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Searching: insurance denials
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Page 1 of 37
Message Board
Views: 239 | Replies: 2
I'm probably not asking your typical DDS out there by posting this to you guys on DT, but we had a Mom call us because resin fillings are not covered on her (obamacare) insurance. She called around to some other offices to see how they handle this and she said they all told her they charge
May 18, 2015
Pediatric Dentistry
Message Board
Views: 491 | Replies: 12
insurance denials for GA and a lot more rough nitrous appointments and a lot more upset parents.. My life would be much harder without OCS. Hmm. This is a good thought. I have a lot of OR cases and I do have some insurance denials, which, makes things tough. I only use versed and hydroxyzine and find
January 02, 2014
Pediatric Dentistry
Message Board
Views: 1555 | Replies: 34
when costs skyrocket. Some insurances have moved from keeping fees stagnant to lowering reimbursement. If you have a low fee, high volume office then you need more supplies, more staff, more phone calls to the insurance and you end up with more insurance denials, more headaches, more paperwork, more
August 22, 2023
Pediatric Dentistry
Message Board
Views: 154 | Replies: 3
, it doesn't cost them anything to deny it and they know 9/10 dentists will likely never fight it.. so 90% of the time they win. -jrStandard operating procedure for insurance these days. I've had to call my personal medical insurance three times this year for denial of non-covered services and every
April 20, 2016
Pediatric Dentistry
Message Board
Views: 419 | Replies: 11
have 5 or 6docs allcompeting to get their numbers up so corporate stays happy with them. That's what you get. And technically I don't even think these are one surface resins. More like a sealant or at best a preventative resin restoration, but that doesn't pay as much so......Not sure if you get the denials from insurance after sealing perfectly clean molars only to have them state the teeth have had an OBL resin placed already
October 05, 2018
Pediatric Dentistry
Message Board
Views: 2031 | Replies: 50
documentation of the denial will be sent to the insurance commission of your state if it is denied again. Include that the consulting dentist is incorrect in his/her assessment and their denial is not in accordance with the standard of care. This is abuse by the insurance company and cannot
May 09, 2018
Pediatric Dentistry
Message Board
Views: 72 | Replies: 2
Which company do you use for Life insurance? I had a plan with protective life as part of ADA membership which I did not renew this year. Now I need to replace my Life insurance policy. You can have your insurance guy shop for you based on pricing and ratings. You just want term. If you have
April 01, 2026
Pediatric Dentistry
Message Board
Views: 598 | Replies: 27
I've had the unfortunate luck this year of getting GA denials the day before the scheduled surgery center visit for insufficient documentation to support GA. These have been for 2-3 yr old full mouth rehabs. I feel the documentation is sufficient from my standpoint but insurances want
May 15, 2014
Pediatric Dentistry
Message Board
Views: 221 | Replies: 5
So sick of this crap, we have been having a slew of denials for GA (in office IV). Our notes are clearly indicating the patient will not tolerate treatment without GA they won't sit in the chair, wont take rads, etc. We keep getting denials from one particular medicaid plan here. They basically
December 07, 2017
Pediatric Dentistry
Message Board
Views: 342 | Replies: 6
had three denials recently- all United Healthcare- all different...Depending on your state, there may be a law that says medical insurance has to cover for dental cases. I had a few denials when I first opened and then sent a letter stating the law (I googled it to see if my state was included
February 04, 2014
Pediatric Dentistry
Message Board
Views: 384 | Replies: 12
this treatment plan to submit to private insurance to approve coverage. Included in the pre-authorization letter is a disclaimer that the treatment plan is an estimate and will likely change after taking radiographs. Perhaps a worst-case-scenario treatment plan will help with approvals? The only
January 11, 2017
Pediatric Dentistry
Message Board
Views: 86 | Replies: 2
Anyone have an airtight OCS insurance narrative they use for predetermination of benefits? I've got a denial one, would that help? Maybe you could connect the dots?I have plenty of thems. Thanks tho
September 17, 2019
Pediatric Dentistry
Message Board
Views: 86 | Replies: 2
ability to do so. Moreso regarding what are your pedo offices charging to insurance when you take pan BWs. Should we fight the denial and say its fine for them to downgrade but shouldn't outright deny it? Have you written a narrative? If not I'd try that first. I think they deny that because it could/would be abused by the mills. I didn't know there was a separate code for PAN BWX vs intraoral- I would just send the typical BWX code.
