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Searching: insurance denials
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Page 1 of 14
Message Board
Views: 2314 | Replies: 56
seeing the dental insurances want a denial from medical insurance before paying. And then I see it covered under medical but the patient has one of those 5k deductibles. Go figure. Funny thing is: I'm reading this thread and read this comment at lunch. The patient immediately after has #1 and 16
February 26, 2015
Oral & Maxillofacial Surgery
Message Board
Views: 582 | Replies: 15
them around like they do you and I and the patients. The TDI will get a concise, complete, and rapid response. Tommy, Never heard of a insurance commissioner. Your idea sounds promising. Yesterday I received a insurance denial for an orthogathic case (double jaw. lefort 1 maxillary advancement
April 10, 2014
Oral & Maxillofacial Surgery
Message Board
Views: 111 | Replies: 0
a medical denial- meaning that we are submitting to medical and dental)? Any tricks OMS's are using to get paid quicker to reduce their AR? I feel like my insurance coordinator is extremely diligent and hard working, and most times our estimates for patient's are extremely accurate (almost to the cent
April 20, 2016
Oral & Maxillofacial Surgery
Message Board
Views: 1005 | Replies: 24
clinical... The entire meeting has been about all the insurance regulations that have changed or will be changing and pretty much it's alldoom and gloom. The old guys are happy they are close to retirement. They keep looking at us young guys and telling us we are pretty much screwed
November 02, 2015
Oral & Maxillofacial Surgery
Message Board
Views: 287 | Replies: 5
at 80%. We never send pre-auth for extraction.Aetna is trying to keep their money as long as they can. This is never going to be covered by any medical insurance, in my experience. So if their medical does, it would the first time I heard. Most likely you need to make a claim with the medical insurance and then send the denial to Aetna. Then Aetna will pay. Probably. Michael
April 02, 2018
Oral & Maxillofacial Surgery
Message Board
Views: 883 | Replies: 26
. Some oral surgeons said the statistic matched what they were seeing with burnout, hospital frustration, insurance headaches, and younger surgeons wanting different lifestyles. Others called the article clickbait, AI slop, or outright nonsense because they personally did not know a single oral surgeon
May 26, 2026
Oral & Maxillofacial Surgery
Message Board
Views: 61 | Replies: 0
, and the final plan. Attach radiographs, photos, CBCT slices when appropriate, and product labels if your system supports it. In today's insurance world, the clinical procedure is only half the work. The other half is telling the story clearly enough that a computer denial engine does not murder
April 25, 2026
Oral & Maxillofacial Surgery
Message Board
Views: 192 | Replies: 3
and getting reimbursed. Thanks. I've been looking at Delta processing policies for the new codes by state, and so far, all the ones I've looked at will not cover it. If you're in a state allowing you to charge UCR for non-covered services, please charge your UCR fee. For other insurances, it won't
February 13, 2023
Oral & Maxillofacial Surgery
Message Board
Views: 481 | Replies: 7
a wall or doing GBR. Hope that helps. Do insurances generally cover bone augmentation in conjunction with dental implants? code i use is 7953. bone graft and membrane is all inclusive. If the plan has implant coverage, it does! The code for this isD6104 - Bone graft at the time of implant
September 04, 2022
Oral & Maxillofacial Surgery
Message Board
Views: 329 | Replies: 8
An insurance company denied a claim for a surgical extraction claiming that the patient does not have coverage for surgical extractions, only for simple extractions. Can we refile for simple extraction instead and write off the difference? Your insurance policy doesn't cover the procedure
December 30, 2021
Oral & Maxillofacial Surgery
Message Board
Views: 1372 | Replies: 33
the perf. I was trying to help the patient and the referring dentist so I only billed for the extraction which was covered by insurance. A month later I get a denial for the extraction because it had already been paid to the referring dentist. The bone grafting is what gets me the most. Had a few
