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Searching: insurance denials
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Message Board
Views: 772 | Replies: 55
altogether. Do that today. If it is as you say and you are 'getting Premier fees' for those Premier patients regardless of status as a DD PPO doctor, the only difference would be those pesky PPO pts will stop finding you from their insurance list and bugging you with phone calls. More likely scenario is you
May 20, 2026
Going Out of Network
Message Board
Views: 772 | Replies: 55
. Currently on pace for 1.9 gross 1.4 collections this year. (Up 5% gross and net production YTD, up 9% collections. 11 HYG days a week. In network with DD premier, Cigna, then TPA for about 6 other insurances. 2500 active patients. Recently started not seeing new DD patients. My schedule is booked 2-3
May 15, 2026
Going Out of Network
Message Board
Views: 373 | Replies: 16
of a pain it is for the front desk to deconflict vs the other typical insurance metrics such as write-offs, denials, and the normal games they play. I think a lot of this will come down to how well its set up in our PMS. I'll have to build out accurate fee schedules for network coverage and then attach
February 12, 2021
Going Out of Network
Message Board
Views: 3713 | Replies: 195
. No debt , no hurry. Amen. The reason we tell folks we accept their insurance is because we do. We take assignment and work damn hard verifying insurance, submitting claims and dealing with denials. It would be remarkably awkward to tell prospective patients yes we accept your insurance but you can
December 09, 2023
Going Out of Network
Message Board
Views: 120 | Replies: 0
Every dentist has had this moment. You present a crown that is clearly indicated. The patient nods. Then they ask, 'What does my insurance cover?' You already know the answer is going to be awkward. Now zoom out. In medicine, there is a story making the rounds about a drug that costs about $47
April 20, 2026
Going Out of Network
Message Board
Views: 232 | Replies: 6
by that insurance? Would we have to send letters to each TPA and the insurance company directly? You want to look at everything globally because you need to know the shared network agreements that each company has in advance. If you opt out or drop something, the insurance company may drop to a lower option
April 02, 2026
Going Out of Network
Message Board
Views: 145 | Replies: 5
them examine it under a microscope and then have it fedexed back for reimplantation....Guys there is no insurance anymore, just blatant scam artists. Do insurance companies make you submit evidence of caries on simple fillings? A human never saw this claim. Theyre just hoping that your
March 05, 2025
Going Out of Network
Message Board
Views: 754 | Replies: 26
Has anyone else received a letter from their State BCBS stating that non-state employee plans will all reassign AOB to the patients now? So Delta Dental pulled this and now BCBS is trying their hand at it. doesn't surprise me one bit, except that the insurances haven't tried this sooner. just
December 25, 2024
Going Out of Network
Message Board
Views: 1953 | Replies: 53
. Dentists across the country describe the same squeeze. Insurance companies keep cutting reimbursements while corporate chains happily sign every plan to fill chairs. In saturated cities, refusing a PPO contract can feel like practice suicide. In rural towns, where one dentist might serve 3,000 people
April 08, 2026
Going Out of Network
Message Board
Views: 1953 | Replies: 53
these threads, as they are a rite of passage for those that take the voyage and gives us pansies some juice. Because Delta has great PR that makes believe they have great insurance. They boast about having 70% of dentists in this country in their network. Pts believe it. I don't' think that's true any
April 08, 2026
Going Out of Network
Message Board
Views: 110 | Replies: 1
collected the contract fee for the crown minus the benefits they had remaining. The crown was denied (the 6th crown denial from UHC in the past couple months), so we sent an appeal and they ended up paying the remaining annual balances leaving the patient with no balance. We never billed the patient, all we
November 01, 2023
Going Out of Network
Message Board
Views: 156 | Replies: 0
DD has been making us do MEDICAL claim first for surgical extractions and IV sedations . Get denials prior to resubmitting for dental! WTH! Further, DD limits IV sedation to 4 x 15 min ONLY! I guess the bonus for the executives have to come from somewhere.... NO MORE DELTA DENTAL!
