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Searching: insurance denials
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Page 1 of 19
Message Board
Views: 206 | Replies: 1
there is considerably less paper work and less headache of collecting and/or denial by insurance company. Same thing is happening in dental practice. Where I work, where all kinds of people with all kinds of insurance/discount/PPO come in. I just found out replacement for O-ring for an overdenture was 340
May 25, 2017
PPOs and HMOs
Message Board
Views: 952 | Replies: 14
, to an insurance company trying to dictate health care decisions when they only care about $$ Less work than dealing with a ton of denials.... But I agree with you, it is kind of stupid. Not sure how we let insurance companies be the gatekeeper for treatment. Welcome to the world of dental insurance
September 05, 2017
PPOs and HMOs
Message Board
Views: 280 | Replies: 3
told them its not covered. almost as if the fee is going to be different once the insurance sends a denial letter. The fee that will be owed by the patient portion might be less than what we submitted. Some people want to see this claim even though they know they will pay out of pocked. I guess what
March 26, 2019
PPOs and HMOs
Message Board
Views: 261 | Replies: 4
when an insurance company would start sending denials. Both companies are smart. They won't change the fee schedule they will get a payment for contracting with the insurance company so the Dr's don't get a cut. Monarch was doing capitation at an office I interviewed at. They had a fee of $15
February 22, 2023
PPOs and HMOs
Message Board
Views: 373 | Replies: 14
to call myself to ask to speak with the dentist who made the original decision as my last (3rd) attempt. -What are some tips when contacting insurance companies regarding denials? -Can Delta Dental deny my request to speak to the consulting dentist? Do I have legal right to speak to consultant
August 23, 2019
PPOs and HMOs
Message Board
Views: 437 | Replies: 13
what were your measurments. What is the CAL? because that is far more important. The biggest reason I ever see SRP claims denied is a perio chart with just pocket depths and nothing else. These are no brainer denials. Learn what insurance wants, and you will get claims paid.Didyousubmit
November 14, 2018
PPOs and HMOs
Message Board
Views: 644 | Replies: 28
that will be in the four digits pretty easily costing thousands and thousands of dollars, he said. Dentist says claim denials are happening more often. Claim denials from insurance companies are happening more and more, Ross said, especially as the claim processing system is becoming more automated. Sometimes
February 23, 2025
PPOs and HMOs
Message Board
Views: 233 | Replies: 13
. Better documentation on the office side ends most denial problems. Understanding how insurance works and what it will and will not pay for solves the rest. Waiting for money....yeah sure that is an issue for the first couple of months, then the cash flow is consistent and it really isn't much
November 05, 2023
PPOs and HMOs
Message Board
Views: 2239 | Replies: 76
. Couldn't quite finish it Friday. I've done it once before and got paid immediately. But, it's been a while, so I didn't realize, without a contract with UC I could have filed the complaint after the first denial. With a contracted insurance company I have to go through all the internal procedures
August 22, 2017
PPOs and HMOs
Message Board
Views: 1315 | Replies: 38
and incomplete fractures and are a medical necessity according to tot he standard of care for crown coverage. The insurance company receives the denial and then shreds the papers and sends back an EOB with the appeal denial. The information submitted was reviewed by our Dentist claim examiners
October 06, 2021
PPOs and HMOs
Message Board
Views: 30 | Replies: 1
authority to promulgate rules and that it did not meet while the language was being altered, raising questions about procedural validity. Drummond criticized the influence of out-of-state, for-profit managed care organizations that favored the rule because it would increase bureaucracy and claims denials
February 26, 2026
PPOs and HMOs
Message Board
Views: 325 | Replies: 7
I'm a conservative dentist, really don't recommend treatment unless it's necessary. So it really grinds my gears when insurances deny my claims. Recently purchased an intraoral camera to help with denials as well. So #19 hadbuccal caries. Needs new crown. The build up doesn't look great
November 07, 2017
PPOs and HMOs
Message Board
Views: 1134 | Replies: 62