July 20, 2017
Oral & Maxillofacial Surgery
Message Board
Views: 3061 | Replies: 41
the medical insurance. Not your job. Often times you need to get a medical denial before dental will cover it. It's a way to waste rime.Most medical policies specifically exclude dental. When we send in these claim s requiring medical first (that will deny their claim) we include something like claim
February 06, 2020
Oral & Maxillofacial Surgery
Message Board
Views: 256 | Replies: 8
Just got a denial for D7251 Coronectomy. The insurance said that the xray did not show that the tooth was impacted. I was surprised that was their reason since I never thought of coronectomy only being for impacted teeth. Sure enough the ADA code mentions impacted tooth . Anyway, I don't see why
August 09, 2022
Oral & Maxillofacial Surgery
Message Board
Views: 289 | Replies: 7
lay out the options for treating the tooth? Is there another underlying problem that could have been detected? Will your insurance deny your claim if they don't have a sufficient picture? I don't think you need to have a perfect picture to take out a tooth, but should anything go wrong, it'd be nice
July 06, 2017
Oral & Maxillofacial Surgery
Message Board
Views: 69 | Replies: 2
it if you're in-network. They'll say you have to write it off, and the patient is not responsible. To appeal this denial or down coding, your clinical notes need to state why the frenectomy was necessary. You'll need to describe how it was a stand-alone procedure, which required notable effort
August 11, 2022
Oral & Maxillofacial Surgery
Message Board
Views: 603 | Replies: 22
All of these teeth are class III or IV mobility. Pt does not want immediate dentures and just want the teeth out first, then dentures later. Her insurance is paying $60 for each simple extraction, $118 for each surgical extraction but obviously all of these teeth will have to be coded as simple
March 09, 2026
Oral & Maxillofacial Surgery
Message Board
Views: 82 | Replies: 3
you receive payment or denial from Medical you can then send to the Dental plan as secondary. Be sure to attach a copy of the EOB from medical as well as the path report. This makes sense, thank you!
March 03, 2022
Oral & Maxillofacial Surgery
Message Board
Views: 579 | Replies: 14
of these last year, caught it in time on my patient. Took about a pound of bone graft to fill it up! Crazy, and TOTALLY asymptomatic until the Pan was taken. he was acting very weired, the whole time he felt so uneasy, and very...Sometimes fear makes people prefer denial rather then taking action, even
July 16, 2014
Oral & Maxillofacial Surgery
Message Board
Views: 233 | Replies: 5
will not be controlled with in-office anesthesia techniques. So.....the plan is to treat her under GA at the local surgicenter. Only problem is.....wait for it....you guessed it, insurance will not cover GA for removal of thirds. 2 months ago she had sinus surgery under GA and the insurance didnt bat
July 16, 2015
Oral & Maxillofacial Surgery
Message Board
Views: 2737 | Replies: 39
and it's getting harder to get paid by insurance. They have learned to create more barriers to get paid. Mainly in claim denials. About 20% of all claims are denied the first time for no identifiable reason. So you have to appeal which gives them as long as 6 months to reply. It's all about delay
May 19, 2019
Oral & Maxillofacial Surgery
Message Board
Views: 520609 | Replies: 24713
to Aspen and got the filling and she didn't like them She went to the local DSO and got the same day crown and her tooth hurts I started to drill and access hole in the occlusion and the crown split in half.....the crown is about 1mm thick I referred to the endo and she changed and went to the insurance
April 23, 2026
Oral & Maxillofacial Surgery
Message Board
Views: 182 | Replies: 3
I was wondering do insurance companies pay more to a specialist? For example if anins companyis paying $150 for asurgical extraction done by a general dentist is it going to be higher for a specialist? Thanks Yes, as far as I...Yes. Certain plans do.Yes most of the time just make sure you have selected the right taxonomy for yourself that is associated with your...
