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Searching: insurance denials
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Page 1 of 14
Message Board
Views: 122 | Replies: 5
. In that regard, its not really a insurance plan at all therefore they dont have to play by insurance rules. Im guessing somewhere in the 100 page contract with delta it states they can do this. Ive appealed insurance denials to my state insurance commissioner a couple of times. In both instances
June 09, 2021
Delta Dental
Message Board
Views: 65 | Replies: 2
Delta attaching a copy of the medical insurance denial or payment. Of course, on EOB it says patient pays zero. We are not set up for medical insurance billing, and we don't even have the patient medical insurance card. Because everything was done in, and around the mouth, I feel like this is just
September 28, 2021
Delta Dental
Message Board
Views: 340 | Replies: 15
it is not covered but not for every single procedure you do. Thanks for the info. We're essentially applying this approach to about half a dozen proceduresthe ones we see the highest insurance denials for, such as crowns, buildups, scaling and root planing, and similar treatments. What is Delta going to do
August 08, 2025
Delta Dental
Message Board
Views: 563 | Replies: 10
complicated it, and any reason the timeline stretched. If a denial lands six months from now, your only defense is a story that makes sense clinically and chronologically. Be honest with the patient up front. Dental insurance is not a treatment plan, it is a cost-sharing arrangement with rules. If their plan
April 28, 2026
Delta Dental
Message Board
Views: 216 | Replies: 0
they said we should pursue medical insurance first. Medical insurance denied the claim because they wanted a more detailed operative report. Both insurance companies kept referring back to the other. We finally received a final denial from our insurance company but now Delta Dental is saying
July 15, 2014
Delta Dental
Message Board
Views: 6743 | Replies: 240
glad I don't have to deal with this anymore. Interesting case. My summary of this thread is 1 delta contract supersedes private doc patient agreement 2 billing DD in this case was the error. But can patient force doc to file? 3 pre determine case as cosmetic (not covered) get insurance denial
February 18, 2021
Delta Dental
Message Board
Views: 173 | Replies: 13
a large following and patients are extremely loyal to him. I do see a decent amount of his patients as they have transitioned to me over the years. Our practice is PPO dominate with Delta at about 45%. It gets complicated because patients that would normally see him and have insurance would then need
May 20, 2026
Delta Dental
Message Board
Views: 94 | Replies: 7
with the rising costs of providing quality dental care. In order to avoid raising fees for all patients-including those without insurance-we have made the decision to transition out of network. What this means for you: You can still continue to receive care at our office. We will still file your claims
May 21, 2026
Delta Dental
Message Board
Views: 156 | Replies: 3
is likely your perio chart, a vast majority of offices do not fill out a complete chart, which is a major reason for denial. This is a case that should go in a book of how insurance companies defraud patients and dental practices. Resubmit again with a proper narrative and ask for a human to review this. It likely was an automatic denial, no human laid eyes on this xrays
February 06, 2026
Delta Dental
Message Board
Views: 82 | Replies: 1
allows it to efficiently compete with large national insurers while still operating through regional organizations. The broader implications could be enormous. If dentists ultimately succeed, the litigation could potentially reshape dental insurance contracting, reimbursement negotiations, and network
May 14, 2026
Delta Dental
Message Board
Views: 86 | Replies: 1
Dental organizations nationwide and results in insured patients routinely paying higher bills for out-of-network care. The legal claims include breach of fiduciary duty and improper denial of benefits under federal law, and the plaintiff is seeking damages as well as court orders requiring changes
March 12, 2026
Delta Dental
Message Board
Views: 7088 | Replies: 171
- but to criticize the process that led the nation's dentists to a predictably bad outcome. Mouhab Rizkallah Unfortunate but predictable. Best short term solution to get long term change is dropping Ins. Take back control of your offices Don't be an employee to the insurance companies you par with As others
April 09, 2026
Delta Dental
Message Board
Views: 889 | Replies: 46
