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Searching: insurance denials
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Message Board
Views: 1264 | Replies: 31
, everything from understanding insurance, avoiding denials, improving treatment acceptance, avoiding EOB mistakes, scheduling perio, etc. etc. Monthly live training and Q&A sessions Day to day Q&A through the site, which is utilized often. Forms and FAQ library Secondary Insurance calculator Non-covered service law database and quick interpretation sheets Does this work with Medicaid?
April 25, 2023
Removable Prosthodontics
Message Board
Views: 101 | Replies: 7
What's the ADA code? Will the insurance pay for it ? The codes are D9938 D9939 for creation and placement (separate codes). Almost no chance insurance will pay anything. In general insurance does not pay for cosmetics or most temporary treatments Why not use D8680? When to Use D8680 dental code
January 14, 2026
Removable Prosthodontics
Message Board
Views: 47 | Replies: 2
of not getting paid and INSURANCE is never gonna cover tissue conditioning. it seems like you never get reimbursed for this service I charge $150 for it, patient pays. I have several patients that for whatever reason love it and we change it out once a year. if its after an immediate i do it twice for free but after that we just charge the patient
May 12, 2026
Removable Prosthodontics
Message Board
Views: 206 | Replies: 8
that it is never a problem. They rarely question extractions, and when they do you can report the infections, root fractures, and/or denial of root canal options. Insurance is extremely easy in F/F w/ Ext cases, no need to estimate anything, their max is their max.The reason insurance matters is because
July 06, 2014
Removable Prosthodontics
Message Board
Views: 103 | Replies: 4
/6192 (Locator abutment and attachment) Do you work with ppo? How does re-imbursement work with these codes? Or does patient pay all out of pocket? Some plans have a fee associated with the code. If they don't, you charge whatever you want for that code. Im more asking if anyone has had a history using these different codes for ppo insurances. If they have, id like to know if they have found decent reimbursment with these codes vs other codes.
April 15, 2026
Removable Prosthodontics
Message Board
Views: 70 | Replies: 0
I referred a patient because every time we cleaned her teeth, her gums would bruise, slough or form ulcers. She finally went to see a specialist (she was in denial) and they diagnosed pemphigus. She recently lost a tooth and wants it replaced with a denture. It is #3 and no other tooth so would you make a unilateral tooth supported denture or a pud with a palatal strap? Any one with experience with dentures and pemphigus????
April 05, 2018
Removable Prosthodontics
Message Board
Views: 1708 | Replies: 75
schools teach the correct way to do these, most dentists just get off track due to costs, insurance, etc. to doing it a very inefficient way. This is the reason I stopped doing removable about 5 years ago. I tried finding a less expensive lab, but still couldn't make it make financial sense when I
February 11, 2024
Removable Prosthodontics
Message Board
Views: 1838 | Replies: 109
for years as you constantly defend their policy decisions and try to get us to see it from their point of view...is that not true? Answer these tough and pointed, hostile questions for example... Would you defend an insurance companies decision to have a policy that states a blanket denial for gold
January 22, 2025
Removable Prosthodontics
Message Board
Views: 82 | Replies: 5
to make a new denture for someone who has worn the same one for decades. My lab said they can scan the denture, return it the next day, and return the duplicate two or 3 days later. I've done it once. Pt had new insurance and wanted to capitalize on a new upper. I had them duplicate the wear and she was very satisfied and I never saw her for an adjustment. So everyone was happy. Obviously a small sample size of n=1.
March 28, 2026
Removable Prosthodontics
Message Board
Views: 295 | Replies: 26
to confirm the conversation occurred. Some report that it takes telling patients three separate times before anything registers, if it registers at all. The consensus is growing: patient communication is deteriorating, memory is fading, and denial has become a default response. Legalized marijuana Hmmmm damn I didnt think of that! I think youre right!