July 24, 2015
Oral & Maxillofacial Surgery
Message Board
Views: 1409 | Replies: 74
of a tooth when a dentist has asked for advice about extraction techniques. Ive extracted hundreds/thousands of teeth like this but anymore im more or a referral if the pt is not interested in a graft here. IMO its not worth the $150 that you will be paid given its an insurance pt. Way too many risk
February 05, 2026
Oral & Maxillofacial Surgery
Message Board
Views: 173 | Replies: 4
I was wondering what insurance code these are. I was thinking 1, 16 = simple ext 17, and 32 = surgical ext. 1,16=7140 17,32=7220 (soft tissue impacted) #17 could be a 7230 (partial bony) if the distal cusps have any bone over them. What if I could see the entire occlusal table including distal
November 11, 2014
Oral & Maxillofacial Surgery
Message Board
Views: 781 | Replies: 15
) it automatically goes to their medical insurance and pays 0 due to a 3000 dedctible......Anyone else heard of this BS? Apparently only two codes in the oral surgery codes are covered by the dental part....Apparently anything that involves much more than forcepts is considered medical....Hey maybe I am
November 09, 2015
Oral & Maxillofacial Surgery
Message Board
Views: 248 | Replies: 2
Hi all, I've had a couple of insurance claims denied when attempting removal of maxillary premolars, due to root tips fracturing. I was able to retrieve entire tooth except for apical 2mm. Both of these patients want implants in the future. My oral surgeon prefers I leave the root tip and he
April 03, 2014
Oral & Maxillofacial Surgery
Message Board
Views: 1460 | Replies: 32
of insurance which had no yearly max. Anything and everything was covered at 80%. Guess what else? His wife and many of his co-workers are also looking for dentists and they all have the same insurance. Guess what? We got them all. Ya, keep referring and refusing. I see your point DFW and honestly, your story
March 13, 2026
Oral & Maxillofacial Surgery
Message Board
Views: 519 | Replies: 19
I've been placing Surgifoam absorbable sponge into my extraction sockets, sometimes I use collagen plug and I think I should be charging for that using the code D7922- Intra-socket dressing for heostatis/clot, correct? Especiallyif it's an in network extraction that insurance pays anywhere between
May 16, 2025
Oral & Maxillofacial Surgery
Message Board
Views: 122 | Replies: 3
Hello, I'm a pediatric dentist. I used to do lingual and max frenectomies here and there, but more frequently now that my practice has grown. What I've noticed is that medical insurance covers these types of procedures. Do oral surgeons contract with medical insurance companies and submit medical
October 27, 2016
Oral & Maxillofacial Surgery
Message Board
Views: 107 | Replies: 2
Do dental insurances pay for super numerary teeth extractions? Do they need narrative? Yes. Write a narrative and add 50 for the appropriate tooth number. So a supernumerary next to #12would be tooth 62Thank you so much!
January 16, 2016
Oral & Maxillofacial Surgery
Message Board
Views: 334 | Replies: 17
many carps, I start to throw them away so I don't know how many I really used. Denial is the best defense....I do a balance check before I dismiss. Big cases like full mouth exts and any kids under nitrous. Patient stands up straight next to chair. Holds arms straight out, locked elbows. I hold my
July 02, 2015
Oral & Maxillofacial Surgery
Message Board
Views: 372 | Replies: 1
I'm writing, in short, to ask if any OMS on Dentaltown has had the PLEASURE of ever getting rid of insurance from their practice and still was able to put food on their table?? I practice in PA where reimbursement is about 50% of my dentalveolar practice and implant reimbursement is 85%. I find
April 20, 2014
Oral & Maxillofacial Surgery
Message Board
Views: 461 | Replies: 21
this IPS replacement paid by insurance, so no cost out of his pocket. The framework and interim fixed denture are all milled together and inserted at the time of implant placement. 1st such case done here in Connecticut. I've included some photos from the workup document and the surgery. Let me know
February 18, 2026
Oral & Maxillofacial Surgery
Message Board
Views: 89 | Replies: 5
denial will attract adulation from every respect of professional in future. Currently, various researches were done on dental stem cells in respect to their isolation, expansion, and application globally and in India, it is slowly picking up. Dental stem cells have some limitations like limited
January 10, 2022
Oral & Maxillofacial Surgery
Message Board
Views: 36 | Replies: 0
How is this billed? For Medicare to pay I've been told they do not pay for HBO therapy for prophylaxis for radiosteonecrosis of the jaw. There is a list for covered conditions for HBO therapy that medicare will pay, such as acute carbon monoxide intoxication, decompression illness, gas embolism, etc. Does insurance pay? Thanks.