. Are they denials or requests for more information? As for the chipped tooth, if you can consider it more cosmetic than decay, you should be billing the patient 100% and leaving insurance out of it. Post the x-rays. So for the chipped tooth he had severe attrition so replaced a part that chipped.So am I stuck
March 27, 2025
Delta Dental
Message Board
Views: 5189 | Replies: 190
. It is no surprise that we can not stand up to the insurance bullying. We are not strong enough nor are we united enough. The only weapon we have is our knowledge to beat the insurances at their own game. Enjoy the enclosed are article on insurance bullying and claim denials. Hopefully, you can grow your own
August 09, 2018
Delta Dental
Message Board
Views: 435 | Replies: 8
of New York. The defendants listed include the Delta Dental Plans Association, Delta Dental Insurance Company, DeltaCare USA and more than 40 Delta Dental entities, according to court documents. The lawsuit accused Delta Dental of breach of fiduciary duty and denial of benefits in violation
January 23, 2026
Delta Dental
Message Board
Views: 353 | Replies: 5
Delta Dental of Washington FINED $130K for Improper Claim Denials What the audit caught: 1 Delta Dental of Washington and its HCBM, Wyssta, were fined for violating state insurance laws, including denying claims based on terms that were not filed or approved by the Office of the Insurance
December 19, 2024
Delta Dental
Message Board
Views: 149 | Replies: 4
Has anyone had this happen? This puts the dentist in a really crappy situation. We got a denial from Delta saying the bone graft we placed 3 weeks after extraction was a non-covered benefit (immediate bone graft is covered) because it is now considered an edentulous site! So what, now we just have
June 26, 2025
Delta Dental
Message Board
Views: 598 | Replies: 24
of the insurance breakdown as to whether impacted wisdom teeth can be submitted directly to dental or need a medical denial first. This is no big deal other than you must wait to get the info back from the medical side. However, in some cases this turns out to be a boost for your practice. Medical tends
March 15, 2024
Delta Dental
Message Board
Views: 98 | Replies: 2
We got this breakdown from delta dental which specifically says D7220, D7230, D7240 and D7241- If covered, it should be billed out to medical insurance first? Do you see this often? We don't bill to medical so only option is don't see the patient because patient made appointment due to wisdom teeth
May 09, 2023
Delta Dental
Message Board
Views: 1073 | Replies: 25
solely to the amount of infection. I gave the tooth a questionable prognosis due to lack of any other complicating factors. I have seen the patient since and she has had complete resolution of symptoms. I would like to appeal this denial. It seems unfair and unreasonable to tie the insurance payment
August 02, 2018
Delta Dental
Message Board
Views: 240 | Replies: 6
We need all Washington dentists, your staff, your patients, and anyone else interested in advocating for these important reforms to sign in PRO. --Sign in PRO for Senate Bill 5351: --Sign in PRO for House Bill 1535: The bills outline three key dental insurance issues: 1)Dental Loss
July 27, 2025
Delta Dental
Message Board
Views: 563 | Replies: 38
did them all at once (sedation, long distance for patient, crazy work schedule, etc.) Documentation is the #1 cause for perio denials however. Can you post the perio chart? And what company are we talking about here? you need 2 5mm pockets per quad . on 2 different teeth. ie can't have 2 5's
August 31, 2023
Delta Dental
Message Board
Views: 685 | Replies: 13
quickly (about 2 days) I was able to get a hold of the consultant. The dental consultant used the ADA CDT code to back his argument in the denial of services. I think the ADA and big insurance companies are in bed together. It seemed like the consultant knew the whole thing is a big game
December 23, 2014
Delta Dental
Message Board
Views: 92 | Replies: 7
We just got a denial from DD for SRP due to Patient exceeds age limit for this service. Is this a thing now? Or do you think this was a random automated/AI rejection? Is this an upper or lower age limit? How old is the patient? Exceeds? As in too old? Not sure there is such a thing. Too young
February 20, 2025
Delta Dental
Message Board
Views: 487 | Replies: 12
where or how much the dentin is rebuild or filled-in to eliminate undercuts. We get annoyed when submitting cores because often we get funky denials. There are way too many plan specific insurance clauses which in the end DO NOT pay for the core build-up. Especially in provider practices So if you
March 02, 2016
Delta Dental
Message Board
Views: 1102 | Replies: 29
that handles insurance matter... threat them nicely in your letter... show them you aren't scared of their scare tactics and absurd excuses of denial... We have a PA and intraoral photos before, during, and after the prep and B/U. Have you folks had any luck with appealing the 2 year previous treatment...Keep
