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Page 14 of 817
Message Board (37849)
Dentaltown Magazine (455)
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Message Board
Views: 248 | Replies: 11
routinely recieve COB denials, mispayments, or overpayments. Inscos are idiots. Good help is hard to find maybe? Esp. when all their 'claims reviewers' are working from home in their pajamas, nowadays.. A couple of corrections here: #3 - UCR is an insurance term. Too many incorrectly use UCR when
March 18, 2022
Claims Processing
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: 430 | Replies: 14
denial will be part of the package to enjoy. On a side note: Most patients reported that they pay high $$$ for dental coverage and are suprised about denials and non payment. Its so easy for an insurance company to have a contract signed from us a decade ago and add ammendments with no signature from us
November 22, 2023
Delta Dental
Message Board
Views: 617 | Replies: 27
far their official position is that it is our fault. We are supposed to follow up with the patient after a denial and make sure they gave us all The correct Info. If we can't, then we are supposed to use all of the insurance websites and search for the proper number. If you guys could hear the call
April 08, 2026
Claims Processing
Message Board
Views: 690 | Replies: 13
to not have to be the collection agent, is always make sure the patient has paid enough that you are 99% sure insurance will pay AT LEAST the remaining balance, if not more. The only times an office should have to collect from a patient after the fact should be a flat denial (which should be rare if your FD
November 19, 2018
Medical / Health Insurance
Dentaltown Magazine
business with a practice. Improves existing patient loyalty. Attracts new patients who are committed to the practice. Increases case acceptance. Differentiates dental practices. Kleer enables dentists to take back control by cutting out the insurance middleman
October 2019
Message Board
Views: 976 | Replies: 27
: Is that chipped lower incisor a F, or MF, or IFM, or IFML? Should I charge a limited exam along with that crown recement? It's up to you in the end. No one will come calling. If insurance denies the BU, switch it to O composite. I dont recall ever having a denial for the core build up. Reality is we
August 28, 2022
Delta Dental
Message Board
Views: 30341 | Replies: 503
(considering monthly premiums, wait periods, low minimums, treatment denials, etc) this would be a far superior plan to have. This is not a PPO plan. This is a plan that for the first time doesn't solely benefit the insurance company. Considering I'm married to a dentist, we own a dental practice, and I
August 31, 2018
Ask a Dental Consultant
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: 257 | Replies: 4
and might require even more extensive longer-lasting more predictable treatment in the near future. I'm also guessing that the Endodontist probably would have received the same denial had their claim been reviewed by the insurance dental consultant as it seems yours was.I just came across this on our
April 26, 2014
Claims Processing
Message Board
Views: 300 | Replies: 20
a patient for clerical reasons as demanded by some executives at an insurance company is wrong. I have never had to provide a seating x ray of any type. It has never been requested. I had been denied numerous times because there was either no pre-op PA or post op BW/PA. Most of the denials came from
March 05, 2025
Claims Processing
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: 318 | Replies: 10
I was wondering if anyone can answer a few questions about coding. 1. Do you have any success coding periodontal maintainence 4910 following repeated coding for prophie?. I've read that insurance will often deny periodontal maintenance following a prophy code. This situation is that we have
July 03, 2023
Coding Q&A
Message Board
Views: 354 | Replies: 7
am being pushed by her to do half assed dentistry as covered by the crappy insurance. She can log in online and see the denials before we get the EOB and starts calling daily (or more) to bug the FD and yell at them that we've done stuff wrong. She is very pleasant to me and crabby with the staff
November 16, 2015
Claims Processing
Message Board
Views: 345 | Replies: 10
I'm being denied payment from Delta Dental for impacted wisdom teeth extractions (7230,7240), the EOBs stating that this procedure should be covered by the patient's medical insurance. Has anybody run into this? Can you really bill medical insurance for impacted 3rds? Mark Yes and yes
August 02, 2022
Claims Processing
Message Board
Views: 3061 | Replies: 41
the medical insurance. Not your job. Often times you need to get a medical denial before dental will cover it. It's a way to waste rime.Most medical policies specifically exclude dental. When we send in these claim s requiring medical first (that will deny their claim) we include something like claim
February 06, 2020
Oral & Maxillofacial Surgery
Message Board
Views: 422 | Replies: 12
Patient fractures #8 below gingiva. Refer to O.S. for extraction. Patient opts for bridge. Bridge placed. Insurance wants radiographs. I send mine, and call O.S. to get theirs, but when I get the panorex etc. ,it is for another patient, and anything for the patient in question cannot be located. I
December 31, 2020
Delta Dental
Message Board
Views: 56 | Replies: 0
Hi All! I need help with two insurance scenarios! patient 1-due for her recall exam and xrays. 4 bw 2 pa. hygienist takes those and a pano to evaluate her 3rd molars. She has a recent history of FMX so we know they wouldn't pay for the pano. Front desk accidentally billed insurance for pano
December 18, 2018
Dental Insurance for Dentists
Message Board
Views: 165 | Replies: 1
then (at least 2-3 times per claim) and called to follow up but they always said they didn't receive them. The kicker is that the claims are sent in with all the claims to that insurance agency so we know they got them. They told us we need to write them an appeal for them to consider payment on the claim
August 06, 2015
Claims Processing
Message Board
Views: 449 | Replies: 12
. Just have the patient sign the treatment plan with an estimate that shows insurance is paying $0. I would still take a photo and still send a claim, just expect a higher chance of denial.
