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Searching: insurance denials
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Page 1 of 24
Message Board
Views: 78 | Replies: 0
when it is appropriate to become aggressive in these cases and treatment plan endo/crowns on teeth that express craze lines and/or cracks running along the mesial/distal ridges. I can use intraoral photos to demonstrate to the patient where teeth might be cracked, but then an insurance denial comes
July 07, 2021
Restorative Dentistry
Message Board
Views: 581 | Replies: 13
an insurance denial from MetLife today on a crown we just did. It replaced an old crown done 6years ago.Well......it's now 7 years before they pay for a new one. Lesson learned. i just hope he stays healthy enough to do my implants in 5 years, I'll fly out to see him...
January 28, 2020
Restorative Dentistry
Message Board
Views: 239 | Replies: 3
before the bur touches the tooth. Saved my ass the other day. Pt. had a crack for a year, delayed crown due to insurance denials. After hygiene visit 2 weeks ago she finally decided to get a crown last week. Go through my speech (I do it at least twice, once hygiene/np exam, and again pre-op). She
March 07, 2018
Restorative Dentistry
Message Board
Views: 281 | Replies: 13
with him/her, option chosen, and what youre going to do about insurance denial. I think it will look more professional and like you care more. Delete the letter. Have your FD call the insurance company and ask what is it they do not like about the x rays, and solve the problem with a 49 minutes phone
March 30, 2017
Restorative Dentistry
Message Board
Views: 3057 | Replies: 97
that is dental insurance. I do not do treatment based on insurance coverage or denial. Call dental insurance what it is, a pyramid scheme with a businessman sitting at the top that pits patients and dentists while they laugh all the way to the bank. Dont get me wrong, I have nothing against
November 06, 2016
Restorative Dentistry
Message Board
Views: 4073 | Replies: 103
crown it? Midoc, do you get a lot of insurance denials for those crowns? What do you send to convince the ins company to pay for the crown? I could see them saying a filling is indicated.Thanks for the great info and photos I really appreciate the thought process and the great response. I agree
September 27, 2022
Restorative Dentistry
Message Board
Views: 3261 | Replies: 173
even 50-50 among dentists suggests the insco should not have denied it based on pictures, its quite ridiculous that they can make a claim with certainty when other dentists cannot. ask to speak with the denial doctor? report to insurance commissioner for refusing to pay?How long until inscos start
January 09, 2014
Restorative Dentistry
Message Board
Views: 3057 | Replies: 97
. Secondarily, we discussed the broader concepts of if insurance companies are illegally engaging in the practice of dentistry and/or influencing treatment, and potentially in breach of contract. As we know, down coding and claim denial is a widely used tactic applied to thousands of claims, daily. Most
January 27, 2019
Restorative Dentistry
Message Board
Views: 357 | Replies: 14
This is another what would you treatment plan for #2 and #3 Thanks Bump I placed crowns/crownlays on these teeth back in february and the patient's Ins denied the claim three times. I sent this picture, an xray, and a narrative. They would not give a reason for the denial other than they need
September 28, 2015
Restorative Dentistry
Message Board
Views: 3421 | Replies: 113
with insurance companies making a blanket denials for any inlay...no matter what. Inlays are not covered benefits, therefore the patient doesn't want them as they don't trust anyone at this point, not you or the insurance company, they trust the system and the system doesn't cover inlays. Dentists do
February 20, 2019
Restorative Dentistry
Message Board
Views: 907 | Replies: 12
prognosis was uncertain.<br/> Pre-opFinalPost-opPre-op BWWhat have you written in your appeal to trump this?<br/>This is the first denial which threatened my clinical judgment and treatment plan like this. I've been angry about it and I feel undermined. They have introduced fear in my
October 11, 2016
Restorative Dentistry
Message Board
Views: 2071 | Replies: 47
and then recommended for full coverage. Using words like pain, fracture and recurrent caries all help, but only if true. On the same page here; and there is never a denial. It just takes a little more time to assemble the claim and document. Insurance companies will pay for crowns on posterior teeth
September 28, 2018
Restorative Dentistry
Message Board
Views: 88 | Replies: 1
for anterior teeth. Don't see a lot of denials for simple operative. Will get the occasional case requesting PA's or photo for anterior composite, but rarely. Others on DT have posted cases where insco refusing to pay for obvious decay on photos (occlusals), so I would take into consideration your personal
February 23, 2017
Restorative Dentistry
Message Board
Views: 270 | Replies: 12
( "pre-denial").... Double NO. I inherited many cantilever bridges, most of them are not around anymore I might do a canteleever on an older patient or against a partial. A patient with some perio or bruxer is asking for trouble. Make her a flipper and move on.
