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Searching: insurance denials
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Page 1 of 7
Message Board
Views: 689 | Replies: 25
? I believe no pocket , no perio may hold up in some situations, and may cause insurance denial if that is a goal ( insurance to pay) . What he's saying is that 100% of people have perio. 100% Now, here's the segue into making money Recession = perio = caused by bruxism = caused by airway
May 14, 2024
Periodontics
Message Board
Views: 83 | Replies: 2
Is standard of care to perio chart full mouth once a year and maybe spot check every 6 months? Or should full mouth charting be done every 6 months? Insurance and the perio community generally point to annual full mouth charting at minimum, with spot checks at the other recall. For any patient
May 28, 2026
Periodontics
Message Board
Views: 456 | Replies: 14
this thread to my hygienist. Perio is so nuanced.In my little PPO-heavy practice in Houston, we could routinely expect an insurance claims denial for SRP's on this kind of case (no radiographic evidence of bone loss), even with subgingival calculus because the calculus is not on the roots and therefore
April 14, 2018
Periodontics
Message Board
Views: 1303 | Replies: 34
. it seems like the reasons they don't accept treatment at your office would be magnified at a perio office. That being said, insurance denials for needed treatment are really frustrating.Thanks for sharing that! I think we may have come up with possible solutions to a common and annoying problem
February 09, 2017
Periodontics
Message Board
Views: 774 | Replies: 45
really think they will pay a periodontist ? I dont think so! You're fighting a battle you can't win. You're dealing with the insurance denial machine and apathetic patients with enough smelly crap on the teeth that could knock a buzzard off a shit wagon. Run some reports, I think you'll find you're
September 15, 2022
Periodontics
Message Board
Views: 60 | Replies: 3
Hi all. I am planning to add a traveling periodontist to my office. I am in the Bay area and most of my patient have Delta insurance. I am in network with Delta and 70% of my income comes from Delta. I want to start with 2 day/ month perio. What are the dos and donts? What are procedures that make
May 26, 2026
Periodontics
Message Board
Views: 485 | Replies: 15
. The insurance dentist isnt agreeing with you because he doesnt have to, because you are not submitting the proper information. He probably didnt even look at anything besides the fact your probing depths werent deep enough to make it over the hurdle. Youre an easy denial. The insurance dentist isnt
July 08, 2021
Periodontics
Message Board
Views: 668 | Replies: 11
Hi Everyone, We recently got set up to submit to our patients medical insurance for Arrestin. We've gotten mostly denials. I would like to add and antibiotic adjunct to our SRP protocol. Arestin is just so darn expensive especially since our patients would need multiple sites medicated. I read
March 16, 2017
Periodontics
Message Board
Views: 536 | Replies: 13
mentions attachment loss first.You have it,you take pictures of it, no insurance should deny anything.It gets very sad when doctors diagnose by insurance because they are afraid of denials or they are scared of losing the patient. Bone loss on bite wings is one sided. I read an article one time on how
April 19, 2015
Periodontics
Message Board
Views: 57 | Replies: 1
Wanted to get an opinion on this topic, as I am at loggerheads with the hygienist in the office I work. My issue is the diagnostic criteria for perio and what insurance companies view as requirements as we are getting an astounding number of denials for soft tissue management. The gray areas I am
January 31, 2025
Periodontics
Message Board
Views: 31 | Replies: 1
with most insurance companies. I was thinking of billing Local anesthesia per quad and doing 2 prophy appointments. Anyone else doing that? Thanks in advance. I would think this would be legitimate- you are not un-bundling a procedure like fillings/SRP where local is expected/inclusive.
