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Message Board
Views: 160 | 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 11, 2015
Claims Processing
Message Board
Views: 788 | Replies: 26
you make to fight the denial? Sounds like that is the main issue, if they paid you would have no problems. I would think you are bound by the primary, not the secondary insurance. Mostly because of contract, your contract with the primary will supersede the secondary, and you are required
February 12, 2016
Claims Processing
Message Board
Views: 5117 | Replies: 74
referrals could be created within his... Easiest patients ever, no claims to send in, no denials. So what if it is $675 per veneer? You can also have $600 bleaching, $500 diagnostic cast and wax up, charge your lab fee as a separate item per veneer, etc. (all non-ADA codes) I love discount plans, so much
April 01, 2018
Coding Q&A
Message Board
Views: 341553 | Replies: 128046
radio in NY was horrible. That's why socialism is so important. We can just have them apply for regular payments for basic expenses as long as they don't have an income. Hi Mark, or we can look at it like the government is providing loss of income insurance during a pandemic. (since insurance
October 06, 2020
Politics - DO NOT Enter if easily offended
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: 938 | Replies: 32
anything about this requirement in his handbook. Ah .....Humana.....one of my favourite insurance companies to do free work for! That's what denials are....free treatment !Chains ruin it for... I will tell you that you are absolutely wasting your time with Humana. They will continue to deny
May 07, 2016
Coding Q&A
Message Board
Views: 270 | Replies: 6
thousands of individuals to obtain long term disability insurance benefits. Our disability attorneys represent claimants nationwide at all stages of a claim for disability insurance benefits, which includes the disability application process, denial of disability benefits, ERISA appeals, lawsuits
April 26, 2021
Disability Insurance
Message Board
Views: 737 | Replies: 25
(hence the post), thoughts? Is this normal? Do they think assigning their 'in-network' (Connection Dental is all we take) provider to collections will make me see their patients. Ive noticed insurance companies getting much more brazen since covid. More denials, more delays. Having to resubmit claims
December 05, 2023
PPOs and HMOs
Message Board
Views: 708 | Replies: 30
, not waiting to get paid or dealing with denials etc... the County of Humboldt actually dropped DD after a 25 year run, as their employees were complaining about poor reimbursements and no providers that will deal with them.. that is thousands of people with new insurance. It's early yet, so I
July 28, 2025
Delta Dental
Message Board
Views: 1016 | Replies: 31
I apologize for the long post. Within the last couple years I partnered at a practice that used PracticeWorks as their software. I disliked it on the clinical end. My front desk / insurance coordinator loved PracticeWorks. I switched us over to OpenDental. Clinically, I really like it. My front
February 09, 2025
Open Dental
Message Board
Views: 350 | Replies: 5
of more pericervical dentin while making retreatment simpler at a lower cost to the patient. Marshall Regardless of who did the endo, it doesn't look great. So I see what the insurance company is claiming here. Could attempt an appeal with the endodontist's findings explaining why the canals all look
June 01, 2021
Claims Processing
Message Board
Views: 672 | Replies: 14
.' That means technical denials. Missing tooth numbers. Wrong provider ID. Incomplete narratives. A radiograph taken but not attached. Dentists have lived this movie. Your fix is not heroism, it is systems. Use templates for narratives. Standardize attachments. Audit your own claims monthly. Find the three
April 29, 2026
Medicaid and Welfare Issues
Message Board
Views: 156 | Replies: 0
DD has been making us do MEDICAL claim first for surgical extractions and IV sedations . Get denials prior to resubmitting for dental! WTH! Further, DD limits IV sedation to 4 x 15 min ONLY! I guess the bonus for the executives have to come from somewhere.... NO MORE DELTA DENTAL!
