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Message Board
Views: 4528 | Replies: 64
Facebook to Twitter. This is a GREAT article! As dental health experts, we need to educate our patients about not only how to keep their teeth and gums healthy, but about the role insurance plays in their care. I have always told patients to look at benefits like a bonus or a partial payment
January 26, 2019
PPOs and HMOs
Message Board
Views: 250 | Replies: 1
really consider dental care an essential service, despite mounds of evidence linking a healthy mouth to the well-being of the rest of the body, from better pregnancy outcomes to a healthier heart. Dentistry has always been siloed off. Dental coverage has been off in its little largely unregulated
November 06, 2023
PPOs and HMOs
Message Board
Views: 156 | Replies: 5
which is my highest one. Good network but it excludes you from all other ucci plans. Some may see that as a benefit tho My other UC insurances are under Sun Financual TPA at a healthy fee schedule. In addition to the good info already mentioned, if you add a direct UC Elite Plus contract because
January 28, 2025
PPOs and HMOs
Message Board
Views: 807 | Replies: 24
said all that, either a patient is periodontally healthy and should get a dental prophylaxis or they are not periodontally healthy and they need periodontal maintenance. Submitting legal documents to an insurance company saying that every three months your patient is alternately healthy or not healthy
May 15, 2019
PPOs and HMOs
Message Board
Views: 169 | Replies: 4
patients at a healthy stream, why take it? Dont feel bad for the patients. Tell them to switch plans or get their company to switch. Some may say "oh they work for a big company and they cant switch" but if you have them tell their colleagues and coworkers, they can get movement. I have had a few
September 23, 2025
PPOs and HMOs
Message Board
Views: 296 | Replies: 6
Patient has #9, #10 broken to gum, and #11. Billed PPO for d5820 interim partial #10. PPO paid a portion. Ptnt lost flipper #10, and now wants bridge 9-10-11. He is close to going over his 1000k annual maximum anyways. What do I do here? I am debating on just collecting his 9-10-11 bridge fee
September 05, 2021
PPOs and HMOs
Message Board
Views: 1755 | Replies: 56
chocolate cake..... Lol you didnt check the insurance of the patients you were treating? And a doctor quitting without notice is pretty much shoe gum in my book. You have an ethical responsibility to finish treatment you started and provide for an orderly transfer of patients. Poor baby.Get off
July 28, 2017
PPOs and HMOs
Message Board
Views: 56 | Replies: 1
Look at this great plan!!! A $5,000 limit? How generous! Oh... wait... looks like it only covers preventative. So, how do I get this $5,000? grrrrrrrrrrrrrrrrrrrrrrr..... I can see the sales person boasting about the $5,000 limit. Easy. Contact your local DSO on how to place Arestin and do four quads of S&RP on a healthy...
October 04, 2017
PPOs and HMOs
Message Board
Views: 302 | Replies: 10
, after the gums have had ample time to heal. ( Typically a few days ) The patient then comes back and either a D0150 or D0180 is billed. 2. Do you have clinical notes to back up why the full mouth debridement was done? It's 6 patients. Send copies of the notes and any data to back up the procedures. 3
January 10, 2019
PPOs and HMOs
Message Board
Views: 222 | Replies: 6
that going in network with insurances for all the people that keep asking about it but don't come because we don't accept their insurance is the best way to ensure that the practice stays healthy and maintains positive cash flow. I imagine Medicaid will be done away with a few months after we are officially
February 26, 2025
PPOs and HMOs
Message Board
Views: 880 | Replies: 45
this antibiotic is placed in your gum pockets after your deep cleaning and it is the best thing ever-your going to need 15 sites of arrestin, medicated rinse and laser therapy for $5000 BobYes sir-after extracting these residual root tips we are going to place this bone powder so your gums heal
June 27, 2019
PPOs and HMOs
Message Board
Views: 437 | Replies: 13
the gum line? Seeing SubG tartar on the x-rays is not good enough, huh? Now they want to play a numbers game. Just out ofcuriosity what are the pocket depth on the perio chart you submitted to the insurance? LuEllenMost of the time you need 5 separate sites of 5mm in the quad to qualify for srp
November 14, 2018
PPOs and HMOs
Message Board
Views: 330 | Replies: 9