December 06, 2022
Going Out of Network
Message Board
Views: 880 | Replies: 33
them we were going OON because we were tired of literally fighting to get paid.Senseless claim denials, repeated requests for the same information, magically missing electronically submitted claims, denied pre-authorizations...I can't work for the insurance company AND work for my patients, so I've
September 09, 2022
Going Out of Network
Message Board
Views: 658 | Replies: 29
a refund after the insurance pays. I try and quote worst case scenario in all cases. With sedation you MUST get approval for worst case because you cannot add any treatment. I only say that if I want half the tooth to crumble away while I'm prepping it. never fails. Actually, that's a safe
February 04, 2021
Going Out of Network
Message Board
Views: 13958 | Replies: 230
. AOB denial is also a tell that the insurance companies don't believe in their own value proposition. If you think about it, this whole game is two parties battling each other to adopt a mindset. The insurance company is telling the dentist he's just a commodity and the dentists tend to believe
July 26, 2022
Going Out of Network
Message Board
Views: 156 | Replies: 4
Hello, Has anyone had any experience with Insurance companies continuing to pay based on fee schedule even though the contract termination date has passed? Unicare (Wellpoint) has agreed that my participation terminated in a 30 day period as my contract stated, yet they are allowing the fee
July 20, 2025
Going Out of Network
Message Board
Views: 230 | Replies: 10
Just sent a desist letter to Aetna's Equian group. They were going back to a filling from years ago and claiming overpayment and sending threatening letters. I sent them an email letting them know Arizona has a 1-year limit on insurance companies pursuing overpayments and that I would be referring
November 27, 2025
Going Out of Network
Message Board
Views: 667 | Replies: 25
on it cause they knew our fees. A ton more were thrilled with it cause now they had free cleanings just like the folks with insurance. We also play up the no waiting period, no denials, etc in our marketing materials for it (we market it pretty heavy now due to #1 below) We have had no negative
April 29, 2024
Going Out of Network
Message Board
Views: 57 | Replies: 1
Dentists and dental students rallied at the Alabama State House this week urging the state Legislature to pass dental insurance reform laws. They're backing bills that would require dental insurers to spend a higher percentage of premiums on actual patient care rather than administrative costs
January 29, 2026
Going Out of Network
Message Board
Views: 109 | Replies: 2
There is a lot of room between taking all insurances and not taking anything. With consideration of Demographics, location, age of practice and our preferences we can be in network with some insurance in a smart way. There are companies that will help you decide what insurances to take based
April 27, 2022
Going Out of Network
Message Board
Views: 3304 | Replies: 88
insurance limitations or financial limitations to ensure that excellent care is still affordable. With out in-office plan there are no claims to file, no waiting periods, and no denial of services. Upon notifying Delta Dental that I was resigning from their network, I understand that they have sent
October 06, 2022
Going Out of Network
Message Board
Views: 37 | Replies: 0
Is it okay to be not a provider for certain insurances in a multiprovider office?