October 28, 2025
Restorative Dentistry
Message Board
Views: 315 | Replies: 7
a way for the insurance company to hold onto money for a little bit longer.yeah number #1 reason for denial for bridge is missing tooth clause. They will deny if pt is missing teeth on opposite side as well. they rather cover partial denture in that case. also if there is incomplete endo or bone loss
December 19, 2014
Restorative Dentistry
Message Board
Views: 757 | Replies: 43
reimbursed for a composite in this situation. The bigger issue is the denial of treatment, not the treatment choice itself. If this keeps happening you are going to get doctors swiping off cusps with a bur and claiming cusp fracture to the insurance companies. My guess is this already happens
October 08, 2014
Restorative Dentistry
Message Board
Views: 281 | Replies: 9
Direct Composite Crown using Greater Curve matrix bands Delta dental denial due to poor prognosis LOL Fantastic work and documentation! Nice work. Do you have any pictures of what it looks like when you remove the matrix? This is the dental equivalent
July 25, 2025
Restorative Dentistry
Message Board
Views: 645 | Replies: 15
always gets pre op and post op Intraoral pics and a higher estimate.Would of stood my ground. By giving up and doing at no charge they think they were right all along and you were trying to cover...Fear Denial Arguing Negotiating Concession Replacement Regret DT Bitterness Anger Acceptance Peace I
January 18, 2017
Restorative Dentistry
Message Board
Views: 393 | Replies: 8
cans of pop a day. Your patient probably doesn't think of Gatoraid or sports drink or fruit rollups or raisins as sugar. Denial. Or lying.I can't stop laughing. Made my day! I don't know what I'd use to restore those. Got any ideas???Nice endos there doc!! ;)Had one of those today. He was stable
January 23, 2017
Restorative Dentistry
Message Board
Views: 28 | Replies: 2
with conditions such as osteoporosis, often achieve the same success rates as younger adults. The key factors are bone density, gum health, and medical clearance. Some insurance providers even extend partial coverage for seniors, though policies vary. Dentures vs. dental implants for seniors Dental
April 10, 2026
Restorative Dentistry
Message Board
Views: 1031 | Replies: 29
to associateships, get beat up by corporate drones/office managers. Go ownership, get beat up by insurance companies. Has anyone here ever gotten to actually speak to the dentist that denied this claim? I've tried several times, but can't have myself or staff wait on hold for hours and of course they never
September 11, 2017
Restorative Dentistry
Message Board
Views: 2424 | Replies: 53
the MB margin down low because that is what the patient can see. Its great that you are using this platform to critique and learn .Few rules of thumb for my sanity that I stick to in my office1. Always place new restorations under permanent restorations2. Always take X-rays , bunch of denials these days
September 21, 2022
Restorative Dentistry
Message Board
Views: 3836 | Replies: 95
noble.....I was very surprised that this worked out.....and glad. How do you guys get paid for inlays/onlays??? I did a few last year and the insurance company downgraded to fillings..patient was pissed..ended up writing off....sucked so I went back to full coverage crowns...what's the secret
September 15, 2015
Restorative Dentistry
Message Board
Views: 198 | Replies: 4
, the insurance would pay for the D only as you already did the O in their mind. It resets the 18-24 month frequency limitation. I'm basing this on a similarcase I had on a patient who came from another office. When we contacted insurance, we were told the portion that was done by the previous dentist would
January 29, 2017
Restorative Dentistry
Message Board
Views: 164 | Replies: 10
I don't do gold crowns due to the lab costs involved. One patient specifically asking for gold crown, insurance patient . I called the lab. Lab bill will be around $ 500. Insurance fee is around $ 800. Can I refuse to do gold crown? What's a good verbiage ? We cover the standard lab fee and let
January 19, 2026
Restorative Dentistry
Message Board
Views: 842 | Replies: 27
when removing the veneer. As a result I'm thinking maybe to wait it out since regardless additional tooth structure is going to be removed with or without recurrent decay. Am I just in denial that this veneer needs to be redone because I am scared it might need a root canal if she goes back