June 27, 2025
Removable Prosthodontics
Message Board
Views: 382 | Replies: 3
Like many of you I am in contract with many PPOS paying 800-1000 per denture. Right now I use a high quality local lab and with custom trays, wax rims, try in, and complete I can easily run up a $600 lab bill. What I'd like to do is formulate a cost effective insurance denture using either
August 17, 2018
Removable Prosthodontics
Message Board
Views: 629 | Replies: 12
I have taken some denture courses and am using Dr. Massads techniques which requires compound impression and gothic arch tracers so I want to charge more. I am also starting to use a lab that charges more in the hopes of getting better quality. ButI am in network with one insurance company
July 18, 2022
Removable Prosthodontics
Message Board
Views: 340 | Replies: 10
the phone and call if they have a question and not make bad assumptions. Would love to hear about the labs you work with and contact information. Thanks in advanced! Can't help you with what lab to use, but with the ultra low insurance payment I go out of my way to not do them. No your denture looks
October 15, 2025
Removable Prosthodontics
Message Board
Views: 443 | Replies: 28
insurance if they dont do the denture for the patient? I would love something like this! Do you intend to get paid as if am endodontist or something was coming into an office? Would you be paid on commission? If I were you, I wouldn't foot the whole lab bill unless you're getting a large cut
August 28, 2025
Removable Prosthodontics
Message Board
Views: 961 | Replies: 32
like my other RPD. that means I get whatever insurance pay for me. Sometimes $750, sometimes $550, sometimes $900. This is the only "RPD" that I have more cash patient than insurance patient. If you think about it, any patient with this amount of destruction on teeth, probably didn't have anything
January 21, 2026
Removable Prosthodontics
Message Board
Views: 685 | Replies: 22
reimbursement from insurances. I am very close to just not doing dentures for anyone other than cash patients, but I don't know if this is legal. Does anyone happen to know if I am allowed to withhold services based on reimbursement if it doesn't make good business sense for my practice? I usually
August 13, 2024
Removable Prosthodontics
Message Board
Views: 1708 | Replies: 75
insurance guy videos. Wish I could go work in an office like that and learn from these thought leaders. You youngsters are lucky to have these resources at your fingertips. I doubt I have different patients than anyone else. But I guarantee HOW you present cases can make a big difference between
February 14, 2024
Removable Prosthodontics
Message Board
Views: 350 | Replies: 8
and the acrylic is too thin for the hook-ups. does insurance cover both interim and complete? Nope, just one. Usually cash for the interm with no insurance filing. Yes, increase VDO if you can. However, for a fixed denture, you need even more space, which means the surgeon needs to be planning to remove
April 03, 2024
Removable Prosthodontics
Message Board
Views: 887 | Replies: 63
and bottom duplicate denture. I occasionally use the HITECH Act paperwork and waver, for acknoagment of noncoverservices cosmetic/ or upgrades services and do not bill insurance depending on how the policy reads. Particularly as it relates to a duplicate denture. 3. The first visit is an interview to see
March 07, 2026
Removable Prosthodontics
Message Board
Views: 89 | Replies: 3
and the occlusion remained in metal. Those cases I have done were not insurance cases and this one is. Does anyone know how to code for all these additional steps? There are no ADA codes for what you describe. Remember, ADA codes are primarily for insurance billing, and no way insurance will reimburse
September 20, 2024
Removable Prosthodontics
Message Board
Views: 436 | Replies: 7
. What I wanted to know is if I could bill code D5211 to her insurance to recover at least some of the balance? (Maxillary partial-resin base?) The interim acrylic denture was not billed to insurance. Yes I would. I usually don't submit D5820 to insurance if I am planning D5213 soon as insurance
February 26, 2016
Removable Prosthodontics
Message Board
Views: 1100 | Replies: 41
What's the point of doing removable work for insurance contracted patients with such low insurance reimbursement? Lab fees have gone up. Reimbursements not so much? How do you handle this? My situation. Contracted Rate for a metal RPD with Cigna $1,070 - Lab Fee for a metal RPD
May 13, 2022
Removable Prosthodontics
Message Board
Views: 530 | Replies: 4
that. D8680 is more for orthodontic retention, not perio. D4321 is a perio code for extracororal splinting, but that is traditionally a fixed split, and one designed to try to eventually save the tooth But two things to remember: 1) ADA codes are for insurance communication and billing only 2) Insurance
February 28, 2023
Removable Prosthodontics
Message Board
Views: 1377 | Replies: 44
