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Searching: insurance denials
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Page 1 of 10
Message Board
Views: 149 | Replies: 11
it is required. Probing is not necessary, but I recommend you follow the AAPD guidelines because they will be your ammo against insurance denials for D4346 if probing is required for claim processing but not submitted. You'll be fine if you can thoroughly document the need without probing. I've attached the guidelines for you. Edited: I found the official published version
May 02, 2025
Coding Q&A
Message Board
Views: 121 | Replies: 4
the patient pay it if insurance...problem is, with insurance denial i can't charge the patient because of the insurance contract. it isn't a non-covered service, it is disallowed and therefore the charge is 0 because i am in network. they say the tooth has been extracted so it can't have an occlusal...You
October 31, 2018
Coding Q&A
Message Board
Views: 244 | Replies: 4
Just recently purchased an intraoral camera - love it, I think it makes a big difference to patients when explaining treatment. I also hope it'll help with claims for procedures as well, things that don't show up on an xray, so insurance will be less denial happy. That being said, I would also
July 25, 2017
Coding Q&A
Message Board
Views: 245 | Replies: 7
that many times when we get denials from insurance companies, many of these are automated denials and many of these claims will get paid if appealed. You don't have to write a term paper. There are only so many situations that require a crown - I have templates for every single one of these situations
April 28, 2016
Coding Q&A
Message Board
Views: 128 | Replies: 5
take to the state insurance commissioner if denied in the appeal? Depends on how the policy is written. Appeal the denial to the insurance company first. Ask for a dentist consultant to review the denial.submitt a corrected claim with the following partial with #20 and 29 replacement and add tooth to partial code for #19 add tooth to the partial code for #30 make sure its a cirrected claim not an apeal at this point
April 22, 2016
Coding Q&A
Message Board
Views: 132 | Replies: 1
take the tooth out on Monday, bring them back Wednesday, and we can all pretend this is smarter.' That is the joke. It is also the tragedy. Because when you slow down and really look at what happened, the denial usually is not random. It is not even mainly about whether the graft was good dentistry
April 21, 2026
Coding Q&A
Message Board
Views: 1272 | Replies: 33
this? Now the patient is stuck with the bill. Did I mention that UC is a...prophy or full mouth debridement first. then bring back for... Prophy before the SRP is pointless in many ways. You will have more insurance denials, less patients show up, and hygienists will have a harder time doing the SRP
May 10, 2016
Coding Q&A
Message Board
Views: 240 | Replies: 8
the retainer code. Does it make a difference with each situation? Thanks. I was asking b/c we did retainers on a pt recently with an insurance company we are contracted with but has a very low fee. So we thought maybe that was a per arch fee. We sent the code twice to the insurance and they paid
June 23, 2022
Coding Q&A
Message Board
Views: 55 | Replies: 1
all think? Thanks. - Leo " but to me it seems insurance will deny that claim?" - First want to address this. If insurance denies something, the patient pays. We ALL need to get out of the mentality that a denial means we should not do something. Now a disallow, that is different. You are correct
March 26, 2026
Coding Q&A
Message Board
Views: 170 | Replies: 3
a buildup (which DDMN did pay) and: a) leave it as a buildup and there would be no additional fee from you, other than your co-pay or b) do the buildup and make a provisional crown to make it last as long as we can, and there would be a good chance that insurance will not pay because the denial
June 16, 2020
Coding Q&A
Message Board
Views: 579 | Replies: 23
it. Insurance appeals do not need to be about venting your displeasure with the denial; keep it to the processing policy they used to deny, and refute that. It will help the appeal get processed faster. Please make it your own. Thanks a lot for taking the time to do this! Can I use this to appeal the Pre-D? Yes! Use it for any SRP downgrade. Your hygienists and patients will appreciate it. Good luck, UDent!