July 31, 2024
Restorative Dentistry
Message Board
Views: 2952 | Replies: 47
cerec colleagues the other day. Since insurance will always deny the class 2 inlay...a superior restoration for this condition...he makes the inlay with a composite block such as lava ultimate or paradigm and charges the patient and the insurance for a filling! How bout that? I just finished one
March 21, 2017
Restorative Dentistry
Message Board
Views: 388 | Replies: 8
. Why? because she was probably in shock and denial and the other guy didn't know what to say other than well the other guys are wrong. OR she needs an endo after he did a restoration and now things are getting blamed on the guy who isnt there. I am not sure what made the patient to go to a different
October 18, 2017
Restorative Dentistry
Message Board
Views: 104 | Replies: 0
Hello! Not sure where to post this but figured to try here. I have had a couple patients come in who are uninsured and was curious to see what are rules and regulations on implementing and in house insurance plan. Do you advertise with direct mailers? Do you determine fee based on insurance comps? Thanks for the insight!
May 15, 2018
Restorative Dentistry
Message Board
Views: 43 | Replies: 1
When RCT is done through PFM crown. What is the code to close the access ? Thank you. occlusal...
December 21, 2017
Restorative Dentistry
Message Board
Views: 245 | Replies: 4
I am currently working with a patient with a government dental insurance plan with a 10k limit! The freedom that this kind of limit gave us, to do work that he really needs and avoid a path that he was heading towards, was so amazing. If I'm stuck as a single tooth dentist due to patients
February 26, 2015
Restorative Dentistry
Message Board
Views: 496 | Replies: 19
FURTHER DAMAGE? Occlusal guard? HOW DO I GET THE PATIENT TO STOP? Not possible, right? He probably used to grind his teeth, but he doesn't any...Can you post the photos again? Only a small strip of them came thru. As far as the denial, we have research that all of us grind our teeth as we
June 06, 2014
Restorative Dentistry
Message Board
Views: 2509 | Replies: 90
. Insurance should not dictate how we treat but isn't it the reason we do all these crowns and fillings and not any of the other conservative restoration?? Right out of the gate I was told no onlays and inlays because the insurance companies simply do not reimburse the work like they should. Hey Boss
November 26, 2024
Restorative Dentistry
Message Board
Views: 44 | Replies: 1
Is there an insurance code for Class 1,2,3,4,5 glass ionomer restorations? And do you charge a fee similar to composite fees for similar surfaces? Thanks in advance for any answers! same as direct resin.
February 25, 2021
Restorative Dentistry
Message Board
Views: 785 | Replies: 36
the above, I suggest, despite the patient being asymptomatic. Insurance, patient finances, medical status all aside, there is a difference between between being an observer and an evidence-based clinician. I make the recommendations and then work thru the algorithm of compromises. The actual
February 05, 2025
Restorative Dentistry
Message Board
Views: 858 | Replies: 17
with magnification. I think Costa's statement about how adamant he is about them being used says a lot because his skills are better than most and he uses a scope. I think those who do not use them are either in denial that no contact is made on the adjacent tooth or have determined that the harm
June 30, 2014
Restorative Dentistry
Message Board
Views: 335 | Replies: 13
Heard a new one from a patient today. He came to me a few weeks ago as a new patient with #29 broken to tissue level. I advised him that only way to restore the tooth was a root canal, post, and crown and that the prognosis would be fair due to possible fracture of tooth and/or post. Patient comes...
December 03, 2019
Restorative Dentistry
Message Board
Views: 166 | Replies: 2
number of dentists are too busy to bother fighting this stuff, and simply write it off. I was at an AGD meeting once and there was a doc there that stated he was once an expert consultant for a major insurance company. He claimed that it's a known fact in the industry that 10% of these claims are not followed up on. Great way to add 10% profit for the company.
