, we're getting more denials of crowns stating that we should be doing direct restorations. I want to put together a form letter that states why we are doing a crown and cite a study that says if criteria a, b, and c are met, a crown is needed vs
November 08, 2019
Claims Processing
Message Board
Views: 32 | Replies: 0
Hello, We have 3 claims that were denied because they need a denial from the medical insurance company before they will process. Currently we are unable to bill medical insurance. Does anyone know how to apply for a medical ID number? The state office has not been very helpful. Thank you!
February 09, 2016
Claims Processing
Message Board
Views: 73 | Replies: 1
I am trying to find a reliable company that will enter EOB's into patient ledgers, file denials and research outstanding insurance claims. Large volume, annual collections for one practice is just over $6 million. Dental Claims Cleanup would certainly like to help you. or call me (315) 415-4941 Dorothy
September 20, 2016
Claims Processing
Message Board
Views: 438 | Replies: 8
the denial of all perio scaling unless bone loss is visible on the xrays. Which is 100% false definition of periodontal disease.By far the WORST dental insurance company IMHO.....I don't even bother to get any treatment approved with...Dropped them last year! They were definitely one of the worst
January 20, 2017
Claims Processing
Message Board
Views: 3175 | Replies: 91
and patients are way more accepting of treatment now that we do them. Maybe if you have a unique case then grab your heavy duty camera...but by God, just use the $150 ebay IO camera for that. We have very few insurance denials since we started doing this. 3) I cannot stand when insurance companies
October 31, 2022
Claims Processing
Message Board
Views: 168 | Replies: 3
First off, I know, get out of insurance. To make a long story short. I pulled a wisdom tooth last year. Delta Dental requires a denial from health insurance before they will pay. Our 3rd party claims processor went 'round and 'round with health insurance to get a claim finalized. Took OVER A YEAR
November 25, 2024
Claims Processing
Message Board
Views: 66 | Replies: 3
Hi All, Recently heard of a denial for x-rays along with an exam, and the reason for the denial was something like 'submitted codes have been bundled into one procedure and are not eligible for payment.' Are we going to stop getting paid for x-rays? Just exams? Gather whatever data you want? Does
April 15, 2026
Claims Processing
Message Board
Views: 827 | Replies: 28
payments (patient and insurance) the front handles over the counter payments. insurance denials, requests go to the OM for follow up. how is that remote person going to communicate special insurance rules to your office? email, phone call, text message, fax? are they going to be in your office w
June 29, 2022
Claims Processing
Message Board
Views: 1112 | Replies: 44
: Pain in UL. Recurrent decay on PFMs #14 and #15. Went over TX plan with insurance's estimated portion. He signs and pays his portion. I prep and put him in temps. Crowns come back along with the insurance denial saying he's MAXED out!!! Apparently he went to another dentist in between his recall
November 05, 2015
Claims Processing
Message Board
Views: 61 | Replies: 0
So many of the dental offices I speak to have problems with claims because there is confusion over a denial versus a rejection. Many times claims are rejected when they reach the clearinghouse because the information does not reflect what the insurance company has on file for the patient
December 12, 2016
Claims Processing
Message Board
Views: 101 | Replies: 3
I am stuck with a wisdom tooth situation. Wisdom teeth were extracted and 2 patients have Guardian. They are the ONLY insurance that we've encountered that require denial of medical FIRST, then dental will pay. We historically have used our dental forms to file to medical and it's worked as we have
February 25, 2021
Claims Processing
Message Board
Views: 778 | Replies: 31
collections, more timely insurance payment, and less insurance denials. He can't afford not to have his AR in order. It also makes embezzlement more difficult because there are extra sets of eyes looking at your accounts. Haha that's funny! Sounds like you definitely need help up there! Where can we find someone with your dedication?!??? Where do you live?