March 11, 2026
Coding Q&A
Message Board
Views: 104 | Replies: 5
(D0470) on the day of an exam and subsequently bill for an appliance (like a partial or denture), so long as the initial records are documented as strictly diagnostic rather than procedural. To avoid "unbundling" denials, your clinical notes must show the records were used to evaluate the patient's
March 10, 2026
Coding Q&A
Message Board
Views: 1471 | Replies: 49
an abutment used in the manufacturing process, but you cannot code for the abutment separately. Same thing for the insurance denial scenario that Dr. Blair shows in his post (page 204 coding companion). I may not like or agree with the stance they are taking, but Im gonna follow it. At the end
August 26, 2022
Coding Q&A
Message Board
Views: 572 | Replies: 21
I saw a NP who needs SRP 1-3 teeth on the lowers. However, the rest of the mouth needs a 4346. What is the proper way to code this? i am asking both for what insurance companies say we should do, as well as the best and proper way to charge private pay patients. thanks! What is more productive
April 24, 2026
Coding Q&A
Message Board
Views: 244 | Replies: 8
Thanks in advance for your tips. We occasionally have patients who come in and are diagnosed with 2 quads of SRP but the other two quads would pass with a prophy. How do you bill this out to the insurance and do you collect for the prophy from the patient assuming it would be denied from insurance
April 24, 2026
Coding Q&A
Message Board
Views: 303 | Replies: 5
written processing policies from more than one major insurer state that patients under 25 will be denied SCRP benefits without X, Y, and Z present and a detailed appeal. An initial pre-d denial is simply a place to start negotiations with the insurance plan for payment. Triple check the correct
May 03, 2017
Coding Q&A
Message Board
Views: 142 | Replies: 7
I have a patient who had a Scaling and Root Planing in 2015. Has been really good about coming in regularly for Periodontal Maintenance every Recently the patient changed insurances to MetLife and the new insurance company says they will only pay for Perio maintenance if Sc/RP has been done
June 13, 2019
Coding Q&A
Message Board
Views: 408 | Replies: 6
and not practicing. Could that be the case?Do you have any recourse with a narrative or is that it? I've seen offices that are in network requiring payment in full with the patient receiving the reimbursement from the insurance company. Seems like it would take the risk of rejected claims off
October 03, 2014
Coding Q&A
Message Board
Views: 139 | Replies: 5
So, we sent a prior for a partial denture. There is zero coverage from the insurance, but instead of billing out at $1000, they say our plan max is $400. Can they dictate that even though its not covered? Not quite sure how to proceed, especially given that the $400 will barely cover the lab
June 02, 2018
Coding Q&A
Message Board
Views: 260 | Replies: 8
Hello everybody, I am looking into signing up with Crossover dental for cross coding. I had a few questions. 1-If I do an FMX for a patient with both medical and dental insurance, do I bill both? How do I address the higher fee with medical insurance? Is it a breach of contract to the dental
July 25, 2015
Coding Q&A
Message Board
Views: 238 | Replies: 8
Performed an alveoloplasty with extandclaimwas denied by MetLife due to claim failed ADA code validation. Any advice on how to get this paid by insurance? I did a full mouth extraction for immediate denture with 1 quad of alveo D7310. Connection dental denied is saying payment is included
March 22, 2023
Coding Q&A
Message Board
Views: 110 | Replies: 3
didn't expect coverage. The reason for their denial had me curious about an anxiety code, though. I suspect it is a medical code, as well. I have never encountered an insurance that covers nitrous. If you want to get to the bottom of this, do 3 way call with insurance and the patient. That way, they cannot say one thing to the office and another to the patient. Good luck! let us know your findings.