January 11, 2018
Restorative Dentistry
Message Board
Views: 488 | Replies: 15
is everyone freaking out that a filling is done. We have no idea what it looked like clinically. You all should work for insurance companies w that attitude Freaking out? We are asking a question. A question that the OP seems to not want to answer. You have asked twice and a few others have asked as well
March 03, 2026
Restorative Dentistry
Message Board
Views: 3227 | Replies: 98
with Tim: give them a chance, (but probably only one). Have a discussion, as Howard suggests, put the cards on the table. If they're still in denial, THEN gently show them the door, but a knee-jerk GTFOOMO isn't appropriate every time. WW It seems am going the reverse direction of you howard. Early
May 15, 2015
Restorative Dentistry
Message Board
Views: 3454 | Replies: 74
. Seriously in denial. I am with Ed on this one. the fit of the OP's crown is poor And on the other case with 30 and 29, there is massive decay on the and big decay on 29, both distal. This is not a case to monitor. If left unattended, odds are that the two teeth will be lost due to decay. I replaced
January 13, 2020
Restorative Dentistry
Message Board
Views: 3261 | Replies: 173
Really ? Wow !! Dave, I love your posts, but if you feel thoses preps are over aggressive, then I must be a hack. Mike, I thought you did a good service to this patient. Would have treated the same way in my office. I'm also in PA but like previous posted, I've never had a problem with denials
January 09, 2014
Restorative Dentistry
Message Board
Views: 1324 | Replies: 51
and radiographs for everyone to analyze. Do you find that insurance companies often deny paying for the crowns? And if so, do you prepare your patients for the possibility that theyll have to pay for the whole crown fee out of pocket? Im curious how you handle the objections from patients if and when
October 06, 2022
Restorative Dentistry
Message Board
Views: 532 | Replies: 13
and consider that a lesson learnt. 5) go out of network 6) always collect the full cost and tell patient you will reimburse if you get paid After that tooth is prepped and old filling/decay removed I could see it needing just a dab of composite. So no would never expect an insurance company to pay
December 06, 2021
Restorative Dentistry
Message Board
Views: 422 | Replies: 17
of attrition on the anterior teeth. I would recommend some sort of parafunctional...Anybody I see in my office with gingival clefting like THAT gets an NTI. This guy IS beating up his teeth. The incisors are flat, and all upper teeth seem to have recession and clefting. Edit - DENIAL of bruxism
May 08, 2014
Restorative Dentistry
Message Board
Views: 352 | Replies: 10
My Schein rep came in today talking about this. Curodont non invasive treatment for early caries. What code would you use? does insurance, like Delta cover this? Any users of Curodont that can offer some advice on this? Thanks! D2991 is the code. Not sure about coverage I don't think it is covered
October 14, 2025
Restorative Dentistry
Message Board
Views: 510 | Replies: 5
. They give everyone the run around and ultimately who loses the most is the patients, who think they have decent insurance through their employer. I could go on and on. You can lump UH with UC, they are equally bad. First we dropped! Delta is starting to gain on my dislike meter though
February 06, 2016
Restorative Dentistry
Message Board
Views: 1300 | Replies: 52
All the parts you left out ARE insane...VDO is what it's all about...the vertical dimension of occlusion...then lip line and all the the other BS that the full arch people are dealing with when they get 50k for a case...us insurance dentists get a couple a hundred bucks after we pay you...the thing
January 12, 2026
Restorative Dentistry
Message Board
Views: 3796 | Replies: 111
is not my concern. She's still in denial and bargaining and all that. I'm zipping in -doing a quick reduce pain thing and a plan for follow up and zipping home. They handle the finances on Monday. I'm too lazy to deal with that at 8PM. $300 bucks means nothing to me at this point compared
December 31, 2014
Restorative Dentistry
Message Board
Views: 3227 | Replies: 98
and tell them This thing ain't cheap and I almost have enough. A few more folks like you and it should put me over the edge Denial... Anger... Bargaining... Depression... Acceptance. Skidoc charges the net and returns yet another deadly volley. BAM!!!!!!!!!!!!!!! I like I miss Everitt Payne, he
May 13, 2015
Restorative Dentistry
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