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Blog
' compensation can be daunting for any business, including dental practices. This insurance provides coverage for employees who experience work-related injuries or illnesses, ensuring they receive the necessary medical care and wage replacement.Workers' compensation is essential in protecting both dental
October 18, 2024
by FFD419
Message Board
Views: 813 | Replies: 28
There's been multiple threads lately about dropping insurance plans. The fallout with Covid has many offices that were on the fence now making a move and there's been several recent threads about Aetna, and now DenteMax, dropping fee schedules in some areas. With many offices deciding to terminate
August 10, 2021
PPOs and HMOs
Blog
. They will not bring the error to your attention. Denial of Claims It does happen that a claim or two will be denied now and again. If you verify insurance beforehand, the number of denied claims you receive should be minimal. However, you are sure to have at least a few each year if not more. When a claim is denied
April 24, 2019
by drmmills
Message Board
Views: 110 | Replies: 1
collected the contract fee for the crown minus the benefits they had remaining. The crown was denied (the 6th crown denial from UHC in the past couple months), so we sent an appeal and they ended up paying the remaining annual balances leaving the patient with no balance. We never billed the patient, all we
November 01, 2023
Going Out of Network
Message Board
Views: 316 | Replies: 42
in dealing with the patient's warranty claims, approval, denial, etc? Just sounds like there are so many other investment vehicles for us to grow wealth that don't potentially add a massive headache with dealing with patient treatment and approving or denying a claim. We form a micro captive insurance
December 15, 2023
Personal Finance
Message Board
Views: 226 | Replies: 15
This has happened to me on a couple of occasions. I send a pre-auth (or claim) for extractions to the pt's dental ins carrier, who states, per pt's insurance policy, I have to send the pre-auth (or claim) to the medical carrier first. Once I have the medical EOB, I can submit that EOB along
August 08, 2018
Claims Processing
Message Board
Views: 1388 | Replies: 52
the denial before payment. It's even worse when they pay you and then send you a letter 3 months later demanding the money back because the coverage was terminated retroactively. Many insurance don't provide ID cards eg.... I agree with what you're saying... but I'm with the OP. This seems
June 03, 2016
Practice Management & Administrative Forum
Message Board
Views: 30 | Replies: 1
authority to promulgate rules and that it did not meet while the language was being altered, raising questions about procedural validity. Drummond criticized the influence of out-of-state, for-profit managed care organizations that favored the rule because it would increase bureaucracy and claims denials
February 26, 2026
PPOs and HMOs
Message Board
Views: 5621 | Replies: 280
believe there are about 1,000 dentists in my County. To Barr, it's interesting how you managed to do this. Questions: 1) how many years in the same location? 2) did you start with insurances? 3) what is your approach with patients? 4) how did you manage to keep patients as insurance offices
September 16, 2014
Claims Processing
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: 484 | Replies: 26
last year denied, just one. Denials are almost always about not understanding what the insurance company needs to see to cover it. Yes Kevin, I/O photos help a ton, but so does sending the correct data. Mid-op info is FAR more important than pre-op info. There is a reason I put together a CE course
June 05, 2019
Patient Communication / Education
Message Board
Views: 454 | Replies: 23
the we have ever been paid interest on a past due claim. My best option is to wait 30 days and inform UHC that we will be fining a complaint with the state board of insurance and see where that goes. Sorry that I cannot be of more help. Have the same issue in my office. Finally got an answer
December 04, 2024
Claims Processing
Message Board
Views: 519 | Replies: 22
. We take most insurances and are aware of which ones have this stupid age restriction. We have successfully made referrals when necessary by calling and writing narratives with the insurance company. This is the first time I can remember just getting an outright denial about it. I guess what Cigna
February 19, 2019
PPOs and HMOs
Message Board
Views: 282 | Replies: 4
Arestin, insurance covers 80% very routinely. Almost never get denials. Patient really buys into it because they hear the charting being called out, they understand what we are doing, why we are doing it, and why they need it now. They can understand WHY they need to be numb and why it cannot
January 12, 2014
Hygiene Discussions
Message Board
Views: 19734 | Replies: 1359
they want you to jump through is absurd. Full treatment plans and probing attached for every single unit crown. Still getting denials. Does that apply to partials also? Yes. We got one crown approved. About 50 denied so far as well. 100% denials here as well. So far We are still trying. Any idea why
January 08, 2025
Legal Issues
Message Board
Views: 724 | Replies: 49
companies and managed care organizations. She's done case management, utilization review, grievances and appeals, QA, etc. It's the same thing everywhere. No insurance company wants to deal with appeals and multiple denials, and especially fair hearings. We may envision them as these huge behemoths
February 08, 2014
Practice Management & Administrative Forum
Message Board
Views: 335 | Replies: 7
