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Searching: insurance denials
Results: 311
Displaying 1-50 of 311
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Page 1 of 7
Message Board
Views: 110 | Replies: 6
the information and let them decide. I have seen this if you did not preauth. If you preauth I rarely see denials. Insurance always wants you to ask. Now wanting to crown a crappy endo is another discussion.
November 13, 2019
Fixed Prosthodontics
Message Board
Views: 5490 | Replies: 239
and the decay removal. U may need a narrative and need to fight a denial. Insurance blows. Yea that one you need pre-op, restoration removal showing decay, mid decay, and final removal showing enough missing tooth to warrant a crown . Silly because you can see where its going just by looking
February 26, 2023
Fixed Prosthodontics
Message Board
Views: 785 | Replies: 42
. Teeth do not send sworn affidavits. Water coolant is still the cheapest insurance policy in the operatory. It does three things at once. It removes frictional heat, lubricates cutting, and flushes debris so your bur cuts instead of rubbing packed dentin. Air alone does not do that job. In fact
May 10, 2026
Fixed Prosthodontics
Message Board
Views: 1087 | Replies: 39
few years, but now I do a lot of them. They are much more conservative than full coverage, but preserve a lot of tooth structure. I wouldn't do them without a CEREC because I wouldn't want to deal with temporizing them. We charge almost as much for them as crowns. do you get denials from
April 02, 2014
Fixed Prosthodontics
Message Board
Views: 1325 | Replies: 21
look bad. So, so , so glad that I am selling the end of this year. Truly can't stand dealing with insurance idiots.After all these months, I finally won the appeal and got reimbursed for the crown on tooth...Awesome! Do you remember what language you used in the appeal?Share the appeal language please!Sounds exactly like theses people will say. they are the consultants claims are farmed out to for denials.
March 02, 2018
Fixed Prosthodontics
Message Board
Views: 1872 | Replies: 54
make the same money doing something else, I would be gone in a heartbeat if I knew how...but I don't/won't. While I'm on MY rant I see shit like this every single day in my face...I didn't do it...we do it...insurance companies have blanket denial policies on inlays...why in the Fuck do we even have
July 27, 2023
Fixed Prosthodontics
Message Board
Views: 552 | Replies: 20
pictures on all teeth needing crowns. Sadly insurance companies do not trust your clinical judgement as a rule of thumb. It looks like it is missing an MOD restoration. Did you send in an intraoral photograph? Was this denial in response to the initial claim or appeal? If you have not appealed yet
March 12, 2022
Fixed Prosthodontics
Message Board
Views: 307 | Replies: 6
treat this case? I dont think her budget is going to support comprehensive care. This is a multidisciplinary case, or just a patch and hold case in my opinion. Sounds like shes in denial. could be the most expensive 6-7k you ever accept For 6K? Metal palate denture with some composites to improve her
January 15, 2021
Fixed Prosthodontics
Message Board
Views: 376 | Replies: 6
OHI...then two options: 1) new crown cash, or 2) wait til insurance covers it. If the questionable area is small, you could always put a watch on it and take care of it later. I took over a practice where there's obvious questionable areas/decay and been watched for years without changes. Just
March 24, 2026
Fixed Prosthodontics
Message Board
Views: 361 | Replies: 17
I get the cavity fixing vaccination first. Or even the miracle drop that regrows teeth. I think AI is just the latest get rich scheme among dentists. None of you are going to be AI millionaires. Nice. Does it also explain to the patient why their insurance won't cover it? What day is it? I won't
April 01, 2026
Fixed Prosthodontics
Message Board
Views: 190 | Replies: 6
by 6 and 7 crowns because it will be splinted. Make flipper and update tx plan. and go from there. This is my plan until you tell me no.No worries- Bet he doesn't come back. He's in denial. Too busy to talk about losing your front teeth....An Essex style temporary should work and give you
December 09, 2015
Fixed Prosthodontics
Message Board
Views: 167 | Replies: 4
I should know this by now, but I don't. Please help. I am doing a 3 unit bridge 7x9. Teeth 7 and 9 are getting RCT cast posts. I submitted the bridge codes as follows Teeth 7 and 9 - 6060 Tooth 8- 6211. Insurance company sends back claim stating that the codes are implant codes. What codes would
April 09, 2014
Fixed Prosthodontics
Message Board
Views: 435 | Replies: 21
Usually we charge 30k/arch with 15/15 split with the periodontist for a fixed hybrid. If pt has insurance usually the surgeon will use that up. We have a pt that is upset because she wants to use insurance fees and is insistent that it is higher than her insurance. Its Delta dental. The delta
September 03, 2020
Fixed Prosthodontics
Message Board
Views: 1185 | Replies: 43
recommended to have a night guard. she said she does not grind her teeth so she did not want one. The bridge is broken again and there is no good abutments to make new one. I told her I would make her a partial at no cost. Then she throws the news that her insurance has changed to an HMO so she
February 20, 2014
Fixed Prosthodontics
Message Board
Views: 92 | Replies: 0
A popular dental insurance company reimburses my office in the low $700 range for a zirconia crown and about the same for a porcelain fused to noble metal. For a porcelain fused to BASE metal, they pay almost $900. Does anyone have any idea why there's such a discrepancy? I like doing zirconia crowns, but an office I associate at nearby seems to be doing pretty much everything as porcelain fused to base metal.