fast. 4. Code 1110-prophylaxis. Typical plan fee-zero to $80. Mauty add-ons: chair with working suction-$50. Friendly hygienist-$100. Unfriendly hygienist-$200. Home care instructions-$50. $100 discount if patient leaves without bothering Mauty or asking the hygienist why their gums bleed
December 10, 2023
PPOs and HMOs
Message Board
Views: 323 | Replies: 2
periodontal condition was treated. 62yr old female. BWsshow loss ofcrestal lamina dura between 2 molars in one locationwith sub G crown margins, but nowhere else. No BOP notedon 5 years of a perio chart with random sporadic 4mm pockets. Bone levels in all areas in a normal and healthy
January 28, 2018
PPOs and HMOs
Message Board
Views: 164 | Replies: 4
worried that my capacity is going to get bogged down with more Humana than would be healthy as their fees are close to my 50% of my office fees. As they flee these offices and find my office. I am a direct contract with Humana, but I also have a Careington, Connection, and DHA (although I don't
December 09, 2021
PPOs and HMOs
Message Board
Views: 1691 | Replies: 43
of patients as good people because what the heck does that actually mean. If you want to treat good people, simply charge people a fee that allows you to run a healthy business. insanity. prices in Mexico: Crowns: $250 Molar RCT: $180 Extractions - $30-100 Fillings $25-35 So you could outsource
May 02, 2017
PPOs and HMOs
Message Board
Views: 252 | Replies: 8
to $1500range usually financed by care credit. Staging waswith the heavy workto be done in 1 big visit and thensidebooked for anydenture intermediatestep visits and/ordeliveryappointment. Hard work but they have healthy mouths when you are done. I had some very
May 20, 2018
PPOs and HMOs
Message Board
Views: 102 | Replies: 6
can get the % of patients that are insurance vs FFS, but this other report would tell me alot more about how healthy the practice is. Are you just trying to figure out how much you got paid via insurance companies verses patients handing you cash, check, card, etc? If so Payment Reconciliation would
March 15, 2023
PPOs and HMOs
Message Board
Views: 912 | Replies: 23
a patient complained that my hygienist made her gums bleed, and she swallowed too much blood and got a stomach infection (the patient was a complete nut-job, and had never seen the working end of a toothbrush). I called United Concordia and talked to some idiot with a 7th grade education on a major
May 27, 2016
PPOs and HMOs
Message Board
Views: 622 | Replies: 6
problems, assess oral sores, lesions, swelling or infections, advise on orthodontia needs, broken, chipped, sensitive or misaligned teeth, gum swelling and bleeding, provide expert second opinions, treatment guidance and more. DialCare has been offering telemedicine through its Physician Access
February 02, 2021
PPOs and HMOs
Message Board
Views: 365 | Replies: 9
usually preventive only. I have opted for the Advantage plans for the last 11 years and they have some nice percs. My wife uses the gym membership which is included and healthy services are stressed. We use a state HSA savings plan to pay the premiums which are a more reasonable $65/month. We also pay
February 15, 2018
PPOs and HMOs
Message Board
Views: 496 | Replies: 12
are cheating them. Another reason to not accept assignment and embrace and promote an in office program. Remove the chains of insanity, treat patients without limitations of big brotherresults in healthier smiles, happier team and much less aggravation Wouldn't the insurance cos want to see
March 28, 2022
PPOs and HMOs
Message Board
Views: 1453 | Replies: 33
year old for a second opinion because they told her she needed quads, a powerbrush and Arestin. Pink gums, 2-3mm pockets. Sick. Sparrow-- I feel your anger at this bull crap laser/ lavage/ Arestin upsell crap. Hard to compete against them if you're an honest provider. And Sonicares in bulk too
October 27, 2022
PPOs and HMOs
Message Board
Views: 416 | Replies: 4
that we estimate - we will do our best to fight them on that and help you maximize your benefits, however at the end of the day - it is your insurance. We want you to know that we are here to make sure you stay stable and healthy and that we will always offer you the best dental care and customer
July 12, 2016
PPOs and HMOs
Message Board
Views: 187 | Replies: 3
. There is no guarantee on the pickup or transition time, some may transition almost seamlessly, others may take 3-6 months where you have a gap in participation so you want to minimize that as much as you can. A 20% write off (assuming your cash fees are healthy) is a good fee schedule. Metlife
January 28, 2019
PPOs and HMOs