December 06, 2022
Going Out of Network
Message Board
Views: 640 | Replies: 10
as well however the quality of radiograph isnt helping. Try to take one a little more mesial. It will give a better look at the DB which might be the one in question. Also, did you locate MB2? Could this be another thing they are looking for? ...sometimes a denial isn't about the RCT but it has to do
July 29, 2021
Endodontics
Message Board
Views: 2993 | Replies: 59
to retire. Soft Teeth, you forget one small detail. Getting the insurance company to PAY! It's not that easy. Just like dental claim denials, they also will require a ton of paperwork before they even think about paying you. They will send you to specialist that may be favored towards them that will say
March 20, 2015
Personal Finance
Message Board
Views: 8084 | Replies: 716
did not have health insurance as he was here from another country to get married. He explained that he had come from a part of the world that Ebola is active, the hospital staff did not share that information and it was missed. The family he was visiting was in isolation and none have shown any
October 15, 2014
General Health
Message Board
Views: 924 | Replies: 20
Hey folks. I've been struggling with this issue for some time. I would greatly appreciate some input. When I graduated dental school (7 years ago) I was denied disability insurance because I had a history of anxiety/depression. The agent told me if I try again in a few years without any med history
August 02, 2017
General Health
Message Board
Views: 1282 | Replies: 36
practice is located in Connecticut, but the patient is covered by Delta of New Jersey? Am I understanding that correctly? And if so, which state laws apply, the law where the tx is performed or the law where the insurance company is located? Good question Can any of our insurance gurus comment?You
May 09, 2016
Delta Dental
Message Board
Views: 627 | Replies: 17
in pursuing it. So, I am in the evidence gathering phase here! If anyone can help, I listed scenarios below, and would like to know if they would be candidates to bill medical insurance, and the likelihood of success. Thanks for any help: 1.) 1.) A patient has diabetes, and therefore
June 08, 2018
Claims Processing
Message Board
Views: 346 | Replies: 22
is almost always the reason for denial, not policy restrictions (even though that is what the EOB will state). You are correct. Hence why as you can tell, calling the insurance company and asking the representatives is worthless and they are clueless to the laws. So which is itbill the patient
February 03, 2022
Claims Processing
Message Board
Views: 460 | Replies: 11
will start sending your patients a notice with their EOBs showing them how much money they could be saving if they simply changed to an in-network dentist. Good luck!This is why it is more and more difficult to be a FFS dentist. A very good indicator of where dental insurance is headed. Something
February 13, 2015
Claims Processing
Message Board
Views: 872 | Replies: 20
in the store. Like a pharmacy. Those are pretty much my insurance fees in S. IL. What state are you in OP? GA The difference is we are short truck drivers, not dentists. Last I heard there were 3 or 4 dental schools being built or in the works. Heck the construction workers making the dental schools
February 08, 2023
Personal Finance
Message Board
Views: 325 | Replies: 11
may result in delay or payment of estimate. This is forone partial quadrantof SRP. Has anyone had to send a copy of the schedule and clinical notes before? Please post what insurance. I will be sure not to take it. Aetna did this to me. Took 6 months to get paid. The guy had 2 perio maintenance
February 24, 2025
Claims Processing
Message Board
Views: 1066 | Replies: 55
, but I think it's across all...You can files a complaint to your state's Insurance Commissioner . And if not , then have a collection Attorney help you collected the money. As long as you provided the service and the patient is happy. Also , politely ask the insurance to send you the contract
October 24, 2016
Orthodontics
Message Board
Views: 364 | Replies: 20
I'm curious to know if anyone has or had experience to not use any of the Clearinghouses and just submitted claims directly to the insurance companies via there portals. Any thoughts on this? Pros/Cons Etc thanks ramzi We do it occasionally if a claim keeps getting kicked back on the Clearinghouse
January 01, 2026
Claims Processing
Message Board
Views: 1141 | Replies: 25
remotelite and vyne trellis: They based the required supporting documentation off of the info they had from the insurance companies which means you may have a D4910 marked as ready to send but really it requires SCRP dates to be sent so that will come back as a denial. We have been in communication
January 06, 2024
Claims Processing
Message Board
Views: 85 | Replies: 1
So today when we call Humana on a past due claim for a prophy and exam, they tell us we now have to submit to the patient's medical carrier first, get the denial and then submit to them? Can I just call the patient and get them to pay or am I obligated to put up with this nonsense? Is this because Patient bought a healthcare plan through Obama care and it has dental benefits ?