of crap! Emax isn't really covered under D2740?!? So what type of all porcelain crown is actually an all porcelain crown? Insurance executives giving guidance on how to charge patients more? This whole thing is laughable. And to take an insurance that you lose money on each procedure is a business
June 13, 2019
Removable Prosthodontics
Message Board
Views: 242 | Replies: 8
If I'm doing an immediate denture with the possibility of having to make another denture down the road how do I bill insurance? My thought is you bill for the immediate then down the road if they need a different denture they pay out of pocket? Or can you bill insurance again for their permanent
November 03, 2020
Removable Prosthodontics
Message Board
Views: 652 | Replies: 26
leaves and drops the lower off an hour later and states she going to complain to insurance. She clearly isnt even going to try to wear it. She paid $0 for this denture. She had 100% coverage and I was paid about $2k. So, question is, if the insurance wants me to refund the money, do I tell them
December 09, 2022
Removable Prosthodontics
Message Board
Views: 607 | Replies: 13
familiar what code should I used for that partial? Insurance fee for partial is only $1030. Any additional codes for attachments? May be the lab fee won't be as expensive, but be careful. I had a person request a precision pd so no clasps would show. I told her the cost and explained the insurance
October 30, 2018
Removable Prosthodontics
Message Board
Views: 278 | Replies: 4
are needed and not lose money? Money does not seem to be an issue for the patient and he is willing to pay for the case, but if I submit to his insurance can I charge any more than what they mark as the acceptable provider fee? Are you allowed to not bill to the insurance if the patient is willing
September 10, 2014
Removable Prosthodontics
Message Board
Views: 185 | Replies: 7
If in network and am giving patient and interim partial after extractions and implant placement until final partial is made. Insurance co denies interim partial because patient is over 16 years old. Can I bill them my interim partial fee or do I have to use the insurance fee? This turns out
February 12, 2019
Removable Prosthodontics
Message Board
Views: 282 | Replies: 13
.... The L&M method is to present the entire fee and offer a 10% discount for pre-payment... Then the insurance is filed as the treatment takes place. You are then working down ledger credits... doug You lost me. I dont take insurance btw. This is why PPO dentists should not be doing immediate
September 09, 2020
Removable Prosthodontics
Message Board
Views: 338 | Replies: 8
for a partial different?A great formula for fees is 3-4x your lab bill. If a flipper is $90, somewhere in the $300-400 is a good starting point. As for coding, yes, often insurance may not pay for temporaries, and if they do they likely won't pay for the final. If you want a final, then billing
August 15, 2018
Removable Prosthodontics
Message Board
Views: 239 | Replies: 5
doing. It was not going through an insurance company so I think we used the ortho retention code and charged what we deemed ok. This is a good additional question: what would people charge for this? We did it in office and are delivering it later today (same day) so I consider the fee to include
January 11, 2023
Removable Prosthodontics
Message Board
Views: 345 | Replies: 17
is, they order the tooth specifically for patient, so if patient does not like it at their wax try in, they still have to pay for it. They are expensive. I'm in a clinic, and patients pay lab fees. I dk if you could do that if they were insurance? charge extra for the gold? I think the last one I did
July 02, 2024
Removable Prosthodontics
Message Board
Views: 782 | Replies: 31
to the lab to repair and add a mesh. lab fee was $220 ppo insurance is paying $110 if it was Medicaid , they pay $70 I have always done these in the past as courtesy since usually I am the guy who did it . now with the 40% lab fee increase since 2019, what do you recommend ? Can I refer this cases
May 28, 2024
Removable Prosthodontics
Message Board
Views: 546 | Replies: 14
teeth. I was asking the question in terms of how to bill the insurance. flex partial. hope it works out! To my knowledge a code hasn't been added for cusil gaskets, is there one I don't know about? Is flex partial still the best code to use? correct not flexible made of acrylic like regular denture
October 30, 2025
Removable Prosthodontics
Message Board
Views: 1602 | Replies: 45
Does anyone charge patients a silly cheap fee like $500 or $600 for a temporary denture that isn't billed to insurance, rather than an immediate denture that is coded and billed?I hate immediate dentures because patients usually hate them, they usually never fit as well as I'd like, and I hate
December 05, 2019
Removable Prosthodontics
Message Board
Views: 153 | Replies: 8
if you are in-network you charge the patient extra for these things, any additional lab costs need to be passed on to the patient. to explain a bit more, it is all about wording on a insurance as to what is a benefit or not. my boss is trying to interpret wording from the insurance to let him place
February 23, 2021
Removable Prosthodontics
Message Board