May 01, 2026
Periodontics
Message Board
Views: 464 | Replies: 17
of attachment loss on the bitewings, and the pocket depths were not deep enough. I have never had a denial of S/RP in the 12 yrs I have been practicing. Next time I see an Aetna patient for whom I recommend S/RP, I plan on submitting for a pre-treatment estimate. A few questions I had for you all
February 17, 2023
Periodontics
Message Board
Views: 931 | Replies: 32
headaches and denials for dentist= more profits for them and we are pretty much powerless and our patients think it is the dentists fault... a win-win for the insurance company....Yep! Humana is so bad that I would not even give them rhe courtesy of calling them an insurance company
December 04, 2017
Periodontics
Message Board
Views: 832 | Replies: 27
be done when x-rays do not show bone loss????, which is an outright lie. How could this be? I am ok with insurances denying any services...but when they give a reason for denial and make it sound scientific, then they should follow science...here they are not. Now, if there was a clause where SRP
June 21, 2017
Periodontics
Message Board
Views: 531 | Replies: 11
evidence of calculus and the patient has 4-5mm pockets it should be approved. Many times you need to appeal. Some procedures are red flagged by the insurance companies. Scaling and root planing is one of them because it is an abused procedure and the insurance companies are wise to it. As long
December 29, 2014
Periodontics
Message Board
Views: 432 | Replies: 17
I have a patient that we did 4341s on three separate appointments. He was born in 1987. Insco denied all 4341s. We have him on a 4 month 4910 and insco is denying that too. How do you deal with this in your office? Let me guess, United Concordia.Insurance company and reason for denial would
May 02, 2018
Periodontics
Message Board
Views: 388 | Replies: 11
on out of pocket. 3) give the patient the option of paying the copay for scaling and root planing, which the insurance is willing to pay for, and have them come back regularly so that this would not be a problem in the future. No, this is not usually the case. These denials happen when pts have been
April 04, 2015
Periodontics
Message Board
Views: 171 | Replies: 3
Does anyone know if we can bill 4341 one month after initial 4346? How do you bill to insurance co. if the patient came in with generalized moderate periodontitis. We did initial scaling full mouth. xkvt For the D4346 code and any associated periodontal treatment, I highly suggest you speak
February 09, 2019
Periodontics
Message Board
Views: 283 | Replies: 5
for narratives if you don't ask them for permission first with preauth. Fmx and perio chart is usually sufficient for most insurances to pre auth. If you do treatment first then they will ask for much more in my experience. I preauth most crowns and srps. Just makes life easier than fighting with insurance
July 13, 2019
Periodontics
Message Board
Views: 846 | Replies: 14
a denial, i give the patient the information on how to file a complaint with the insurance commission. I tell the patient that their dental benefit is a part of their paycheck from their employer and this insurance company is trying to keep part of their families pay. That usually outrages them. However
December 14, 2015
Periodontics
Message Board
Views: 254 | Replies: 6
amount of debris, there was no other reason for her swelling. I irrigated it with chlorohexidine and she seems to be fine now. How do I code this for insurance? Of course, code 4342 comes back from insurance denied. Thanks! 4342 is the proper code for 1-3 teeth. Did the ins co give a reason
September 23, 2014
Periodontics
Message Board
Views: 446 | Replies: 11
So we had an ins tell us we shouldn't do 4 quads in one session. Why is a full mouth rehab 24-28 crowns OK, or 4 FBI OK and not the SRP? Is it the time? The trauma? the post... anything excuse to get out of paying. the excuses are getting really really bad lately....I'm sure the insurance company
March 12, 2015
Periodontics
Message Board
Views: 843 | Replies: 26
definitely full perio chart with CAL for another insurance carrier. You won't win this without it. Learn from it. If you can't probe its a FMD period. I do this for all my SRP patients. So far one denial with United Concordia in November when they seem to deny everything. Dentist reviewed the claim took all
August 27, 2021
Periodontics
Message Board
Views: 226 | Replies: 0
I am appealing a denial for a claim where I performed a flap for debridement and a bone replacement graft in the same quad. Does anyone have any clinical sounding jargon for the purpose of the bone replacement graft/GTR concept?