December 11, 2017
Claims Processing
Message Board
Views: 415 | Replies: 11
That is... Congrats! Good decision. Did the same 1 year ago. Don't regret it one bit. It's like breaking up with an abusive girlfriend that wasn't really even that good in bed.What scares me, is we see a very large number of the teachers in our area. Guess what insurance they have
February 04, 2015
Claims Processing
Message Board
Views: 889 | Replies: 35
to pay, because it's not free. Tell her you'll gladly refund her money once the insurance company pays for it. Sorry, I will respectfully disagree with this (and I never disagree with what you say, :) ). Explaining insurance issues, payments, EOB's, denials, balances, etc. are not the doctor's job
January 12, 2026
Claims Processing
Message Board
Views: 171 | Replies: 7
this for years. It will be a battle of the AIs. OP , this is a common denial pattern for Cigna. We get duplicate denials after claim payment, denials for missing tooth numbers when their letter has the tooth number in it, and denials for missing attachments. We call; all attachments were there. The list goes
April 08, 2026
Claims Processing
Message Board
Views: 334 | Replies: 7
will be reviewed by individuals who were not initially involved in the adverse benefit determination. Level 2 will be reviewed by a panel that includes a health care provider. If you still receive a denial, the insurance will advise you on the next step of the appeals process for your claim. It may be another
March 20, 2019
Claims Processing
Message Board
Views: 3175 | Replies: 91
not for an endo but this one slipped by us. But I still feel its obvious. I have been getting a lot more denials from insurance on cases that I feel are very clear. Insurance denied this because it was not clinically necessary We resubmitted with a narrative and were denied again. I had
November 22, 2013
Claims Processing
Message Board
Views: 1023 | Replies: 25
Hello Townies, I am not sure how to proceed with this matter because I have never seen a consultant be so blatantly incompetent, unethical and have such poor judgment. I rarely get insurance denials because we document very well at my office, and the few denials I have received, when I have
May 15, 2014
Claims Processing
Message Board
Views: 58 | Replies: 4
We have a dilemma with a patient under Anthem Blue Cross, we tried to submit a claim for an extraction done by OS and the Dental insurance is denying because we do not have paperwork of the denial from primary medical insurance. We have tried to get some form of paperwork from Anthem Blue Cross
November 22, 2017
Claims Processing
Message Board
Views: 223 | Replies: 5
I recently performed an extraction of a hopelessly decayed #30. Insurance claim submitted with supporting documentation. A denial letter comes back stating that the extraction needs to be processed under medical. Huh? Anyone know how on earth they can deny a claim like this with that rationale
February 01, 2016
Claims Processing
Message Board
Views: 158 | Replies: 6
When and how are we, as dentists, going to stand up to the absolutely abusive practices of the insurance companies in delaying reimbursement for procedures done. Not only is this a financial issue, but it also puts us at the battle front with patients, and makes us look bad. Yes, I'm venting here
April 22, 2020
Claims Processing
Message Board
Views: 584 | Replies: 20
years, absolutely dirtbag tactic! 2) The code for a retainer is similar to a maryland bridge for what you describe. D6545 - for your tooth #6 The reason for the denial is a posterior cantilever is not considered a stable restoration, and almost no insurance pays for unstable or uncommon treatment
August 26, 2024
Claims Processing
Message Board
Views: 405 | Replies: 10
I am sure this topic has been discussed heavily in the past. Our office has been seeing increased number SRP denials by insurance companies.I would like to see how you would handle such a patient in your office. A typical case would be a younger individual (in their 20s) presented with generalized
January 09, 2019
Claims Processing
Message Board
Views: 62 | Replies: 1
Patient has Cigna and we are trying to authorize for wisdom teeth extraction. Cigna Dental says we need to bill medical (I believe it is with Cigna as well, since they gave us a different Cigna address to mail it to). I'm also not sure when they say medical if it is government sponsored. How do we...
September 17, 2016
Claims Processing
Message Board
Views: 617 | Replies: 27
far their official position is that it is our fault. We are supposed to follow up with the patient after a denial and make sure they gave us all The correct Info. If we can't, then we are supposed to use all of the insurance websites and search for the proper number. If you guys could hear the call
April 08, 2026
Claims Processing
Message Board
Views: 199 | Replies: 10
think we need to educate patients about the fact that we are looking out for them and their oral health - The insurance company is not. I carry on as usual with scheduling but I always send a pre determination because it only takes a couple of seconds. I'm looking for down grades and denials. Why
January 02, 2020
Claims Processing
Message Board
Views: 240 | Replies: 3
Info pt. gave us for insurance showed it wasn't in effect, denial, pt owes $225. Pt was chased after, finally received payment from her months later. She then gives us updated insurance info. The claim is paid, a mistake was made and payment was supposed to go to her, didn't happen. Insurance
July 11, 2015
Claims Processing
Message Board
Views: 510 | Replies: 18
will go away. In the meantime, he asked how to prove denial. That's how you prove denial. In medical insurance with multiple coverages, you submit copies of the EOB with each claim when submitting to the 'next' insurer in line to show/prove to them what's been covered, denied, paid, not paid
August 13, 2014
Claims Processing
Displaying 1-50 of 1843
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