Message Board
Views: 666 | Replies: 9
healthy and clinically acceptable other than appearance. The patient has been told they have recurrent decay or need to be replaced. It makes me question how Dentistry is going to look in 3, 5, 10 years when I am still no where close to being done practicing. EOJ - good for you for doing the right
November 12, 2018
PPOs and HMOs
Message Board
Views: 613 | Replies: 11
this bs and Ill have to drop them too I dropped them years ago when I got the letter. They are at present trying to get me back with a way healthier fee schedule. Go figure. The lowest. Thats the game. Not trying to derail the thread..... These companies join together as partners to screw
October 12, 2021
PPOs and HMOs
Message Board
Views: 2641 | Replies: 67
once you see it. Think about it, dental schools are infection driven; treat decay and gum disease. Insurance is infection driven; treat gum disease and decay and do so with limited benefits. TMD is Beyond Infection and Beyond Insurance!!!!!! Article: My father, grandfather, and older brother were
November 14, 2018
PPOs and HMOs
Message Board
Views: 6504 | Replies: 235
and amalgams on anterior teeth. I try really hard to get patients on regular recalls and try to resolve all their dental disease. in my dream practice I have 10,000 patients coming for recalls with no pathology or treatment needs. I want my patients healthy. It seems your aim is a bit different
February 13, 2016
PPOs and HMOs
Message Board
Views: 4993 | Replies: 97
is mostly perio with some fillings; they are basically healthy. Not too many agree for treatment anyway, about 10-15%. You can charge whatever you want. Just keep in mind, if you charge $10 for a prophy, $100 for a prophy, or $500 for a prophy, they are going to think it is too expensive compared to $0
June 20, 2017
PPOs and HMOs
Message Board
Views: 4562 | Replies: 237
others cant do it, but I know that I couldnt. I have no doubt it can be done, and that those doing it can still lead balanced, healthy lives. And it's admittedly a sensitive subject to broach without one side implying at least a little criticism of the other. But it was a little entertaining
March 09, 2024
PPOs and HMOs
Message Board
Views: 1084 | Replies: 21
of years of dentists effectively lobbying, cultivating and maintaining strategic relationships in Congress, and participating in political activity at the highest level. Thank you for your support! Wishing you all the very best this Holiday Season brings, and a healthy and prosperous New Year
May 14, 2021
PPOs and HMOs
Message Board
Views: 502 | Replies: 25
down the center of the tooth creates gum line fractures we all see. hmd i have seen your posts and your solid. just food for thought. Would you eventually bill patient for this if Guardian keeps on denying payment?
December 28, 2023
PPOs and HMOs
Message Board
Views: 397 | Replies: 15
and her team helped me condense my agreements and moved several of my insurance company contracts to healthier fee schedules. If you are thinking of doing your own negotiation, I am happy to share the letter I sent introducing myself. I think Unlock the PPO did similar letters. I never felt GEHA
October 30, 2022
PPOs and HMOs
Message Board
Views: 2142 | Replies: 45
a different tune, If my renumeration was as low as the fee schedules I saw on this thread. I am sure there are many ways to have a healthy financially sound PPO practice. I must be geographically lucky at this time. Who knows what the future will bring. I have not lost any staff due to the supposed great
September 19, 2021
PPOs and HMOs
Message Board
Views: 2291 | Replies: 62
down (thanks to a negotiations company that initially encouraged this and screwed things up for the entire industry). Cash fees should be healthy but also what a doctor would truly charge a cash patient because insurance companies can and do now cross check claims. Along the same lines, for PPO
February 10, 2020
PPOs and HMOs
Message Board
Views: 752 | Replies: 32
along lines of health of abutment teeth. Sorry I don't have radiographs right now, but day of procedure I vitality tested #8 and #10, both healthy. #8 has existing PFM crown but no decay, #10 virgin tooth with no decay, PA's show no periapical pathology, and periodontium around both abutment teeth
January 10, 2020
PPOs and HMOs
Message Board
Views: 4562 | Replies: 237
, or a forcep/elevator etc. You know, people suffering from real problems, not just a mirror check every 6 months on perfectly healthy teeth. Where are these amazing dental markets? It's very possible with PPO. Have a few HGs, a solid associate or two, run it well...it will most likely be above 600k