March 31, 2023
Delta Dental
Message Board
Views: 459 | Replies: 11
else have experience with Medicare documentation requirements and...Many of the Medicare fees are ridiculously low meaning that you actually can lose money on those patients. The documentation rules are actually the same as with any insurance with the big difference being audits. With private
September 19, 2015
Medical / Health Insurance
Message Board
Views: 214 | Replies: 3
money here unless your claim is denied. Much of your claim will depend on your doctor's notes, so speak to him clearly and let him know that you are having problems at the chair. Ivan M. Kirshner, DDS i like your signature dds262...It is always best to contact your insurance claims department
December 06, 2016
Disability Insurance
Message Board
Views: 670 | Replies: 18
Has anyone seen this waiver from Delta? It's asking out of network dentists to agree not to charge patients when an appeal is denied, in order to start an appeal. Seems like this would run afoul of state insurance laws. Doesn't it translates to not appeal. I wouldn't sign the waiver. What
November 16, 2021
Delta Dental
Blog
Dental insurance verification is a complex task that requires not only a lot of time but also sheer expertise. Even a slight inattention to the task can lead to severe repercussions such as aging accounts receivables, declined dental claims, dissatisfied patients, and whatnot. A rightful
November 30, 2021
by nikkigordon12
Message Board
Views: 176 | Replies: 9
they call? And can't answer the phone What if you're on the toliet everytime they call? And can't answer the phone The mute button helps a lot in that situation. Ha, have they earn the polite courtesy of the mute button? I did one of those calls a few years back, and there was a number on the denial letter
January 23, 2026
Dental Insurance for Dentists
Message Board
Views: 58 | Replies: 0
to denial. You're forming emotional attachments to the smear layer. You're whispering to calcium through a slurry of contamination and hope. It's the Adhesion Illusion - a polite fiction sustained by marketing and moisture. No room to question chairside, though... time is money. Every 'universal
October 29, 2025
Bonding Products &Techniques
Message Board
Views: 296 | Replies: 8
/dental services.If you are in contract with insurances, by contract you are required to submit all procedures performed, elective or not. This is because insurance wants to establish and have a tcird history of procedures performed for future frequency claim approvals or denials. Let's say a tooth
April 04, 2019
Coding Q&A
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: 246 | Replies: 9
of pocket for it (legal to charge in New York after getting a denial from medicaid) or you can get an extraction or just do nothing. If they think now they need a root canal or an endo consult because the insurance said so and they can get an approval after that, I would say I disagree
October 24, 2023
Medicaid and Welfare Issues
Message Board
Views: 215 | Replies: 4
, blah. I will say I have never seen this issue with Met Life before. Just a heads up. They are going to ask for a copy of your initial diagnosis chart notes, so hopefully these match up with the narratives you are writing. Insurance companies are finding more ways to control how they pay making it so
August 22, 2014
Claims Processing
Message Board
Views: 225 | Replies: 10
Anyone ever hire a person from the medical field ----->dental field. Prospective hire has worked for a medical clinic as front receptionist/biller/insurance/accounts for 20 years in the medical field. Last job lasted 10 years. Great references and great personality. Knows how to read EOBS, claims
November 09, 2017
Staff Management Issues
Message Board
Views: 2153 | Replies: 91
difference does it make if insurance doesn't pay due to a waiting period or a denial due to downgrade or a complete denial. In any of those above scenarios it's patients responsibility to pay the balancd for the treatment. For eg.An existing emergency patient called yesterday to be schedule
October 06, 2021
Claims Processing
Message Board
Views: 855 | Replies: 33
. Just a consult. Worst dental experience of my life. I am on Amerihealth and this doctor was supposed to file a Benefit Limit Exception to get me treatment. He claimed he did. The insurance company, three times, said they had received nothing from him. Today he spoke rudely, crudely
December 07, 2014
Practice Management & Administrative Forum
Message Board
Views: 252 | Replies: 9
Like most offices, we have been submitting insurance claims for our patients as a courtesy. My front office has informed me that this courtesy is becoming more and more costly and difficult to do. In trying to figure out a solution to this problem we have considered outsourcing this part
October 09, 2021
Claims Processing
Message Board
Views: 862 | Replies: 29
will cover xxxx and started saying We will submit a claim for XXX to you insurance company on your behalf. If we were to take a hit on every single denial and not bill the PT we would be doing community service. Oh wait... we did that a while ago, but we called it accepting medicaid (the scars
April 14, 2014