July 06, 2016
Fixed Prosthodontics
Message Board
Views: 717 | Replies: 29
a lot of details that may make one of these choices preferable to others, including occlusion, esthetic concerns, spacing and alignment of anterior teeth, gingival resorption in the 10 space, bruxism, dentist's experience and preference, insurance coverage, patient habits (such as fingernail chewing
April 04, 2026
Fixed Prosthodontics
Message Board
Views: 1560 | Replies: 51
Bill for what you do. Charge both. I refuse to even look if a patient has insurance or not so I am not tempted to selectively apply discounts. If they have insurance and its not covered due to frequency, then they need to pay. They can complain to their HR department that their insurance
August 07, 2021
Fixed Prosthodontics
Message Board
Views: 3027 | Replies: 87
in this situation before? This is not an insurance treatment. This does not get billed to insurance. If you can't make the patient understand that, than you should not perform this treatment because you will not get reimbursed and you will end up paying for their treatment out of your pocket. It gets
February 03, 2018
Fixed Prosthodontics
Message Board
Views: 242 | Replies: 4
#11 implant placed in a few months and we'll be making individual crowns #9,10,11,12 once the implant is ready to restore. The plan is for #13 &14 implants in the following insurance year. Has anyone billed insurance for these and got them to pay? If so, what sort of narrative would you recommend? I
May 24, 2022
Fixed Prosthodontics
Message Board
Views: 1683 | Replies: 66
Tommy, I believe you're OON correct? For OON dentists A FGC can still be profitable, but for in network, not possible. At least with the insurance companies I participate with. Why don't you insurance offices file for a Base metal crown and get paid. Tell the patient if they want a higher quality
March 02, 2021
Fixed Prosthodontics
Message Board
Views: 443 | Replies: 7
I have a patient that is planning on having the All-on-4 procedure done, oral surgeon will place the implants, put on my immediate temporary and then in 6 months the permanent prosthesis. How do I get send a predetermination for this to the insurance companies? Is it even possible? Will they pay
February 04, 2020
Fixed Prosthodontics
Message Board
Views: 3027 | Replies: 87
Just gonna putthis here Really frustrates me that so many are sowilling to be insurance pawns. Wow, pretty interesting. So all you do is have the patient sign a paper requesting the service and not to send a claim? But patients can be unpredictable. You could have a clause where
February 09, 2018
Fixed Prosthodontics
Message Board
Views: 384 | Replies: 15
endodontists fees so you can ballpark total tx cost. Or dont start tx until after the endo consult. Or learn endo. The last suggestionis the easiest, most efficient, most appreciated by patients,and most profitable.A Bruxzir with perm cement will certainly be seen as a final restoration by insurance/peer
April 21, 2017
Fixed Prosthodontics
Message Board
Views: 1560 | Replies: 51
, (mainly given the lower income area in which I work.) Would be nice to earn more by charging for limited exams, but I wanted to check if this is the norm. Needless to say, with insurance patients, I always charge for the limited exam. For my nice established pts , I only charge limited exam and do
June 29, 2021
Fixed Prosthodontics
Message Board
Views: 208 | Replies: 10
with how to temporize and prep design I completely agree.LazMy experience has been that for those patients with dental insurance, any partial crown is downcoded to a 3 surface amalgam. So a 3/4 crown or modb gold inlay that I might charge $800 for now has an allowance of maybe $125 and if i am
September 06, 2019
Fixed Prosthodontics
Message Board
Views: 1284 | Replies: 23
We did a root canal and then I did a CBU prior to restoring with a porcelain onlay. Tooth #3. Primary insurance reimbursed patient without issues after documentation. Secondary has denied the CBU because they stated a crown was not done. WTF??? Any advice. I told the patient to handle it at work
November 03, 2018
Fixed Prosthodontics
Message Board
Views: 486 | Replies: 9