January 11, 2019
Oral & Maxillofacial Surgery
Message Board
Views: 333 | Replies: 15
was at least partially driven by patient prefrences. They were cash/ HSA pay with no dental insurance and only a health ministry sharing plan for health insurance. I suspect keeping cost low was a big factor in the decision to monitor it for now as it was when I saw her for initial visit. She
January 03, 2026
Oral & Maxillofacial Surgery
Message Board
Views: 136 | Replies: 3
I do a lot of extractions, I rarely refer out 3rds cases these days and I know I can comfortably get these 3rds out, but this patient's insurance (a HMO plan) pays $275 for each full bony EXT and $225 for partial bony. Considering the proximity of #17 and 32 to the IAN, I honestly don't think
May 08, 2025
Oral & Maxillofacial Surgery
Message Board
Views: 402 | Replies: 15
Have you ever seen such a thing? Some kind of unlimited Humana plan? This, plus the other Pre-Ds add up to 13K. Can this be right? I've never heard of such a thing but I'm really hoping this is accurate and we are on the verge of an insurance revolution. Sorry guys.... This was supposed
February 24, 2017
Oral & Maxillofacial Surgery
Message Board
Views: 426 | Replies: 8
Anybody have this happen before? I spent a lot more time on the alveoplasty than I did on the extractions. Any suggestions on how to get the insurance company to pay for this? Thanks in advance for any ideas. From my experience if you bill out as surgical extractions then they will not pay
October 11, 2014
Oral & Maxillofacial Surgery
Message Board
Views: 130 | Replies: 4
How do insurances determine what to code for impacted thirds whether we say its soft, partial bony, or complete?Do they use the Pell and Gregory classification? Anyone know the answer for this? Thanks! The only thing that matters is whether it is a surgical, soft tissue, partial bony, full bony
September 16, 2024
Oral & Maxillofacial Surgery
Message Board
Views: 316 | Replies: 8
without advanced radiology support or direct physician oversight . So they could have missed the severity of the fracture etc..So this poor guy started calling a bunch of private practices, and everybody said that they dont take his insurance and I was itFor 3 months he got bounced around from
November 11, 2024
Oral & Maxillofacial Surgery
Message Board
Views: 1028 | Replies: 24
level of confidence. If you're going to do procedures you need to be a surgeon/scientist and apply you training. Your posts are full of denial and defense. Its totally okay to have complications. I have them all the time. Those who don't have complications either don't operate or are full of crap
January 29, 2019
Oral & Maxillofacial Surgery
Message Board
Views: 319 | Replies: 10
locations. what do you think? I think it could potentially be pre-malignant...screams biopsy to me. I suspect this is little more then hyperkeratosis. However biopsy is not a bad thing. For me, this would be a referral to ENT. Reason being, Dental Insurance rarely if ever covers
July 26, 2024
Oral & Maxillofacial Surgery
Message Board
Views: 2454 | Replies: 70
consistent with the OP's question (communication following the extraction of an upper molar) than the one he posted. Dumb question: Who's paying you for this? the pt? dental ins? medical ins? the previous dentist ? Are you in network with dental or medical? I love all the cases you post! The patient paid me around $7,000 I think. Dental insurance won't pay for this. I am not in-network with medical insurance.
December 10, 2025
Oral & Maxillofacial Surgery
Message Board
Views: 289 | Replies: 9
that she will need to see OS to have it removed if we didnt remove it at the time of the extractions due to her insurance declining the pre-authorization.See attached pictures from her CT What do you mean if? If you are not completely removing that, you should probably refer this case out. This thing
March 13, 2025
Oral & Maxillofacial Surgery
Message Board
Views: 1213 | Replies: 53
the insurance company forces due to being in network with them. Of course my assumption here is the surgeon is in network. I was thinking the same thing. Mission trips ? Glad to help. The last one I did 6 cases of wisdom teeth plus the restorative before noon. Wow that could have been $6000 x 6
September 20, 2025
Oral & Maxillofacial Surgery
Message Board
Views: 520609 | Replies: 24713
there! ^^Tooth #32 Kid has some pain I do the exam and panorex and recommend immediate extraction The kid is 21 and a college student He calls mom Now this is a new one for me Mom tells me that she knows that I work for insurance companies that pay lower fees than what I quoted her. Really? I said
June 28, 2012
Oral & Maxillofacial Surgery
Message Board
Views: 159 | Replies: 4
Hi.Yesterday at 4 PM I took out tooth nu. 3. Surgical extraction with odontectomy and osteotomy. Front desk send reclamation with computer. Answer: not a covered service I called the dental insurance and she confirmed me that extractions (simple or complex) are not covered
December 18, 2024
Oral & Maxillofacial Surgery
Message Board
Views: 413 | Replies: 7
of the lung provides a bigger disability and they deem a greater sense of urgency to treat.They dont realize that the origin of their malady may haveresided in their oral cavity. Medical insurance used to magically cover everything, now with high deductible plans, the playing field is leveling
October 10, 2023
Oral & Maxillofacial Surgery
Message Board
Views: 454 | Replies: 11
Hi all! I recently saw this 90 YO female patient for extraction of #22. I work at an FQHC (practicing for 2 years now); patient did not have insurance so I could not refer her to an outside oral surgeon at the time. Our clinic does have a rotating oral surgeon that comes in 1 half day per month
July 06, 2024
Oral & Maxillofacial Surgery
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