December 12, 2018
Delta Dental
Message Board
Views: 270 | Replies: 3
excellence. This autonomy allows for individualized treatment planning based on clinical need, not insurance limitations. Moreover, being out of network helps preserve the integrity of the doctorpatient relationship. It places decision-making squarely between the dentist and the patient, rather than
May 13, 2025
Delta Dental
Message Board
Views: 481 | Replies: 7
, this kind of denial crapola from carriers is causing people to risk losing teeth. IMHO, if they had to pay a few malpractice claims on this sort of BS, perhaps they'd reconsider their nonsense... or not... So today did a big ass BU with Forte and Fusion with a wide greater curve. The plan
March 20, 2017
Delta Dental
Message Board
Views: 2650 | Replies: 60
The ironic thing is is that most of these procedures were pre-authorized by delta wondering if we should just pay the 10k or try to fight these denials. concerned that if we try to fight that they will audit more charts and cost us more money or should we just pay it to hopefully just get a 10k slap
September 19, 2020
Delta Dental
Message Board
Views: 157 | Replies: 10
that the insurance paid and the portion she paid. She said she doesn't want to come back to our office to get it delivered. With delta ppo I complete the bridge at the prep date and sent my claim and got paid for it. Will delta make me pay everything back since I never seated the bridge? Should I call delta
April 08, 2026
Delta Dental
Message Board
Views: 708 | Replies: 30
, not waiting to get paid or dealing with denials etc... the County of Humboldt actually dropped DD after a 25 year run, as their employees were complaining about poor reimbursements and no providers that will deal with them.. that is thousands of people with new insurance. It's early yet, so I
July 28, 2025
Delta Dental
Message Board
Views: 2840 | Replies: 74
....and the insurance company is also speaking to their client in that same sentence pitting them against your claim of needing a build up. They are clever. But fortunately you were just taught how to read between the lines.There is difference between the term denial and not a covered benefit
November 18, 2018
Delta Dental
Message Board
Views: 430 | Replies: 14
denial will be part of the package to enjoy. On a side note: Most patients reported that they pay high $$$ for dental coverage and are suprised about denials and non payment. Its so easy for an insurance company to have a contract signed from us a decade ago and add ammendments with no signature from us
November 22, 2023
Delta Dental
Message Board
Views: 354 | Replies: 6
Definition (received with denial). They had the film of a large, deep amalgam on #3. About 3/4 the width of the occlusal and additional decay on the distal. After I removed all of the amalgam and decay, there was a big ol' hole left. Surprisingly, they paid for the crown. I got to do the buildup
April 02, 2016
Delta Dental
Message Board
Views: 248 | Replies: 2
(though not easy) is just to be aware of histories. If you know they're not eligible for Pano or FMX, but they are for bitewings, and you still want the pano, is to just take the pano free of charge and only submit the bitewings to insurance. Then you won't trigger the automatic conversion to FMX and resulting denial of payment for the FMX code (and by extension, the bitewings). Thanks!...
July 12, 2017
Delta Dental
Message Board
Views: 1019 | Replies: 42
future treatment on patient. I would write a letter to delta throwing lots of dental words at it then threaten to send to the insurance commissioners. This worked for me on a double rejection from another insurance carrier. They also wanted me to charge nothing. After about a month they reversed
January 23, 2020
Delta Dental
Message Board
Views: 6743 | Replies: 240
Can you share the denial EOB and the Delta recoupment request. They arent making a determination if the crowns are necessary. Delta, based on his contractual agreement, is stipulating that he must render the treatment on their fee schedule. If he had sent out a pre-determination and they accepted
February 26, 2021
Delta Dental
Message Board
Views: 415 | Replies: 16
the total of an FMX the insurance bundles it into the FMX. File your BW and PAs separately on a different claim, usually they will get paid. I tell patients that Delta is a crooked, corrupt den of snakes, and unfortunately they are denying payment for needed treatment so Delta's CEO can afford gas
November 11, 2020
Delta Dental
Message Board
Views: 449 | Replies: 12
. Just have the patient sign the treatment plan with an estimate that shows insurance is paying $0. I would still take a photo and still send a claim, just expect a higher chance of denial.