February 09, 2015
Periodontics
Message Board
Views: 136 | Replies: 6
specifically your Delta patients. Delta patients are generally known to be the most insurance conscience and the "I only want what my insurance covers" type Gotta explain to them they have perio and need 4 perio maintenance appts per year, which is not a 'preventive treatment' it is treatment
March 24, 2026
Periodontics
Message Board
Views: 777 | Replies: 15
Doing a little bit of research of the feasibility of this in my practice. What codes are you guys using for LANAP treatment? What fees are you guys getting (ballpark), and how do insurances deal with this treatment? additionally, how much time does the procedure take? I take a few PPO's so
January 15, 2014
Periodontics
Message Board
Views: 1792 | Replies: 63
act by the insurance companies. This equates to a colluded act by a group of individuals to manipulate a process for monetary gain. The penal legality is vague but the civil is not. You may want to clarify your statement. They are 4999 with a narrative or 4240 with a narrative or if you are bold
July 31, 2015
Periodontics
Message Board
Views: 3171 | Replies: 82
insurance, results in lower out of pocket costs (20% of $400 vs one uncovered cleaning) steve I used to believe so as well. As I am sure this has been discussed many times, a pre-authotrization means literally nothing. I routinely get denials on pre-authorized procedures. Or am asked to write
November 06, 2014
Periodontics
Message Board
Views: 434 | Replies: 12
months old (I am not participating and have no contract with them). Do they think the pockets resolved on their... That sucks Jay. It's always something with the insurance companiesWow that is bizarre....just like asking for pre op photos at random....a total scam by making up rules after the fact
January 26, 2017
Periodontics
Message Board
Views: 2193 | Replies: 71
depths. I'll give you a real world answer which probably isn't the the American Academy of Periodontics answer. The existence of calculus on the root surfaces with attachment loss and that calculus must be clearly visible on radiographs is about the only way insurance will accept a scaling and root
August 07, 2023
Periodontics
Message Board
Views: 2554 | Replies: 93
This is with principal life insurance. This reminds me of a girl I once dated for like 5 minutes. She was incapable of admitting she was...That's a good case for the perio section in a licensing exam. unnecessary, unbelievable is more like it! I am guessing
August 29, 2017
Periodontics
Message Board
Views: 4332 | Replies: 126
now that it will either be non covered or covered at prophy level only, leaving us to explain to the patient why they have to pay when their cleanings are covered at 100%. And we all know how that goes. So, patients with gum disease will no longer get gum treatment. No reason that the same insurance
December 17, 2016
Periodontics
Message Board
Views: 1065 | Replies: 14
. I'm forseeing a lot of denials, downgrades and confusion. That and I'm doubting it will be worth the extra time on the front end submitting clinical data to get these paid. I know for a fact that corporate offices (and a lot of private ones too) are GOUGING insurance companies on 4341/4342
November 27, 2016
Periodontics
Message Board
Views: 408 | Replies: 11
omission I saw was perio disease. Otherwise, I thought it was pretty good. My favorite line: "Most private health insurance schemes cover a dental check-up and clean once every six months" Hi Thomasaurus, Interesting comment. I agree re the perio. Once again - word limit was an issue. Out
March 08, 2026
Periodontics
Message Board
Views: 3171 | Replies: 82
insurance will reject the pay,and moreso doctors get on board with that.Who is really thinking what is the best for the patients ?best way drop them and then they will learn.hopefully.I think that the CDA had a lawsuit against United as we speak .And that is the reason .Denials on most claims.Sometimes
October 20, 2017
Periodontics
Message Board
Views: 3615 | Replies: 47
% of scalings are done on new patients. Extremely rare for a patient of record to need it, only if they were away for 2-3 years. On existing patients, we will use 1-3 code more often, but it's not common either. Other than Arestin, insurance covers 80% very routinely. Almost never get denials. Patient
December 07, 2019
Periodontics
Message Board
Views: 4137 | Replies: 99
and the denial rate is BS, all on a code that was supposed to help fix the problem and ended up being completely useless. What needs to happen is insurance companies need to start raising their premiums to make their profits and not screwing patients out of the benefits the are told they should get.No
May 19, 2018
Periodontics
Message Board
Views: 445 | Replies: 14