Ive been having issues, like many others here, with UHC denials. Mostly buildups and SRPs, but we have had increased success using Dental Insurance Guys tips from his book. Win, right?! Then, we got hit with this onePatient had bridge for 20+ years #7-#10 with pontics at #8 and #9. #10 completely
March 11, 2024
PPOs and HMOs
Message Board
Views: 110 | Replies: 5
, that this does not happen for existing non medicare dual complete patients. Please help! You could file an appeal as outlined in the denial eob you received. I have been successful going that route.However, I have found that those on Medicare are not afraid to get scrappy with their insurance plans. Punt
February 08, 2024
PPOs and HMOs
Message Board
Views: 395 | Replies: 8
seeing dual insurance coverage. But, now it is more paper trail, phone calls, denial of coverage leading to frustrations. TIA for any advices. Anyone have any input on this? Thanks! Our office policy states that we will file secondary as a courtesy but will only calculate copays based on primary
March 22, 2025
PPOs and HMOs
Message Board
Views: 486 | Replies: 15
Question 2 passed easily in Massachusetts yesterday. It appears dental insurance will need to follow the same rules as medical insurance...spend 83 % of the premium money on patient care. How will the insurance companies do this? Increase patient annual maximums, decrease premiums, increase fee
September 24, 2025
PPOs and HMOs
Message Board
Views: 391 | Replies: 12
and began raising his voice. We said we can talk to his insurance to double check but it is ultimately his plan that has changed without our knowledge. He stated since we received the first denial of payment from the insurance company we should have informed him and he would have investigated
May 26, 2022
PPOs and HMOs
Message Board
Views: 201 | Replies: 7
on the size) and show the parents afterwords. I also tell parents that if we see a few incipient lesions, that soda doesn't discriminate and decalcifies all the interproximal surfaces, and all posterior teeth should be done. It is certainly cheaper than drilling. I hope it helps. I forgot the insurance
March 17, 2026
PPOs and HMOs
Message Board
Views: 239 | Replies: 6
with us and just pay the difference, some have switched to other, better paying insurances that we participate with. We definitely lost approx 25% of our UC pts but going OON was totally worth it. I haven't had a denial from UC since going OON. Prior to that I would usually write at least one appeal
September 04, 2019
PPOs and HMOs
Message Board
Views: 524 | Replies: 16
will submit their networktermination letter as of 1/1/2019 and watch the sparks fly! Ok back to reality UC is the absolute worst and the only practicaloption is to drop them. Low reimbursement is one thing, but constant unfoundedclaim denial is just
September 10, 2018
PPOs and HMOs
Message Board
Views: 102 | Replies: 2
is there a reason insurance companies don't share information with eachother? claim history, freq limitations, etc? Some actually do. We had an issue with Anthem and Humana sharing claims data on one of our patients. It resulted in a denial of a crown due to being 2 months short of 5 years. Unless they share the same network and claim processing companies, HIPAA laws will get in the way.
December 10, 2021
PPOs and HMOs
Message Board
Views: 2239 | Replies: 76
, I am filing a complaint with the state insurance board. I do not have a contract with UC. We spent lots of time on these frivolous denials, and I've heard I could bill for my time and my office managers time and the myriad of copies that costs money as well. Could someone tell me which codes
July 15, 2017
PPOs and HMOs
Message Board
Views: 989 | Replies: 26
your location or zip code? Doesn't surprise me with Guardian. I bet 90% of my denials were from Guardian last year crown wise. The insurance game to me is getting worse and worse, really wish the general public was more educated on dental insurance. Free Luigi Our patients received the letter
November 08, 2025
PPOs and HMOs
Message Board
Views: 171 | Replies: 2
Hi, I have a young startup and have a billing question- when a patient has used all their benefits and is maxed out, would you still bill any work they have done to insurance? In general I'm asking about all services, but in this instance the patient prefers to have 3 cleanings per year
February 18, 2020
PPOs and HMOs
Message Board
Views: 450 | Replies: 10
This morning, my office manager informed me that our office has been receiving a noticeable increase in denials for patients that recently switched insurance companies.... ex. BCBS to Aetna... or ... MetLife to Guardian. For example, a patient had an FMX taken 2 years ago with Company A, but now