March 31, 2023
Delta Dental
Message Board
Views: 976 | Replies: 27
: Is that chipped lower incisor a F, or MF, or IFM, or IFML? Should I charge a limited exam along with that crown recement? It's up to you in the end. No one will come calling. If insurance denies the BU, switch it to O composite. I dont recall ever having a denial for the core build up. Reality is we
August 28, 2022
Delta Dental
Message Board
Views: 1147 | Replies: 24
(okay, no surprise there...) * Contracting providers agree to charge the patient only the amount indicated as 'patient pays'. Hmm, patient pays amount = $0. We've agreed to this? Since when? The alternative is to just allow the tooth to rot out? Sorry man, but that's standard insurance practice since
November 08, 2024
Delta Dental
Message Board
Views: 670 | Replies: 18
Has anyone seen this waiver from Delta? It's asking out of network dentists to agree not to charge patients when an appeal is denied, in order to start an appeal. Seems like this would run afoul of state insurance laws. Doesn't it translates to not appeal. I wouldn't sign the waiver. What
November 16, 2021
Delta Dental
Message Board
Views: 422 | Replies: 12
Patient fractures #8 below gingiva. Refer to O.S. for extraction. Patient opts for bridge. Bridge placed. Insurance wants radiographs. I send mine, and call O.S. to get theirs, but when I get the panorex etc. ,it is for another patient, and anything for the patient in question cannot be located. I
December 31, 2020
Delta Dental
Message Board
Views: 573 | Replies: 25
even if denial is an age limitation. That is not my interpretation. Straight off the PDA website it says: According to the Act, if a dentist signed an agreement with an insurance carrier, the dentist is obligated to accept the insurance carriers allowance even if the insurance carrier does
November 13, 2023
Delta Dental
Message Board
Views: 621 | Replies: 15
with a predetermination for the crown. You should be asking the questions before you do the work. 😀 Check with the insurance before you do anything that they might not cover or have questions about because if it's after the fact then you're running
April 14, 2018
Delta Dental
Message Board
Views: 495 | Replies: 12
of denial of the claim (etc. but no provision for denying the assignment.) North Dakota* Optional An insured under a group health insurance policy, pursuant toagreementamongthe insured, the group policyholder and theinsurer,may make an assignment of all or any part of the incidents of ownership held by the insured under the policy, including any right to designate a beneficiary.
December 31, 2016
Delta Dental
Message Board
Views: 683 | Replies: 26
using AI claim denial algorithms since 2020. One of my patients is the guy tasked to clean up that mess. There is, stop participating. Not going to help when the entire problem in this thread is insurance giving problems to OON offices. When you're OON with delta, its a waste of time trying
January 29, 2025
Delta Dental
Message Board
Views: 5874 | Replies: 181
is included. PPOs are making a big mistake. Word is getting around quick among patients. With the ObamaCare disaster, my patients are already primed not to trust insurance companies. We are with the culture. I've started CCing all my patients when I send a narrative after a denial. I send
October 01, 2020
Delta Dental
Message Board
Views: 1116 | Replies: 24
would treat them but I could not use their insurance benefits? Or is that concerned illegal, and if I decide to treat I have to accept Delta fees? I've never known the answer to this and would love to know what the rules are. If you are in network with Delta then you have to accept their fees
July 30, 2020
Delta Dental
Message Board
Views: 404 | Replies: 8
to insurance company so I get paid for the crown. I show the photos to my patients to get paid for the build ups. The system sucks but it is what it is.From now on, if you have the intraoral camera in the op, snap a photo before you do the build up and after. This will strengthen your case vastly
December 12, 2014
Delta Dental
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