January 08, 2016
Claims Processing
Message Board
Views: 785 | Replies: 44
. If it is written correctly, it waives the insurance participation obligations, like fees. Dont believe anything UC says.They cant even cover PAs or SRPs. Getting SRPs covered is more about the documentation that anything. I have less than a 1% denial rate on them, even with UC. I had a delta patient
January 23, 2023
Coding Q&A
Message Board
Views: 1039 | Replies: 54
%, Mar 88%, April 75% . This does not make sense to me. In March I ran the numbers and found unsent insurance claims due to a fillin at the front desk. We also had issues in the first quarter with not knowing which Delta plans would send the check to the patient. We fixed those two issues, yet
May 04, 2023
Practice Management & Administrative Forum
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: 64 | Replies: 2
Tells you if pt is bruxing. I'm tired of pts with extreme wear in denial about their condition...or hell, basic wear....like a suck down that shows wear patterns that won't break the bank. I palpate people's muscles but apparently no one has sore muscles....it's making me go crazy. Use a black sharpie on the discluding element (a la Melkers). What about this product brux checker? Seems pricey but if one buys a night guard it pays for...
December 14, 2017
Appliance Therapy
Message Board
Views: 965 | Replies: 29
I am a GP and I'm researching a possibility of using third-party companies to submit claims to medical insurance. I would love to hear the opinions of those here who actually do it . How reliably do you get paid for things like comprehensive exams, night guards , extractions, bone grafts ? I don't
October 18, 2018
Front Office Discussion
Message Board
Views: 541 | Replies: 20
want to know if it's illegal or considered a discrimination to ask if the applicants have had history of crime. If asking about criminal history is illegal, then all the government agencies including the state boards, DEA, etc. and insurance companies are criminals. When renewing your license or sign
March 15, 2021
Staff Management Issues
Message Board
Views: 373 | Replies: 9
the door.these patient had TONS of dental work....mostly surgery, restorative, and removable. It was truly a win-win. The insurance company NEVER gave me the BS other companies do...no pre-tx authorizations, no losing of X-rays and fraudulent claim denials. If the patient had a dental need and I provided
June 14, 2016
Dentistry In The News
Message Board
Views: 674 | Replies: 13
DECISIONS ARE PATIENT CARE-FOCUSED Require that 94% of Delta revenues be directed to paying for patient care, and require any administrative costs above 6% be refunded to those purchasing coverage. Require that Delta, like other health insurance providers, work with the Office of the Insurance
June 19, 2017
Alternatives to Dental Insurance
Blog
, and includes just a few steps and automated tools your staff can easily manage. Registration: Ensuring payment begins with verifying insurance eligibility and collecting accurate patient information before service. This step is crucial, as it is estimated that denials represent approximately fifteen
August 11, 2014
by Josh Shipman
Message Board
Views: 683 | Replies: 26
using AI claim denial algorithms since 2020. One of my patients is the guy tasked to clean up that mess. There is, stop participating. Not going to help when the entire problem in this thread is insurance giving problems to OON offices. When you're OON with delta, its a waste of time trying
January 29, 2025
Delta Dental
Message Board
Views: 1008 | Replies: 22
Has anyone here tried to open up an office catered to the uninsured? I don't want to get involved with insurances because of the increased headache and overhead required to bill out to them. Insurance is mired with administrative/bureaucratic red tape, collecting issues, denial of payments, fraud
September 06, 2018
Practice Start-Up
Message Board
Views: 4323 | Replies: 121
PPOs to improve the bottom line and maintain our sanity and the health of the staff and patients. I think that's exactly WHY you drop the PPOs. I am adding the cost of extra sterilization protocals to the cost of tx's to counterbalance the extra overhead. Cant do that w dental insurance ;) Who says