Need some advice on how to successfully appeal a BCBS denial of benefits. 22 y/o female. Prophy, pan, 4 BW taken. #14 serviced with a 3 surface onlay (DOB - the buccal cusp was undermined by caries and broke off). Denied by BCBS. BCBS response to asking for reconsideration: tooth 14 appears
November 17, 2014
Claims Processing
Message Board
Views: 341553 | Replies: 128046
. Trump is a fucking idiot. He IS a petulant child. The rest is all just buillshit justifying your poor choice..denial. He has fucked up this country royally...and yeah..even you guys are going to pay a huge price for his incompetence. If I post how nice it is to not have to worry about any
May 21, 2020
Politics - DO NOT Enter if easily offended
Message Board
Views: 10648 | Replies: 3095
month, titans of corporate America are calling for laws mandating greenhouse cuts, green magazines fill newsstands, and the film based on Al Gore's best-selling book, An Inconvenient Truth, won an Oscar. But outside Hollywood, Manhattan and other habitats of the chattering classes, the denial machine
August 22, 2007
Politics - DO NOT Enter if easily offended
Message Board
Views: 997 | Replies: 57
it fit and send her on her way. I did not answer the survey because I don't have enough information from the op. Questions for OP: 1. Did you send the patient to collections for the entire amount of the crown procedure even though you only did the prep/temp? 2. Is insurance involved
June 28, 2023
Billing
Message Board
Views: 648 | Replies: 18
is required between srp appointments. Although not commonly done, there have been occasions that we have done four quads in one visit without any insurance issues. We will attempt to appeal the decision, but do others have suggestions for the appeal? I presume it will be denied again. My next step
October 28, 2016
Delta Dental
Message Board
Views: 546 | Replies: 20
... Your super hack is InsideDesk. We either use our own software for claim tracking or InsideDesk if our software isn't compatible with the PMS. It updates outstanding claim statuses every night and even pulls in the EOBs/denials for most major payers. You can email Whitney for more info
May 11, 2023
Billing
Message Board
Views: 694 | Replies: 22
needs even with great documentation. I dont fight it. I just refuse to treat the patient and refer to a periodontist. In this way the patient still gets great treatment and the insurance company now has to now pay much more at a specialist fees. I agree with delta dental. How old is the patient? I
June 30, 2025
Claims Processing
Message Board
Views: 838 | Replies: 24
procedure when needed to hold a crown. Based on what was submitted, you do not need this procedure to hold a crown. Talk to your dentist if you have questions. The x-ray should be sufficient to show significant tooth structure missing. Even if it is not, why will the insurance assume the worse
June 28, 2016
Claims Processing
Message Board
Views: 1317 | Replies: 52
I dropped UC as they were one of the worst companies I've ever dealt with. Low fees, then transferring their low fees to other insurance companies. Denying obvious R/P and crowns. Now I get a fee schedule with amounts higher than my fees. My fees are not low. I only participate with insurances
August 23, 2018
PPOs and HMOs
Message Board
Views: 1645 | Replies: 73
Insurance has been sending a checks with eob's and checks get deposited. Recently, they started offering to make direct deposits to the bank account. I am not sure how I can track this and have no experience. Who's tried this before and what are pros and cons? Most insurance companies this past
May 08, 2019
Claims Processing
Message Board
Views: 1885 | Replies: 121
insurance industry, it is generally accepted by providers that only about 60% of claims get paid for. Denials are over 20% for first time claims, often for no identifiable reason. By requiring providers to hire a room of ladies to sit on the phone all day appealing denials, they know that providers
July 21, 2021
Pharmacology
Message Board
Views: 543 | Replies: 8
audit the billings and patient records of the hospital, treatment facility, mental health facility, or health care professional. (c) A hospital, treatment facility, mental health facility, or health care professional that violates Subsection (a) is subject to disciplinary action, including denial
May 27, 2016
Ethical Issues
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: 207 | Replies: 2
A new patient following his exam requested if I could predetermine his benefits so that he could plan for his future treatment. I predetermined oclussal composite restorations for teeth #3,14,19,30 and 31. The correspondences from Principal Life Insurance company denied the benefits. The form
March 09, 2015
Claims Processing
Message Board
Views: 1311 | Replies: 26
Insurance denied this case because there is no attachment loss. I'm not sure if it's me but I see some loss of the lamina dura and angular bone loss between the molars. The bone level is apical to the CEJ. The patient is only 33 and I think that they have mild generalized chronic adult
April 10, 2017
Claims Processing
Message Board
Views: 1210 | Replies: 23
sometimes too. They will scrutinize your claims and the last thing you want to do is let them build up a history of denials. Incos can profile you based on your claims so it is in your interest to stay unchallenged.Guardian just did this to us...So between this and the new practice of applying other
September 21, 2016
PPOs and HMOs
Message Board
Views: 684 | Replies: 18
based on a flat fee, but the service fee based on % of collections seems appealing to many Providers. I just thought if you receive this insurance refund request, it does not apply to the normal recoupment laws of your state because it is based on unethical fee-splitting laws. See article attached