January 08, 2020
Coding Q&A
Message Board
Views: 800 | Replies: 20
for wasting time with a pre-denial. The bigger problem is the illegal use of disallows by insurance companies. Very large onlay fractured. UHC dentist denied the crown stating that a four surface amalgam is sufficient. The consultant works in Beverly Hills and consults as a side gig. Hee hee. Im having
January 21, 2022
Coding Q&A
Message Board
Views: 450 | Replies: 8
insurance rep states they don't cover it, sounds like Delta will want a denial letter. So, you bill, get a denial letter and move on from there billing Delta.What a PIA huh?Suzanne This is happening more and more frequently. I am a dental practice management consultant with a specialty in training
December 30, 2014
Coding Q&A
Message Board
Views: 297 | Replies: 8
. All they are is benefits checks, not whether insurance WILL pay. (Some states have passed laws that make PreD a requirement of payment, but still not widespread). You should almost never have a denial for a crown or BU, if you do have challenges here, preD aren't going to solve them. You need
March 03, 2023
Coding Q&A
Message Board
Views: 129 | Replies: 2
I am in the process off a startup and I was wondering if anyone recommended the Administration with Confidence book by Charles Blair, DDS. I was hoping to have some suggestions for narrative to minimize denials. I plan to purchase his Coding with Confidence Book. I appreciate any feedback or other
March 04, 2020
Coding Q&A
Message Board
Views: 214 | Replies: 4
Remote Sourcing A common question asked of me is, How do I get core buildups covered? We are frustrated with so many claim denials for this service. Theshortanswer is proper clinical evidence of the need and adequate execution of the procedure as described by the ADA CDT current code for a core buildup
September 29, 2023
Coding Q&A
Message Board
Views: 997 | Replies: 38
on this. LEAT/APB is just insurance paying less of the service, not the dentist agreeing to that lower fee. Patient pays more. No again, denials are not synonymous with non-billable. Denials are legal and normal. Disallows are non-billable services and are illegal, doesn't mean insurance doesn't try though
August 29, 2024
Coding Q&A
Message Board
Views: 685 | Replies: 10
They are evaluating all my endo. They refuse crowns on old endo that is 30 yrs old and fine and not done by me. Deny all kinds of stuff. I am considering dropping them and maybe adding a PPO to take their place? BCBS? I was not told in dental school that insurance companies would
August 09, 2021
Coding Q&A
Message Board
Views: 150 | Replies: 3
We are getting denials for pre-authorizations for scale and root planing because we don't have the proper quadrant code, supposedly. Anyone know about this? I am not aware of any changes to the code. Did you call the insurance company and ask why in their opinion the codes do not match? Check you
March 26, 2014
Coding Q&A
Message Board
Views: 755 | Replies: 24
this thread on topic) Thanks! So with coding, there is really only one correct way to do this. First, you need to understand downgrades do NOT affect you, downgrades only mean insurance is paying less, therefore patient pays more. EOBs are often wrong or misinterpreted with this concept. You have
February 12, 2025
Coding Q&A
Message Board
Views: 155 | Replies: 4
for the treatment they need.Any insight into this new insurance problem would be appreciated.Thank you I have noticed a general tendency for insurance companies to make it much more difficult to file any kind of SRP or perio related claims. Much stricter rules, more and more documentation required. They know
August 21, 2019
Coding Q&A
Message Board
Views: 175 | Replies: 5
much you all charges? Thank you Depends on why: Most often you have the scenario that these things are covered, just downgraded. Meaning when you do a porc/composite insurance will pay based on metal/amalgam. If you are in-network, you charge the patient up to the in-network fee of the procedure you
August 23, 2019
Coding Q&A
Message Board
Views: 318 | Replies: 10
I was wondering if anyone can answer a few questions about coding. 1. Do you have any success coding periodontal maintainence 4910 following repeated coding for prophie?. I've read that insurance will often deny periodontal maintenance following a prophy code. This situation is that we have
July 03, 2023
Coding Q&A
Message Board
Views: 228 | Replies: 7
My patient is convinced that his medical insurance pays for his implants. Apparently his medical plan required a formal denial from the dental ins. company before paying for the implants. He wants to know whether his med. insurance company would pay for the abutments and crowns. Is there a way
January 24, 2015
Coding Q&A
Message Board
Views: 146 | Replies: 3
When a pt has extractions and needs something immediately. I use code5140 immediate denture. I will include a temporary denture for day of surgery, all the monthly tissue conditioners, and adjustments. This code also includes a final denture 6 mths later. I am now taking insurance- and trying
June 17, 2015
Coding Q&A