! If the patient has dental insurance, how do you bill a direct wax up? And how do you code this as well in a treatment plan for the patient? In your case it appears that the patient was partially edentulous for some time prior to treatment. In that case I would just prep and temp the abutments. I
February 03, 2020
Fixed Prosthodontics
Message Board
Views: 730 | Replies: 31
I have a former patient who moved away. He is back in town visiting family and he came in today with a broken temp on #9. I made him a new one to get him by until he gets his crown seated next Monday. Wondering what you would charge and if you would/could send anything to insurance. Ideas
May 24, 2017
Fixed Prosthodontics
Message Board
Views: 371 | Replies: 10
plan in question. Some do allow, some do not. There is no generic answer to this. My PPO fees for gold crowns are so low that even if the patient pays for the gold, we lose $300 off the already $300 discount if we were to do zirconia. So we just tell patients their insurance doesn't pay enough
February 02, 2023
Fixed Prosthodontics
Message Board
Views: 193 | Replies: 5
the crown replaced? We take patients problems as ours. It's patients tooth, patients insurance- let the patient deal with it.Prep and temp the tooth, have patient pay portion of Crown now insert temp with final cement. Cut off and reprep and make when insurance will pay. Patient will be very
February 09, 2016
Fixed Prosthodontics
Message Board
Views: 200 | Replies: 4
I did molar endo/BU/crown prep on a pt in December and the front office has called the pt at least 10 times to come in for the crown seat and she will not return the call. She has been in a temporary. She paid half for the crown and the insurance paid their portion. What should I do at this point
March 24, 2016
Fixed Prosthodontics
Message Board
Views: 186 | Replies: 13
Any tx plan options for this case without implants? It is a workmans comp case involving #26,27, the patient can not afford implants and the insurance will cover fixed but not implants. Would not like to end a long span on centrals and would not like to prep a ton of teeth that don't need it just
September 08, 2015
Fixed Prosthodontics
Message Board
Views: 552 | Replies: 8
that too.Unfortunately, since the temp has been off so long, your teeth shifted and we have to start the process of making a bridge all over again. Since we just made a bridge for you a year ago, there is no way the insurance will cover it. Our full fee for the new bridge will be $X. Also, since
March 09, 2016
Fixed Prosthodontics
Message Board
Views: 1086 | Replies: 36
and reevaluatefrom there. Only because you mentioned insurance. Does Cigna pay for PET? It's cool and all, but is ita financiallyfeasible insurance case? I'm in network with Cigna, I'm sure they won't pay for PET. I would honestly just do it as a favor and get paid for the buildups and crowns. I have a cerec
April 08, 2021
Fixed Prosthodontics
Message Board
Views: 150 | Replies: 1
to do a bridge. <br/><br/>Okay, the patient has insurance she wants to bill HOWEVER I have no idea how to code a pontic between #21 and #22. It'll be a 3 unit bridge and I just need to know how to code the procedure.<br/><br/>Hope to hear from someone soon.<br/><br/>
January 17, 2014
Fixed Prosthodontics
Message Board
Views: 521 | Replies: 13
We routinely take an x ray to verify that margins are sealed on a crown before seating the crown. Is this considered part of the crown procedure, or is the X-ray a separate fee billed to insurance? Literally asking for a... how does a 2 dimensional object verify something in 3 dimensions? Just
January 03, 2019
Fixed Prosthodontics
Message Board
Views: 627 | Replies: 11
? MarshallCan someone explain what margin elevation is? Also what is an endolay? I'm a bread and butter guy, what are you all doing with onlays vs insurance? Will insurance cover an onlay? My patients are huge on what ever insurance will cover. Margin elevation is when a tooth like in this case has
July 13, 2016
Fixed Prosthodontics
Message Board
Views: 586 | Replies: 3
for? Implant maintenance . Most insurance don't pay for this...Hmmm there has to be a code. I don't think think the implant maintenance one is the right code. Any other thoughts anyone?Nope. He's right. Implant maintenance code. Or internal code. Or unspecified emergency code. Who cares. Insurance won't pay. Just collect the money and be done.