July 10, 2021
Going Out of Network
Message Board
Views: 1898 | Replies: 92
insurances and umbrella companies. The report is going to be ready soon. I've practicing over ten years and have worked a couple year in network and several year out of network as an associate. I know the work load difference. I'm not afraid of busting my butt in network if that is what it takes to grow
November 21, 2024
Going Out of Network
Message Board
Views: 2802 | Replies: 108
I bought a FFS practice that had all insurance payment sent to the patients. The previous doc collected in full, insurance payment sent to patient. I thought I'd be nice and just try to collect co-pays for about 1 year. I then went back to payment in full. So much easier and if we've lost patients
January 18, 2026
Going Out of Network
Message Board
Views: 1794 | Replies: 116
mailboxes with flyers promising tons of free shit for patients who can't tell the difference between value and price capitalizing on the term in-network simply because people are clueless about their insurance benefits. To help them with the carpet bombing, the insurance company not only prints
March 02, 2023
Going Out of Network
Message Board
Views: 4500 | Replies: 158
. (For instance the school district patients)Has anyone gotten feta to allow coverage for patients with out being in network due to geographic restrictions ?Thanks Are you talking delta sends the check to patient or literally has no OON benefits? If insurance isnt paying at all then patient pays, I
June 30, 2025
Going Out of Network
Message Board
Views: 2466 | Replies: 90
. How about implant supported CD downgraded to regular denture and patient is just responsible for D5110 copay ? No shekwe lose about 150 profit per appointed delta premier vs standard fee insurance OON per year hygiene associated my comment was to make it up in easy restorative like abfraction fills
May 17, 2024
Going Out of Network
Message Board
Views: 423 | Replies: 10
Hi all, just wondering if anyone has had a situation similar to mine. I have been in network with an insurance company since I bought my practice nearly 13 years ago. At the time, the insurance company was called POMCO, but several years ago it was bought out by UMR. My contract was grandfathered
September 25, 2024
Going Out of Network
Message Board
Views: 140 | Replies: 1
In a couple weeks, I will be leaving my position at a PPO office to start at a 100% OON office. My understanding is the majority of insurance companies follow the office tax ID for payments. However, should I still contact all the networks (Careignton, Zelis, GEHA, BCBS) to notify them? Or will my
February 19, 2022
Going Out of Network
Message Board
Views: 4500 | Replies: 158
I had one insurance, delta fucking dental. Its gone. Im insurance free! Started 6 months ago of writing letters and emailsglad to be done with insurance. awesome! Keep us updated. Has it had any effect on your monthly billings? What has the patient response been like ? Not sure what you mean
February 11, 2022
Going Out of Network
Message Board
Views: 33 | Replies: 2
We started verifying insurances for 2026 and ran across a plan that in network offered a $1000 max but OON only had a $500 max. I know this is common in medicine (higher deductible, but same concept), but has anyone else seen this? It was an employer sponsored plan, whereas usually the poor
January 03, 2026
Going Out of Network
Message Board
Views: 227 | Replies: 6
I'm in the process of dropping Delta. As I sit here, preparing letters to patients, I find that I don't know the history of dental insurance well. Is there a book that I can buy? I'm perplexed with this idea: If dental insurance can be bought with pre-tax dollars (allowing leverage
August 16, 2020
Going Out of Network
Message Board
Views: 13958 | Replies: 230
people will have a beef with that) This is also why OON (not FFS -- see post #1) accept whatever low UCR fees the insurance company pays and consider the bill paid in full as long as there are is no co-insurance or deductibles. Some question the legality of that -- look for other threads on this where
October 04, 2021
Going Out of Network
Message Board
Views: 185 | Replies: 4
Hello Colleagues, I'm reaching out for advice on improving the accuracy of insurance coverage estimates in my practice as an Out-of-Network provider. What strategies, tools, or communication techniques have you found effective in obtaining reliable insurance breakdowns regarding their coverage
January 25, 2024
Going Out of Network
Message Board
Views: 557 | Replies: 30
. The dream, straight cash, fair rates, no insurance headachedes: I think this type of advertising will become more and more popular. I think people appreciate the up front information. Healthcare is changing and so should the approaches. Are there any GP out there with the same type of website
November 21, 2025
Going Out of Network
Message Board
Views: 286 | Replies: 5
Has anyone had MetLife sent a letter wanting to visit the office for site evaluation and review x rays, restorative, and endo treatment in your office? Thanks! Ive never had any insurance companies come in for a spot visit. Should I be concerned? What are the ramifications if I decline their visit
February 18, 2023
Going Out of Network
Message Board
Views: 351 | Replies: 6
or is there an easier way? Thanks again everyone ! Just tell patients it's their responsibility to know their insurance and you will do the SERVICE of submitting claims on their behalf. see? put the responsibility back on the patient. But at the same time- give them a little bone by saying you will submit
January 18, 2026
Going Out of Network
Message Board
Views: 102 | Replies: 0
Hey all I am interested in dropping some insurance plans, potentially delta dental. I was wondering if there are advisors or consultants out there to help with this. I reached out to Unlock the PPO but unfortunately they are not working with offices that have multiple doctors at this time(We have 2 doctors). Any other potentially good contacts? TIA!