March 11, 2024
PPOs and HMOs
Message Board
Views: 1717 | Replies: 45
their same day emax crowns done by the old dentist. They were cemented poorly (probably) with bleeding gums and margins of the crowns are bad. Makes me way mad, but 99% of the patients think its their fault, and they just say oh well, another root canal.They dont care that much or accuse the old
December 31, 2024
PPOs and HMOs
Message Board
Views: 884 | Replies: 41
to every single crown prep. Thats on top of the core build up and lab fee, which were legitimate. Troughing around gums with a diamond during a crown prep doesnt warrant its own code. I just couldnt look patients in the face and act like these add ons were necessary.I understand these offices need
June 22, 2020
PPOs and HMOs
Message Board
Views: 719 | Replies: 24
their insurance benefits as partial payment towards the final cost of the treatment. As their dental provider, you are going to recommend treatment that is necessary in order for them to keep their mouths healthy. Isn't that what is important? So, if your patients have been educated about how insurance works
January 07, 2018
PPOs and HMOs
Message Board
Views: 558 | Replies: 18
for 10 years now. but I do still know most of the upper management of the company, and they are honorable people. I view any and all insurance companies with a healthy dose of cynicism, but as far as insurance companies go, Delta Dental of Arkansas has been straight with the dentists of Arkansas, where
February 28, 2017
PPOs and HMOs
Message Board
Views: 8229 | Replies: 436
on perfect gums? Or crowns and build ups for teeth with small occlusal amals and no cracks? These people are not my competition. Patients fly out of that place...........straight to me... Mayo DDS I tried the be the community dentist deal for a while. Volunteered for stuff, etc. It did not work out
February 15, 2020
PPOs and HMOs
Message Board
Views: 3713 | Replies: 195
could graft later. Which we already have. Sonja done further then this nowSo this case received lots of different disciplines from ortho to surgery, implants , sinus grafts, gum surgery , expensive ceramics from a man amazing lab. no the point isnt about deception. Its about insurance fees. You cant do
December 13, 2023
PPOs and HMOs
Message Board
Views: 1227 | Replies: 27
at working with others to be better -- and that's why my clients get great results (and I also throw in a healthy dose of compassion, humor and encouragement, which ALWAYS helps!). Specialties: The premier hygiene training and coaching resource for dentists and hygienists who want to grow
March 15, 2019
PPOs and HMOs
Message Board
Views: 423 | Replies: 33
then mailing out membership cards. No claims, no reviews, no payments. They already know who the PPO docs are so they send them more discounted fee patients. You have to look at how healthy your practice is and see if you can boot them out. I would ask new patients how they came to our practice and when
March 31, 2017
PPOs and HMOs
Message Board
Views: 816 | Replies: 20
to feel and have been feeling for 20, 30, 40,50 years. That doesn't make it right, and it doesn't make it healthy for you or your family. I wouldn't necessarily characterize you as depressed, at least not just yet, because you are reaching out to the community and asking for some help. People who
January 16, 2017
PPOs and HMOs
Message Board
Views: 1209 | Replies: 23
radiographic image). List any missing cusps. Estimate and statepercentageof healthy tooth structure left after fracture, caries and/or any previous restoration is removed. Document any existing circumferentialcariesat gingival margin and extensive caries detectable by explorer under existing
September 21, 2016
PPOs and HMOs
Message Board
Views: 1670 | Replies: 115
a full schedule and a healthy net. And not the craziness of a busy practice. Good luck to you. Heres a novel way of looking at it. Dont look at signing up PPOs as signing up for insurance, look at it as signing up for patients. Employers change their insurance like underwear. Once in your practice
April 06, 2023
PPOs and HMOs
Message Board
Views: 6756 | Replies: 152
to the dentist in a long time, expect to have cavities, and don't know what a dentist is like. They go to XYZ corp because it has a sign, advertises at football games, takes their insurance, they are told they have 20 cavities and gum disease, aren't surprised because it's been years, and just go
January 13, 2022
PPOs and HMOs
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