May 22, 2015
Fixed Prosthodontics
Message Board
Views: 104 | Replies: 1
provisional (#8-11), and harvest the receptor site using bone and an ovate pontic. What are the appropriate insurance codes for the bone, ovate pontic and provisional and what ball-park fees would you recommend? Get Charles Blair's insurance coding book, invaluable. (not at the office to check through it.)
May 01, 2014
Fixed Prosthodontics
Message Board
Views: 631 | Replies: 13
if attachment is encroached long term Nicely seated crown - but patient in pain There lies the problem . I agree with the periodontist Think like a Dr. Not a technician On a side note have not been in a situation lately with insurance in the picture with all 3 procedure. When we called
October 04, 2020
Fixed Prosthodontics
Message Board
Views: 112 | Replies: 1
My patient recently came in with a broken Emax on tooth #14 that was only about 6 month old. I replaced it for her, and billed it to her insurance because when it was originally done, she was already out of benefits so they didn't pay anything anyways. Of course, insurance denied it due to having
January 27, 2016
Fixed Prosthodontics
Message Board
Views: 329 | Replies: 22
out last week. Language is a barrier. She doesn't want ext. Would it be unethical to fill it with composite and charge it out as a filling? Would insurance cover this? Would it be unethical to fill it with composite, code it as a core buildup, and then give the patient a referral for a crown? Want
September 05, 2024
Fixed Prosthodontics
Message Board
Views: 418 | Replies: 8
of incident. I wouldn't think that you would be on the hook for testing and all that, but what do I know.We sent her to the ER to get treated and paid her $1300 bill. I guess my question is: Should the school have covered her bill? And if it was our employee, does any of our insurance coverage cover
October 22, 2015
Fixed Prosthodontics
Message Board
Views: 150 | Replies: 5
most likely a crack in there somewhere already. I've seen too many upper premolars split down the middle (sometimes unrestored teeth without endo) to chance it. Hi, studies show that root canaled posterior teeth last longer with crowns. Crown it. Premolars fracture all the time. Insurances also never deny when I tell them it has been RCTed.
May 15, 2025
Fixed Prosthodontics
Message Board
Views: 1803 | Replies: 27
out an MODBL ag when you actually did a core build up? And, please don't tell us that you submitted the MODBL amalgam code to an insurance company?? Not only the above, when you DO have to remove it likely the extraction will become a real clown show. Nothing like a brittle, cored out endo
January 08, 2017
Fixed Prosthodontics
Message Board
Views: 243 | Replies: 5
Can you charge out a crown on prep date? Thanks Yes... Yes. I charge out every crown on the prep date. You will find some insurance companies pay on the seat date, and for those you may have to call them back to give them that date if they ask for it. I find this to be pretty rare though.I am
August 14, 2016
Fixed Prosthodontics
Message Board
Views: 284 | Replies: 4
i was contacted by deltacare usa to evaluate these two crowns done by another dentist. coincidentally this patient was a patient of mine but left due to insurance changing. she had crowns #'s 2 and 32 done recently and she has pain to biting and around the gums. i felt open margins on the distal
August 29, 2019
Fixed Prosthodontics
Message Board
Views: 72 | Replies: 1
I am in the process of tx planning a larger case and was looking for input. Pt. is tx planned to crown 5-12. Pt. is 19 years old and her mouth is in an awful state. Her state insurance will cover root canals and crowns before she turns 21 and the pt. is motivated to improve her oral hygiene
April 25, 2018
Fixed Prosthodontics
Message Board
Views: 749 | Replies: 22
Ed. Getting an Insurer to benefit the treatment is another matter. Generally, InsCo's will not benefit a cracked tooth. pjb 46176 you need to change your mind setTeeth are a want, not a needWhen you get the patient to want to fix their teeth, insurance becomes the reimbursement tool it was supposed
August 13, 2022
Fixed Prosthodontics
Message Board
Views: 1455 | Replies: 47
to patients and insurance? As an example. An MOD restoration with recurrent caries planned for a crown, how would you approach this? Thank you What is the restorative material The process is pretty simple and repeatable in 80% of situations. Excavate all old restorative material, remove any decay
July 13, 2022
Fixed Prosthodontics
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