April 11, 2024
Pediatric Dentistry
Message Board
Views: 1429 | Replies: 52
. Interesting.....and thank you for the write up Jarod. My biggest concern is in the use of AI for insurance purposes and the likelihood that it WILL lead to more denials. Imagine HAL 9000 working for Delta Dental..... Hey Hal, can you please explain this denial for treatment I'm sorry Doctor, I'm
January 18, 2025
Pediatric Dentistry
Message Board
Views: 555 | Replies: 20
. They always pay it after you jump through thishoop. You have to send the letter attn: Dental Advisor Unit.Drop them. Insurance safe getting ridiculous They are doing it for OON providers too, participation has nothing to do with it.We are getting ready to drop UC. They've been getting ridiculous
January 27, 2016
Pediatric Dentistry
Message Board
Views: 99 | Replies: 5
for unilateral. We are always fighting them for Space... Man what a PITA. Is AZ Medi paid by 3rd party companies? In NC the state still manages it but they (I think) just voted to farm it out to 3rd party, for-profit, companies to manage. I think that's when the denials start.yep, not just one either. seven different plans for us to fight with. We are often explaining to the reps how their own insurance works.
January 26, 2016
Pediatric Dentistry
Message Board
Views: 218 | Replies: 10
codes for Medicaid claims. Monitor Claims: Follow up on claim status and denials. Educate Patients: Inform about coverage and non-covered treatments. General: Patient Education: Ensure patients understand their financial responsibilities. Compliance: Keep up with insurance and Medicaid regulations
February 15, 2025
Pediatric Dentistry
Message Board
Views: 480 | Replies: 10
I'm seeing special needs patients in a hospital OR. Outside of the Medicaid realm (so let's say typical 3rd party medical insurance), do you expect medical insurance to pay for hospital facility fees and MD anesthesia for dental procedures? Any input from experience is appreciated
June 12, 2017
Pediatric Dentistry
Message Board
Views: 1273 | Replies: 40
Not to derail thread Laz, but i was just saying that similar insurance related issues are not specific to medicaid. Even PPOs have similar issues with bogus claim denials and jumping through hoops for obvious stuff. As far as insurance help goes, for most its like $700 of premiums every year to get
September 03, 2020
Pediatric Dentistry
Message Board
Views: 178 | Replies: 4
a D0140 for patients that call for second opinions or have been referred for txmt. They bring up the point that some insurances will not cover a D0150 if they just had one less than 6 months ago at a different office. How do others handle this? Never really thought about it. Where I was an associate
August 30, 2016
Pediatric Dentistry
Message Board
Views: 374 | Replies: 11
a breakdown on the front end on those common procedures so you don't get burnt on the back end. United Concordia is officially the worst insurance company I've dealt with yet Dropped those A-holes last week... Go back to your igloo.Have not seen this yet but they are one of the worst. Won't pay for PA X
June 17, 2015
Pediatric Dentistry
Message Board
Views: 677 | Replies: 22
Currently working in CT (Near Hartsford) and the medicaid fee schedule here isn't half bad. Actually, I am quite disappointed with private insurance fee schedules that pt has to pay their out-of-pocket as their fee isn't that great What do you guys do? Is private insurance really what
June 07, 2018
Pediatric Dentistry
Message Board
Views: 319 | Replies: 11
is clinically acceptable but I do think it's heavy handed. If you take that approach for all of your patients the reason you are getting denials is because your crown to resin ratio is likely a big outlier for the insurance company. That's probably why it started happening out of the blue.Could fillings
September 14, 2018
Pediatric Dentistry
Message Board
Views: 735 | Replies: 40
with denials/stalls? 4. Are payments easy/prompt? 5. Does your state have any data reporting requirements or does it sync into your server for data? I've been told that our state will require data reporting and possibly need access to our dental PMS nightly. This is a huge deal breaker for me
October 19, 2018
Pediatric Dentistry
Message Board
Views: 1732 | Replies: 40