April 02, 2017
Claims Processing
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: 2176 | Replies: 69
. This also goes hand in hand with AR. The nice thing is your wife will be more diligent in looking at every claim and the reasons for denial or approval and each insurance company really processes claims.Whitecliff, every day I reconfirm what a bonehead I have been for not fully utilizing our
March 29, 2019
Front Office Discussion
Message Board
Views: 1591 | Replies: 40
I think I saw somewhere post about insurance changing anterior two surface fillings to one surface claiming that we can get mesial decay without lingual or facial approach. I got my first claim for 2016 where delta dental for retired military officially started downgrading all anterior fillings
May 18, 2016
Delta Dental
Message Board
Views: 695 | Replies: 26
delay treatment over things like this. I have seen people with cancer do the same thing. Maybe it's denial in some form, who knows. Good luck finding a private oral surgeon who is in-network with any medical insurance these days. Especially for this complex stuff. None of our local oral surgeons
September 07, 2016
TMD and Occlusion
Message Board
Views: 230 | Replies: 11
Happy Thanksgiving, everyone! We got out of network for TRICARE patients with United Concordia once they took over from MetLife. We noticed a definite increase in denials since then. MetLife, they didn't reject SRP. With UCCI, we get ridiculous reasons like attachment loss not seen on the x-ray
November 30, 2017
PPOs and HMOs
Message Board
Views: 957 | Replies: 30
Anyone have a statement for a patient to sign acknowledging that the service being provided is not covered by their insurance and will not be submitted to their insurance and they are responsible for the entire cost of the service. Or you can note it in the chart and have the patient initial
July 29, 2020
Claims Processing
Message Board
Views: 575 | Replies: 22
Dear Colleagues, I was told that when the patient reaches their insurance maximum that the dentist is not required to honor the negotiated rate. In other words we can charge the office fee. I'm in Virginia, can someone clear this up for me? Patients of course expect to get the negotiated rate
November 15, 2019
Claims Processing
Message Board
Views: 2883 | Replies: 125
for the crown.Need great photos, pulp testing results, narrative. Based on xray alone, that's a home run denial for Dr. InscoSo would you pre-d something like this? steveWhy bother? They're just going to deny it. Just be honest with the patient. Look, insurance companies have become a bear to work
June 12, 2015
Claims Processing
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: 572 | Replies: 12
, or the Provider acting on behalf of the Member, believe a service has been wrongfully denied or rejected, you may contact the California Department of Insurance for review at:.... Since I'm in Kansas, do I have no recourse? Bill the patient and say tough luck? Mostly I'm just venting
April 25, 2014
Claims Processing
Blog
In our last post, we discussed the importance of knowing when to file a disability insurance claim, and explained that certain actions dentists take before filing can make collecting benefits more difficult or even result in the denial of a claim. In this post, we're going to talk about a few more
July 01, 2018
by Edward Comitz
Message Board
Views: 1630 | Replies: 68
insurance process hasnt changed nor is it unique from being in network. We just verify insurance, downgrade the benefits, and have patients pay the estimated benefits before treating. Then of course fight insurance on behalf of patients for denials and bill/credit accounts as needed. Its just best
April 26, 2022
Claims Processing
Message Board
Views: 3308 | Replies: 440
products. Six possible dental insurance reform issues were targeted: assignment of benefits, disallow clause prohibitions, non-covered services, prior authorization, retroactive denials, and virtual credit card-payments. Dentistry would need to educate state attorneys general, state insurance
September 20, 2023
American Dental Association
Message Board
Views: 141 | Replies: 4
, they asked for 1120 tax returns, copy of DL, 4605 form and copy of blank voided check. After sending all that, I got another denial. WTF. Now they are asking me to provide the same things plus SBA form 3502. Looks like I receive generic denials for no reason. All of my friends dentists got this loan
July 20, 2020
All Things Coronavirus (Covid-19, SARS-CoV-2)
Message Board
Views: 911 | Replies: 22
it with the prep will guarantee denial just because they're rejecting a buildup on what they assume is the date of insert. Exceptions are made with CEREC users with a narrative showing the prep and seat date happened on the same date. Delta frequently wants the insert date for payment as well
April 10, 2017
Front Office Discussion
Message Board
Views: 378 | Replies: 17
. In all honesty, I would not be as great at billing if I didn't also have the clinical knowledge that I do. My entire team sends me x-rays to review when they are working denials - especially when their offices don't make the best clinical notes. I have one that can do both. She was a surgical
March 26, 2023
Practice Management & Administrative Forum
Message Board
Views: 435 | Replies: 8
of New York. The defendants listed include the Delta Dental Plans Association, Delta Dental Insurance Company, DeltaCare USA and more than 40 Delta Dental entities, according to court documents. The lawsuit accused Delta Dental of breach of fiduciary duty and denial of benefits in violation
January 23, 2026
Delta Dental
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