January 12, 2021
PPOs and HMOs
Message Board
Views: 90 | Replies: 3
see us, That gets confusing. PPO will only pay after denial from DMO. Ahh, the lovely world of having two insurances. Patient's think they'll be covered 100% and never owe co-pays. Unfortunately, insurance companies don't see it that way due to the Coordination of Benefits Clause. Don't bother trying
January 10, 2020
PPOs and HMOs
Message Board
Views: 341 | Replies: 5
Do you suspect PPOs don't even look at your patient's health? We all know they do it but for their medical director to admit it is astonishing.Yea. Not shocking at all. Definitely already knew this by some of the denials I've received. I had a patient that received SRP 5 yrs agothrough Aetna
February 11, 2018
PPOs and HMOs
Message Board
Views: 187 | Replies: 8
been dealing with this. I am in cigna , ameritas and delta when I signed up for cigna in 2021 I signed an opt out form so other insurances could not share network with cigna. Well, in november ameritas and humana started using cigna fees. I am not in network with humana and I am directly signed up
April 11, 2026
PPOs and HMOs
Message Board
Views: 1134 | Replies: 62
Pre-D's dont always solve the problem. Had similar situation couple years ago with Metlife. Sent everything for a new bridge for a patient, pre-d approved great. Did the bridge, submitted to insurance and it was downgraded to a partial and paid that way. Patient was all pissed at us, not Metlife
May 03, 2024
PPOs and HMOs
Message Board
Views: 243 | Replies: 11
the United States. The top reason for claim denials is the incorrect or missing supporting documentation. 2.Implementing systems for insurance verification before their visit is essential for cash flow and minimizing headaches. You don't have to worry about this if you're collecting your fees
March 07, 2023
PPOs and HMOs
Message Board
Views: 46 | Replies: 0
Can someone point me to a thread or explain what is allowed for professional discounts in regard to writing off the patient's portion after insurance pays on a normal fee? Is a professional discount that does this allowed for employees? For employees' immediate family members? For extended family of the dentist? Do the rules change if I am in-network vs out-of-network? Thanks!!
January 22, 2026
PPOs and HMOs
Message Board
Views: 753 | Replies: 32
. Extracted #9 same day and prepped for FDP 8x10. Let her heal and she came in for final impression about 6 weeks later. After impression appt, she got an EOB (I'm assuming) and so did we of insurance (United health care PPO) saying they are denying the bridge and downgrading to partial for reason
January 10, 2020
PPOs and HMOs
Message Board
Views: 98 | Replies: 1
New Year and thank you for being a participating provider in Humanas Federal Employees Dental and Vision Insurance Program (FEDVIP) PPO network
January 10, 2023
PPOs and HMOs
Message Board
Views: 130 | Replies: 2
in the future. Send out claim, gets denied due to missing teeth clause. And guess which insurance company it was? Drumroll......................United Healthcare....no surprise there. I can understand some of the denials on cracked teeth without narratives, fillings vs crowns.... but where can you draw
September 29, 2016
PPOs and HMOs
Message Board
Views: 320 | Replies: 24
their email ? I'm pretty fast with the Texas Dept of Insurance complaint forms, I fill those out real fast, mostly for entertainment purposes because it gets to the right dept in insurance companies. cigna did this to me. I wrote about it on another thread. I tricked the cigna rep into sending me
April 08, 2026
PPOs and HMOs
Message Board
Views: 943 | Replies: 63
.... why know the plan terms? It provides you the knowledge to 1. improve your treatment plan acceptance when patients expect to pay less out of pocket because insurance will pay towards treatment 2. avoid unexpected claim denials/anticipate claim denials and collect upfront 3. verify that the patient
February 04, 2021
PPOs and HMOs
Message Board
Views: 148 | Replies: 2
Hi,New grad here. Accepted a position with a small DSO and was able to submit license, diploma, NPI, and DEA number to credentialing dept for PPO/DMO insurances. Any idea on how fast this process takes? Submitted paperwork a month ago and credentialing dept is telling me theyre not sure how long
August 11, 2021
PPOs and HMOs
Message Board
Views: 252 | Replies: 7