audit with the dental boogey man? Seriously...I don't think I have done too many of these SRP cases that dont have bone loss radiographically, but if I did would this be seen as someone who is over treating and doing fraud and all that? Here is one SRP from a insurance patient who's implant I
July 08, 2015
Periodontics
Message Board
Views: 463 | Replies: 33
. Logically, this would mean going back to 1110 for some people. But the reality of insurance means staying with 4910 forever. This allows you to reverse from 6-month recalls back to 3-month recalls when needed, with less likelihood of denial of benefits. Not my world, I just live here. MIf a patient had
January 25, 2019
Periodontics
Message Board
Views: 1601 | Replies: 103
. Patients think you are scamming them, perio is by far the most time consuming education/case discussion for low treatment acceptance (I don't have the breakdown by procedure, but I bet it is 10% of what our overall non-perio case acceptance is) 4. Getting insurance approval for coverage is difficult
March 26, 2025
Periodontics
Message Board
Views: 2554 | Replies: 93
insurances are disinclined to cover sc/rp treatment. It is a shame. Thus the questions I posed on post #18. Is whatever some insurances do, eventually becoming the standard of care? Or should it be based on research? P.S: Realistically I agree, what insurances dictates eventually becomes
October 14, 2017
Periodontics
Message Board
Views: 615 | Replies: 20
not work eazilly. You might find a lot of mush on the external walls making it difficult to get beyond. It is certainly not impossible to do, but better be prepared for plan B just in case:) Crown:root ratio=terrible, even with extrusion. Implants are way too predictable to even consider saving that puppy. Immediate placement. Your brother is in denial I'm afraid. I would hate to be in his boat too, but listen to everyone here.
January 30, 2015
Periodontics
Message Board
Views: 1683 | Replies: 67
to go more often. This makes a lot of sense. What if insurance were on board...Let me play the devil's advocate: Some would say that, in a great number of cases, the ultimate cause of extensive dentistry is prior dentistry... If we can only find a way to keep these people away from
March 10, 2016
Periodontics
Message Board
Views: 406 | Replies: 13
of the US for just what I shared that you're in denial about. Don't shoot me, I'm just the messenger. Dan So this guy, Zinman, who is a spokesman for LANAP, is suing people for not recommending the procedure he gets paid to represent. http://www.lanap.com/pdf/MDT_LANAP_testimonial_031008.pdf OK
February 25, 2015
Periodontics
Message Board
Views: 4465 | Replies: 129
I see some pt when insurance covers only 80% of SRP and covers 100% adult prophy they want just regular cleaning. Some dr gets pt's sign on tx refusal form and do just prophy while some like myself can not justify that since it's a lot of work for a prophy and I can't see myselfcleaningjust
September 26, 2016
Periodontics
Message Board
Views: 567 | Replies: 32
. This is not an emergency. How many crowns did she co diagnose? Thanks for the feedback. My other concern would be that if an Insurance consultant were looking at this, I am highly doubtful that they would approve SRP. Any other thoughts? To me this is Scaling in the presence of gingival inflammation
October 14, 2025
Periodontics
Message Board
Views: 1241 | Replies: 38
. It is easy for them because by the time a patient goes to see a periodontist, they have already been sold on the value of getting it treated. Insurance keeps fighting treating perio and patient out of pocket expenses keep going up, however, if I patient isn't willing to shell out $50 bucks for a perio
February 03, 2015
Periodontics
Message Board
Views: 415 | Replies: 9
Seems like insurance companis are getting more agressive with declining periodontal treatment these days. I need to write an appeal to Aetna on this one. I would appreciate your thoughts. Healthy 40 year old female. BOPs multiple locations. My substitute hygienist (the world we live in now) probed
February 16, 2022
Periodontics
Message Board
Views: 53 | Replies: 1
every 2 months if I have to. I know insurances typically allow perio maintenance once every three months. What do you do to have insurances to cover more frequent perio tx. Do I need to submit clinical photos with narratives? Any suggestions will be appreciated. Also, some insurances covers perio main
December 26, 2016
Periodontics
Message Board
Views: 2306 | Replies: 47
teeth underneath with all the mamelons...I've never gotten queezy looking at dental pics.... til now! I am sure if they were a Concordia pt they would still get a denial for scaling/RP. :P I had a pt when I was in dental school who came in with a baggie with pieces of what she though were her teeth
December 30, 2014
Periodontics
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