Views: 887 | Replies: 63
than someone that is paying $2200. I think it is ok to have different workflows and offer a different product based on insurance write offs and reimbursment. For this current dentrue I am looking to do the "very best" I can do and see the time and materal cost with a no holds barred, spare no expense
March 02, 2026
Removable Prosthodontics
Message Board
Views: 287 | Replies: 7
I have a patient that needs to have all of the maxillary teeth removed but wants the denture inserted when the teeth are removed. My plan is to make her an immediate denture for insertion immediately and then another denture after about 2-3 months. My patient has a PPO insurance and I want to plan
March 05, 2014
Removable Prosthodontics
Message Board
Views: 140 | Replies: 4
extracts the 1st molar the fit will not be the same, and insurance won't pay toward a new one until 2025. Now she's wondering about removing 3 and 14 and getting a new RPD. My concern is that her previous RPD with 8 teeth supporting 6 replacement teeth didn't make it 5 years, will a new RPD with 6
February 20, 2024
Removable Prosthodontics
Message Board
Views: 75 | Replies: 4
This happens quite often. Pt needs tooth added to partial. When I get it back the lab has charged for adding the tooth but also charged for a weld. Is there any code that covers the weld? The lab bill with the weld included will equal the insurance reimbursement so it is basically a break even deal
November 06, 2022
Removable Prosthodontics
Message Board
Views: 345 | Replies: 1
to report every service, but only to report services that potentially may be reimbursed by insurance. Both the cosmetic and temporary nature of an essix retainer means insurance will not participate in payment for this service. This means you are best off creating an internal office code to bill
October 05, 2020
Removable Prosthodontics
Message Board
Views: 393 | Replies: 7
. Reimbursement rates from certain insurances are pretty abysmal especially when you consider the follow-up adjustments. Thank you for this - hope I can ask additional questions: - do enjoy digital more because its easier to take records or because it is cheaper / another reason? - how many adjustments do
March 11, 2024
Removable Prosthodontics
Message Board
Views: 218 | Replies: 5
I am 14 years into private practice and am finally putting together the knowledge of what it takes to provide great dentures. It takes more knowledge than I previously had but it also costs more to deliver. I am not in network with all insurances but still am with some. My question is: How do
March 12, 2019
Removable Prosthodontics
Message Board
Views: 236 | Replies: 8
of the dentures. I'm not contracted with insurance. Also, if someone is coming in for adjustments a lot, don't be afraid to tell them that they won't be happy without implants. In conversations with dentists I work with, the general consensus is 5 post op appointments rather than months. They also insist their patients adhere to a yearly recall in order to continue no-cost adjustments if they needed less than 5 after initial delivery.
August 11, 2025
Removable Prosthodontics
Message Board
Views: 679 | Replies: 14
relines during healing/ final dentures after 6 months to a year vs. In school we did an upper interim denture with 8 anterior teeth and let them heal for 6 weeks and then started fabricating the final dentures. This becomes complicated with insurance involvement. I'm just trying to figure a set way
September 13, 2014
Removable Prosthodontics
Message Board
Views: 1017 | Replies: 115
am for sure failing to fill my books with fee paying patient.The thing i do understand is, the margins of profit in the insurance game are so tight that the 150$ you could get most of these things made for in a lab, you have to do it yourself.Tough for me to say given the effort and skil applied here
February 05, 2009
Removable Prosthodontics
Message Board
Views: 386 | Replies: 18
or partial down the road, the fee for the temp. denture will be completely outside of insurance. Be very careful doing repairs or changes on a denture through insurance if you are going to make a regular denture within the next 5 years! Best to charge for the cheaper procedure (repair or temp denture
August 30, 2019
Removable Prosthodontics
Message Board
Views: 193 | Replies: 3
a different fee depending on the number of teeth we are temporarily replacing. Good news is, interims are almost never covered by insurance, and therefore in 39 states you can set your fee wherever you need. Even if they were covered, the patient's best interest is NOT to involve insurance, because
December 14, 2020
Removable Prosthodontics
Message Board
Views: 19273 | Replies: 1680
that then get's a bling layer of lightcure composite. Uwe its insurance man... insurance complicates the whole thing Thankfully, up here in the socialized snow zone Lab fee is Patient pays and really thankful that the insurance companies haven't gotten their filthy claws on it yet. But I do have a few
March 13, 2021
Removable Prosthodontics
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