August 04, 2021
Going Out of Network
Message Board
Views: 123 | Replies: 2
I have a small FFS private practice which I'm getting ready to transition to a new owner. She will be staying OON as well. We don't accept assignment of benefits, but do file insurance claims for our patients. For the next couple months she's working scattered days as an associate to get to know
January 12, 2025
Going Out of Network
Message Board
Views: 118 | Replies: 5
. The EOB states that they won't even consider my appeal without this Waiver. How can an insurance company refuse to reconsider a claim unless I promise not to bill the patient? Is this legal? Does it supersede my patient's promise to pay me whatever the insurance doesn't cover? To be clear I do
December 02, 2025
Going Out of Network
Message Board
Views: 1073 | Replies: 30
for d1110 (prophy) $85 Agreed but just for your future knowledge, most if not all insurance companies will not provide an OON fee schedule. You have to compile it yourself. The distinction with Delta as compared to others is that they will assign AOB to patients. Other companies will allow you to accept
February 01, 2026
Going Out of Network
Message Board
Views: 1027 | Replies: 40
Thanks, in a large part, to guidance from this community I have transitioned to an out of network model for my practice. Through the process my practice demographics have changed. Most of my patients are retirees who no longer have insurance and have enough of a nest egg they can afford to pay
February 23, 2026
Going Out of Network
Message Board
Views: 516 | Replies: 11
collections by dropping specific insurances and renewing some of your contracts. Bump Nothing new or unusual there. Unlock the PPO has been these EXACT things for many years. Unlock the PPO was great for us 3 years ago paid for itself 10x over. Painfully slow process though. Now the insurances moved
June 08, 2022
Going Out of Network
Message Board
Views: 4500 | Replies: 158
sensitivity, increase bond strength and restoration longevity. Otherwise I wish I had the testicular fortitude to go insurance free. ive done the Holy Triad for years. Im def a fan of it. what is it? Chlorhexidine? Thats what we did when we dropped Delta, with a similar response. I like how you polled
April 04, 2022
Going Out of Network
Message Board
Views: 4500 | Replies: 158
for a dental office team to read. I dont think more than a handful of people will even read a long letter and I really dont think it will sway many. If any one of us gets this same thing from MD would we do anything other then find the insurance website and start looking for another in network MD? Maybe Im
March 11, 2022
Going Out of Network
Message Board
Views: 304 | Replies: 2
Last year I went OON and dropped BCBS and Delta. BCBS sent a letter to our patients scaring them that we no longer take their insurance. From what we can tell Delta did not send patients a letter. I'm wondering if we should send a letter notifying Delta patients that we are no longer in network
January 31, 2022
Going Out of Network
Message Board
Views: 5332 | Replies: 189
When a new patient calls and says, Do you take my insurance? Does that mean, are you in-network or does it mean will my insurance pay you some? I'm not really sure how to respond as I am out of network for all insurances. Does anyone have a good script to respond? You will probably get multiple
December 09, 2020
Going Out of Network
Message Board
Views: 280 | Replies: 4
Hi! I'm Lisa, Dr. Young's Office Manager, I am writing on his account: I am OON with a couple of insurance companies that still show his practice as In network when patients search their websites for Dentists. Does anyone have a form letter thatthey are willing to share with me that theysend
December 01, 2020
Going Out of Network
Message Board
Views: 5332 | Replies: 189
Friends for a reason, friends for a season...... What the patient really means is Can I just hand you this little card instead of paying you any money ? Try this it works Take that insurance card and try to get it to run through your credit card machine then say, Oh, this card doesn't have
December 31, 2024
Going Out of Network
Message Board
Views: 1794 | Replies: 116
So I know going out of network is all the rage on Dentaltown, but I'd like to know when is it beneficial to go in network? For example, if an insurance company reimburses more than other current in network companies, would it be good to join that one and drop others? What about to fill up
March 01, 2023
Going Out of Network
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