Practice Management & Administrative Forum
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: 747 | Replies: 14
Hi all. I'm not really sure how to handle this one. My office received a letter from a collections agency for a small debt of a couple hundred dollars. It took us some time to figure out it was for a patient who's insurance had terminated for the date of service in question (back in 2017) but we
August 28, 2019
Claims Processing
Message Board
Views: 67 | Replies: 1
From a front office insurance processor: I've run into an interesting issue with an ADDP patient; those of you familiar with ADDP know that fillings are considered a routine service, and thus don't require pre-authorization unless the fee in one visit exceeds $750. Well, I have a client
January 02, 2017
Claims Processing
Message Board
Views: 577 | Replies: 12
We had a patient who had multiple large failing composites on anterior teeth. We typically don't take PA's at recall, only if there is suspected issues or something like that, but I can usually diagnose clinically. Insurance came back asking for pre-op X-rays or they won't pay the claim (PPO ins
July 18, 2018
Claims Processing
Message Board
Views: 495 | Replies: 12
of denial of the claim (etc. but no provision for denying the assignment.) North Dakota* Optional An insured under a group health insurance policy, pursuant toagreementamongthe insured, the group policyholder and theinsurer,may make an assignment of all or any part of the incidents of ownership held by the insured under the policy, including any right to designate a beneficiary.
December 31, 2016
Delta Dental
Message Board
Views: 342 | Replies: 12
have paid me on appeal for 6 month prophy denials. Guardian and United Concordia are not appeal-worthy. Either way make your employee write the letters. She will be sure to get better at checking. Standards should be without specific insurance policies in mind. The reason for 6m +1d always is so
January 21, 2024
Billing
Blog
EHRsimplifies this by automating billing processes and ensuring accurate insurance claims submission. Integrated Insurance Verification:Patients' insurance details are verified in real-time, reducing claim denials and errors. Automated Billing Statements:Patients receive clear
February 09, 2025
by shenchao
Message Board
Views: 520 | Replies: 14
reimbursements were lowered by 4%, and we have recently had a lot of random denials. I am just getting frustrated with dealing with it on a daily basis, plus even after 3 years my FD lady is still just confused by it as I am. I am contemplating dropping it for any individual once they turn 19. Or even
October 13, 2016
Practice Management & Administrative Forum
Message Board
Views: 1228 | Replies: 18
. If theres history and theres a frequency, they wont cover it again. This is in NY anyways. If you get the denial letter, you can ask the patients parents to pay for the redo... or, sometimes, I just explain to them that we got the denial and if they dont want to pay out of pocket, then they can always
May 01, 2021
Ethical Issues
Message Board
Views: 749 | Replies: 31
, and an extraction. In my state, the insurance commission wont get involved if it is a self funded plan, which is the over whelming majority of dental plans. They just come back and tell you that you have to take it up with the department of labor. I never have escalated a claim denial to the department of labor
December 11, 2020
Claims Processing
Message Board
Views: 621 | Replies: 15
with a predetermination for the crown. You should be asking the questions before you do the work. 😀 Check with the insurance before you do anything that they might not cover or have questions about because if it's after the fact then you're running
April 14, 2018
Delta Dental
Message Board
Views: 369 | Replies: 13
, not jailtime. I would do a PFM and prepare the patient for multiple attempts to achieve acceptable esthetics. Not a case to use a budget lab. Is it a downgrade or is it a flat out denial of D2740? What did you send on the pre-d?Working with federal insurance plans is different than normal PPOs. If they say
November 07, 2018
PPOs and HMOs
Message Board
Views: 626 | Replies: 9
out what kind of risk you will be. Being untruthful or withholding information is an automatic denial of the claim (the better companies will refund your premiums). You never want to be in that position. Find a new agent. I have not had the interview yet. This was just the initial application
May 18, 2015
Disability Insurance
Message Board
Views: 203 | Replies: 7
is based on a completely false claim which ruins the doctors reputation with the pt and to others the pt may inform. At what point is the insurance company liable for these damages? Im guessing most just pass it off and say its not worth the headache, bu if the doctor and practice is young, one could
January 15, 2026
Legal Issues
Message Board
Views: 547 | Replies: 24
covered after 1 year! Good thing we have medical insurers running the show. Nothing physicians have to deal with Retroactive denials and the like. Them insurance cos are doing a bang up job fer sure
February 07, 2020
Dental Insurance for Dentists
Displaying 651-700 of 40839
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