for Illinois. Ask UCCI for yours. I don't think it'll be too different. For the most frequent codes, Region 44 and Region 60 are the same. My OM told me that UC has partnered up with Assurant insurance. This means that if you are in network with UC you will be forced to accept lower Assurant fees even
May 17, 2017
Pediatric Dentistry
Message Board
Views: 274 | Replies: 9
for the whole fee, how do you guys handle this situation? I've never had an insurance deny strip crowns as esthetic and unnecessary before, but I'd like to avoid this problem in the future. Do you do a preauth for every GA case? (yes I know preauth doesn't always avoid this denial) Do you code
February 06, 2018
Pediatric Dentistry
Message Board
Views: 5436 | Replies: 179
will retain. PS. I'm not saying you should or shouldn't OON. This is true. I dont think a lot of dentists realize this. WTP realized this when he dropped some insurances. Anecdotal, but I also don't get many denials OON. I prob have decent narratives, but not as good or detailed as some of you
October 25, 2023
Pediatric Dentistry
Message Board
Views: 819 | Replies: 17
with insurance verifications. Many times on patient days we don’t have time to verify patients for future dates because front desk girls are busy with the patients in the office. So then the insurance gets backed up and we end up using our 2 back staff floaters in addition to the front desk check in girl
March 09, 2016
Pediatric Dentistry
Message Board
Views: 292 | Replies: 9
changed. They love to deny things left and right for unfounded reasons (perhaps to meet an auto-denial quota??). The fee schedules are all screwed up. For the 1st month or so they kept paying us on the wrong fee schedule. We've had to resubmit countless claims. It's become like a 2nd job
March 13, 2015
Pediatric Dentistry
Message Board
Views: 853 | Replies: 10
Does anyone use a virtual front desk (StellaDesk, Dental Support Specialist, etc) to help out with insurance verifications, online EOBs, outstanding claims? Thank you. I have a lot of clients using Dental Support Specialties with success. These tasks are time consuming. I use stella desk
March 30, 2026
Pediatric Dentistry
Message Board
Views: 957 | Replies: 11
I need some advice as to how your offices complete insurance breakdowns for a pedo office . It really seems as though it is a time consuming task, and I wanted to see if anyone has a more efficient way of doing it. For new patients, sometimes it could take 45 minutes to complete the breakdown
October 05, 2015
Pediatric Dentistry
Message Board
Views: 207 | Replies: 8
I saw adults with special needs. Dentaquest has been good for us for Illinois Medicaid. Only complaint was a denial on a indirect crown on a 12 year old after endo. Reported them to the state insurance commissioner and it was paid. We will accept Delta Dental which will administer one of the two
January 13, 2021
Pediatric Dentistry
Message Board
Views: 540 | Replies: 10
the interests of our patients when the insurance companies dump so many millions of dollars to lobby our lawmakers? Sorry for the rant, but it's getting harder to believe that I'm going to be able to continue to provide the level of care that I have enjoyed for my patients. I know that many on this board
February 03, 2015
Pediatric Dentistry
Message Board
Views: 758 | Replies: 14
over the last few years, and every time, we get knocked back down. We write a letter of medical necessity to the medical insurance company, asking for GA as an alternative to conventional care, and have for years. With this approval in hand, we then collect our portion of the dental side, and get
March 25, 2021
Pediatric Dentistry
Message Board
Views: 398 | Replies: 16
...they will not guarantee payment and their denials are much more arbitrary than dental insurance. If you do the case then you risk not getting paid at all for the anesthesia and because you are in-network, you cannot bill the patient. I have had this happen to me when I was in-network with medical
January 11, 2017
Pediatric Dentistry
Message Board
Views: 89 | Replies: 3
requires it. These requirements can change from year to year. Medicaid makes the rules and they decide whether or not to follow them. I have seen more medicaid GA denials in 2022 then in previous 15 years , even kids with abscessed teeth and eight bombed out primary molars w/ F1 behavior. This is in Texas.