Greetings, Pardon my ignorance on this but if someone can please clarify. I recently partnered into my practice and was reviewing protocols. I'm told by the manager (and therefore all the front desk staff) that it is against HIPAA to gather new patients insurance info over the phone to verify
September 27, 2024
PPOs and HMOs
Message Board
Views: 4678 | Replies: 244
, if the insurance doesn't cover it, then I must not need it. So is the strategy to get a denial and have an upset patient? How not sending pre-d's makes it better? I am not following the logic. That and how is it different from telling the patient that the estimated insurance contributions are 0
December 02, 2022
PPOs and HMOs
Message Board
Views: 439 | Replies: 9
I have been a participant with United Healthcare for several years now. I find there fees on the low side. They also give me the hardest time with claims. They are far worse then any other dental insurance company I have dealt with. They seem to deny crowns for almost every time we submit
December 06, 2017
PPOs and HMOs
Message Board
Views: 600 | Replies: 28
Dear ADA: Reimbursement rates Association uses advocacy, education to address decreased reimbursement Dr. Hughes Dental insurance issues are often rated as one of dentists' biggest challenges. In response to an in late 2025, more than half of dentists reported that one of their top concerns looking
March 26, 2026
PPOs and HMOs
Message Board
Views: 593 | Replies: 7
Has anyone else had annual bitewings denied by UC? We had our first denial for payment and when my front desk contacted UC, she was told they only cover bw's every 18 months now. I never received any notification, did I miss... Cool, you should start to find more cavities to treat now that you only
June 15, 2017
PPOs and HMOs
Message Board
Views: 73 | Replies: 2
in network with both. If you're OON with one or the other, Depending on which one is primary sometimes you have to bill the HMO or the PPO justto get a denial beforea secondary will consider the claim. Crazy!
February 08, 2018
PPOs and HMOs
Message Board
Views: 419 | Replies: 12
for permission they make your life hell. Clinically you did what you think is best for patient. Insurance doesn't have same concerns. Delaying payment helps them make interest on premium payments. Even if you preauthorize, they will deny at that time These denials along with rificulously low
September 17, 2020
PPOs and HMOs
Message Board
Views: 308 | Replies: 8
This is the first time I ever saw this. Guardian is denying a patient a full upper denture because he had no teeth. The preauth actually said that the extractions were done prior to his insurance being active. Patient had extraction several months ago and switch jobs. Has any one ever encounter
January 24, 2017
PPOs and HMOs
Message Board
Views: 887 | Replies: 19
and cracked teeth etc that could use crowns, that we monitor. And when I do a crown on a patient that needs it and is symptomatic, and then get denied and told to resubmit to an advisory board, it's borderline criminal what these insurances are doing to their clients. So we can't collect or bill
October 15, 2017
PPOs and HMOs
Message Board
Views: 172 | Replies: 10
, for other OON. With UHC, we are in-net thru Careington only so we've had denials if pt has no OON bene. We have also had a UHC plan where the employer did not pick us for their plan so we were OON and the plan did not have OON bene. As part of our customer service, we try to answer insurance questions
October 19, 2019
PPOs and HMOs
Message Board
Views: 328 | Replies: 10
I live in Virginia where insurances can't cap fees for non-covered services. I've noticed though that when we use a code that is on their fee schedule for cosmetic treatments, veneers for example, they reduce the fee to the contracted fee but don't pay anything on it. Legally, can they do... if its
November 07, 2016
PPOs and HMOs
Message Board
Views: 96 | Replies: 3
Metdental has recently changed their website portal for both in network and out of network dental offices to view patient benefits, eligibility, and claim status to a platform that allows anyone from anywhere to be able to create login credentials with any dental office's TIN and no control over...
January 19, 2026
PPOs and HMOs
Message Board
Views: 398 | Replies: 16
is that ? Contracted fees we have are terrible. Maybe it's just the DSO I currently work for... i just checked mine with them and its awful !!! For OMFS, have you considered seeing what fees the medical side will offer you for In Network? Typically, medical insurance has higher allowable than
July 31, 2021
PPOs and HMOs
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