May 15, 2020
Coronavirus (Covid-19, SARS-CoV-2)
Message Board
Views: 531 | Replies: 5
I doubt Ill get any this round. Ive applied but since I didnt show a loss between the periods, I doubt Ill get anything. Who knows, maybe govt will surprise me. Did anyone get this week? I received a denial email this past Thursday at 5:59 PM this week.Figured Id get denied. Still waiting. Got all
February 20, 2022
All Things Coronavirus (Covid-19, SARS-CoV-2)
Message Board
Views: 3701 | Replies: 174
I'm done with PPO ins, done with their games, denials, payment delays all their BS. I want to be OON, my goal is to see less patients a day, reduce my days and spend more time with family. I already terminated guardian. Metlife and aetna are next on my radar. the problem is if I get pt
August 24, 2022
Practice Management & Administrative Forum
Message Board
Views: 1933 | Replies: 59
with new insurance. Some companies will also give the option to include copays calculated for the scheduled procedures for restorative Core Billing Services:Submissions, Posting, Aging Claims (denials/appeals) -Most billing companies work these parts of the rev cycle together because they are closely
October 03, 2023
Billing
Message Board
Views: 1082 | Replies: 34
Which of the 5 stages of coronavirus grief are you in: denial, anger, bargaining, depression, or acceptance? Denial Anger Bargaining Depression Acceptance Bargaining. But I have been all my life lol. To me thats like constantly using my second favorite organ.Laz I moved through all 5 stages
March 23, 2020
Coronavirus (Covid-19, SARS-CoV-2)
Message Board
Views: 934944 | Replies: 348121
of their lives. what is PBD? So is this a sign of her discipline or her stupidity? Or is she stupidly disciplined? Liberals are starting to panic. Donald Trump is going to win in a landslide Opinion by Roger Kimball Denial is not only a river in Egypt. It is also a seductive expedient
October 17, 2024
Politics - DO NOT Enter if easily offended
Message Board
Views: 2842 | Replies: 89
dentures. It's like going to Mc Donald's and looking for steak in their dollar menu!!! As a code grouping, removables are the most undervalued procedures by the vast majority of insurance carriers. I'm not certain why that is, and have actually invited dental directors and carrier reps to shadow
October 31, 2021
Laboratories
Message Board
Views: 11553 | Replies: 1394
contracts, IMO, in my office, BCBS and UC due to their shitty reimbursements and notorious, outright denials of s/rps treatments for many of our pts over the years... Enough is enough. Please tell everyone if your sanity and your practice suffered from that action, or they improved. (Everyone else
August 26, 2023
Ethical Issues
Message Board
Views: 1449 | Replies: 28
due to the fact that someone is not stealing the money. It is very hard to find classes on insurance - I did a lot of personal investigation on my own and made phone calls to other offices and insurance companies to get help. I rarely get a denial. She needs to come to the office and learn from
January 15, 2015
Practice Management & Administrative Forum
Message Board
Views: 1505 | Replies: 31
for them to cause problems with ill conceived updates is a bit too much of an ask. I'm thinking for switch to Curve as I'm hearing good things about its automation in insurance verification and AR/aging report accuracy. Can someone please speak of their current experience on that? My insurance
March 11, 2026
Curve Hero
Message Board
Views: 57 | Replies: 1
Canada's Canadian Dental Care Plan is not socialized dentistry. It is not the end of private practice. It is also not 'free dental care.' It is something much more familiar to dentists: a large, government-funded insurance program with copays, eligibility rules, preauthorizations, fee gaps, patient
May 27, 2026
Canada
Message Board
Views: 1060 | Replies: 23
this. flagrent denial of existence of judicial system?? Makes you wonder why some even bother going to dental school if they would go to such extremes for money. Seems like such a waste of time, money and others health. That is greed , not crazy.. to methodical. Patel also called another dentist
December 21, 2017
Legal Issues
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