Message Board
Views: 359 | Replies: 9
. We are seeing more and more insurances request medical necessity for taking xrays.If you take an x-ray at prep appointment, and you already took a recent x-ray at the recare visit for crown treatment planning, you may get a denial since you already took an x-ray for medical necessity of a crown
January 05, 2020
Coding Q&A
Message Board
Views: 296 | Replies: 8
/dental services.If you are in contract with insurances, by contract you are required to submit all procedures performed, elective or not. This is because insurance wants to establish and have a tcird history of procedures performed for future frequency claim approvals or denials. Let's say a tooth
April 04, 2019
Coding Q&A
Message Board
Views: 107 | Replies: 12
was told that D6111 (implant supported denture) with D6191 - semi-precision abutment D6192 - semi-precision attachment do not get reimbursed well. Can someone who does this on the regular chime in? I know ada said that 6191 was the way to go but they don't care about ppo insurance reimbursment. Im so
April 24, 2026
Coding Q&A
Message Board
Views: 166 | Replies: 7
Background info: 3 partner, private practice OMFS office. We are all 3 board certified OMFS and do our own sedations for bread and butter OMFS. We are in network with a couple of the major dental insurances and a few major medical insurances for our orthognathic surgery cases only. Everything
March 05, 2022
Coding Q&A
Message Board
Views: 277 | Replies: 5
we are in network with most PPO's. With the past 2 weeks three insurance claims have come back with the following (and not from the same PPO company): 1) three unit bridge with recurrent decay, decayed tooth needed unplanned ext/nonrestorable, and treatment turned into 4 unit bridge. No way
May 17, 2016
Coding Q&A
Message Board
Views: 559 | Replies: 22
might want it, but if the insurance company pays for patient's wants, then the CEO might not be able to afford his new jet. A CEO needs a jet.I agree, this is a poorly worded denial. If it isn't a covered benefit, then it isn't a covered benefit. That doesn't make the insurance company or the claim
September 11, 2017
Coding Q&A
Message Board
Views: 212 | Replies: 17
and CBCT at the same time. If I submit a CBCT to insurance they will deny it and likely deny the PAN since a CBCT was taken the same day. So would you submit just the PAN or would you Submit both and Charge the patient for any denial of the CBCT. I usually discount CBCT for anything routine and just
March 06, 2025
Coding Q&A
Message Board
Views: 532 | Replies: 18
Ive read that some may call it unbundling to code D9215 administration of local anesthesia in conjunction with operative or surgical procedures. Is it considered insurance fraud to routinely code this? Seems to me the code exists to use it. Looking for guidance please. Bump I don't think it's
July 05, 2025
Coding Q&A
Message Board
Views: 785 | Replies: 44
. If it is written correctly, it waives the insurance participation obligations, like fees. Dont believe anything UC says.They cant even cover PAs or SRPs. Getting SRPs covered is more about the documentation that anything. I have less than a 1% denial rate on them, even with UC. I had a delta patient
January 23, 2023
Coding Q&A
Message Board
Views: 5117 | Replies: 74
referrals could be created within his... Easiest patients ever, no claims to send in, no denials. So what if it is $675 per veneer? You can also have $600 bleaching, $500 diagnostic cast and wax up, charge your lab fee as a separate item per veneer, etc. (all non-ADA codes) I love discount plans, so much
April 01, 2018
Coding Q&A
Message Board
Views: 938 | Replies: 32
anything about this requirement in his handbook. Ah .....Humana.....one of my favourite insurance companies to do free work for! That's what denials are....free treatment !Chains ruin it for... I will tell you that you are absolutely wasting your time with Humana. They will continue to deny
May 07, 2016
Coding Q&A
Message Board
Views: 506 | Replies: 20
assuming you are trying to save your patient money but going without a metal substructure will likely fail and the patient very well may blame that failure on you (the no good deed goes unpunished). In any case, best to you! Gr8 Simple answer: Exts Interim Denture (no insurance help) Overdenture
March 16, 2026
Coding Q&A
Message Board
Views: 2871 | Replies: 80
I went to lunch with a dentist down the street who has a very successful practice. I asked him how he was navigating increases in overhead with insurance reimbursements. He basically said he hasn't worried about insurance reimbursements for 15 years because he charges a la carte. Basically, if he
January 17, 2024
Coding Q&A
Message Board
Views: 152 | Replies: 6
implant consult with an OS but ultimately pt wanted to keep teeth and so elected to have bridge placed. Thought the least invasive approach would be a bridge 6-9. 6 and 7 would benefit from crowns and act as stabilizers for loose 8 and 9. Insurance denied treatment saying it was not medically
August 14, 2023
Coding Q&A
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