May 24, 2022
Pediatric Dentistry
Message Board
Views: 183 | Replies: 5
guys run into this? Parents in denial about their children possible being on the SN spectrum? How would this have changed your treatment? Mom's probably thinking Stick with teeth , Champ I came across this quite a few times when I worked at children's. One was a 16 year old , non verbal but mom
February 12, 2021
Pediatric Dentistry
Message Board
Views: 578 | Replies: 31
can't get seen, they wait 12 months for hospital slots, the MCO plays games of denials, on and on. At least this letter didn't use that phrase access to care. Nails on a chalkboard. Not sure if anyone involved in Illinois politics should be shaming providers or insurance plan administrators
November 24, 2023
Pediatric Dentistry
Message Board
Views: 713 | Replies: 31
this is the last one that slipped through the cracks. Most people just left. A few left some bad reviews. Every single one I was happy to see leave. No amount of money is worth it for myself or my team. So she wants to be seen at an office that cannot provide the services she desires? If there was no denial
April 02, 2024
Pediatric Dentistry
Message Board
Views: 297 | Replies: 7
states that insurance companies should not deny benefits that would otherwise be payable solely on the basis of the professional degree and licensure of the dentist or physician providing treatment, if that treatment is provided by a legally qualified dentist or physician operating within the scope
June 16, 2017
Pediatric Dentistry
Message Board
Views: 481 | Replies: 14
all of my sealants as well. I was just denied a claim on a pt where I brought them in for sealants and did all the premolars and 3 or so 2nd molars. The reason for the denial was because there was no narrative. I call stating that they don't have anything in the manual about needing narratives
December 04, 2015
Pediatric Dentistry
Message Board
Views: 810 | Replies: 49
. Endodontist called me requesting I don't bill as pulpotomy because he gets endo denial from insurance if pulpotomy was coded.D3222 partial pulpotomy for apexogenesis - permanent tooth with incomplete root development assuming open apex Is that indefinitely or within a time frame? I agree with kiddent
October 11, 2019
Pediatric Dentistry
Message Board
Views: 767 | Replies: 33
minutes for something better.Sigh. Everyone in my town has Tricare. D7140 = $80 I more so meant that the average fee is around that. I doubt most get their fee in regards to insurance. Our tricare sucks too and I discount military 50%. Medi here is 67$ which isn't a knock on the medi, but tricare
May 08, 2019
Pediatric Dentistry
Message Board
Views: 217 | Replies: 4
I would give a benefit of doubt to my dentist colleague in this case, that he/she offered Pano to this patient and they probably denied it due to out of pocket expense ( because of frequency issue ). I believe it is important to note down the denial though so that patients can't blame you down
March 28, 2021
Pediatric Dentistry
Message Board
Views: 317 | Replies: 10
attorneys and super bright. avoidance and denial are great coping mechanisms. I remember this awkward conversation with a mom that brought her child into our residency clinic. The child was 4 years old, non verbal and had a thick unibrow. She was wearing a pull up diaper that was sticking out from the top
September 05, 2020
Pediatric Dentistry
Message Board
Views: 224 | Replies: 12
tell the kids about the movies I've watched recently and that helps to distract them. Amen on that. Happens a lot, and probably a combination of either denial or lack of awareness/diagnosis. I can say that as time goes by.....yes I'm old....I tend to see/notice more kids with ASD tendencies. Hell
September 07, 2018
Pediatric Dentistry
Message Board
Views: 1272 | Replies: 46
. Consider outsourcing your Insurance billing and payment posting/adjustments to a company like eAssist. They take a % of what they collect from insurance companies, post and adjust all your payments and fight any denials. They also help clean up systems in the office that prevent you from being paid
August 22, 2020
Pediatric Dentistry
Message Board
Views: 1187 | Replies: 30
that Dentaquest is stopping sealants, nobody is going to be able to keep up with the requests at their admin level. Rubber stamp denial is in process here. Plus no busy office is going to take photos and then sit at a desk and submit hundreds of photos and claims. What is their end game? Pay for one
December 05, 2015
Pediatric Dentistry
Message Board
Views: 383 | Replies: 13
in a temp and call it a day. We schedule him for the OR to do a SSC and several composites. We reschedule hospital 3 times because of sickness, insurance issue. Finally get him scheduled, parents pay up front as we require. Morning of, surgery they call the hospital (mom is an OR nurse no less
November 13, 2014
Pediatric Dentistry
Message Board
Views: 727 | Replies: 25
I have some questions that I would appreciate your feedback on. I am currently OON with all insurances. Take medi but limited. Office has been growing steadily since I started up in 2011. We average about 60 NPs per month. We do accept assignment of benefits, so we file for our patients
June 02, 2018
Pediatric Dentistry
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