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Message Board (37852)
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Message Board
Views: 219 | Replies: 5
Some of these insurances i dont understand. We sent a claim 15 mos ago for an partial denture. they dont need anymore info but they are still procesing claim. is this even possible? Humana Don't take that crap. Call them and tell them you want that claim determination tomorrow otherwise you
May 10, 2017
Practice Management & Administrative Forum
Message Board
Views: 152 | Replies: 2
Do most insurances cover the Periodontal Maintenance code? I am trying to change the Periodontal program at my office and I am getting push back from longtime hygienist that insurance won't cover the maintenence code. Any thoughts or suggestions would be appreciated. Most insurances will pay
November 02, 2016
Claims Processing
Message Board
Views: 107 | Replies: 3
Here's the deal. We as dentists get the primary insurance payment. Because of coordination of benefits we submit the primary eob to the secondary insurance. Since all dental insurances are getting secondary claims, this let's them know what their competitors are paying. They use this as leverage
February 05, 2021
Claims Processing
Message Board
Views: 1982 | Replies: 59
I have life insurance. I wanted it for tax deferment benefits. I asked my adviser again today and this is what he told me: Life insurance a bad idea? Without seeing the article, it’s had to comment on it. Personally, I like it as an investment. If you remember (and I’m going to run
December 16, 2014
Life Insurance
Message Board
Views: 735 | Replies: 12
they wouldn't pay me to work on his teeth. I called and as I don't have an eligible participant on the plan they don't have a way to look up the benefits I am paying for. I'm here in California. I'm currently paying $33 more a month for my kids dental insurance. No one has given me the dental insurance
January 17, 2015
Pediatric Dentistry
Message Board
Views: 753 | Replies: 20
I am purchasing a practice and the seller would like me to buy the A/R. He offered for me to buy 0-30 days at 90%, 31-60 at 80% 61-90 at 70% and anything 90+ is included for free. I was looking at an account aging report that was provided to me and noticed that ALL outstanding insurance
February 27, 2015
Practice Acquisitions
Message Board
Views: 660 | Replies: 25
How can insurance companies get away with this? I get it. They deny this and that, ok so we get intra-oral cameras and whatnot...but how can you downgrade a fning bridge to a 700$ partial????????????????????? WTF. Did your narrative say that you seated it with temporary cement? Lol. I had a pre
September 22, 2020
PPOs and HMOs
Blog
is safe, and nobody is injured. Call 911 immediately if anyone is hurt. Go to a safer location if the scene is hazardous. To report the incident, notify the police. Gather proof and descriptions: Exchange details about contact and insurance with other drivers and injured parties involved in the crash
November 13, 2020
by FFD419
Message Board
Views: 641 | Replies: 16
dentistry .Can I create a code for our office like when I place ribbond or sell a toothpaste thats not going to be covered by insurance . So we have an in office code for that .There are some pts that I have spend a lot of time trying to restore their sub gingival decay . Everything costs money
February 24, 2024
Delta Dental
Message Board
Views: 93 | Replies: 3
I called support and nobody could help me with this...what am I paying for??!! I also researched on DT but can't find my answer, so I need help. We signed up as an in-network provider with a number of insurance companies this year, and I need to run a report showing how much we've charged out
March 17, 2016
Practice Management & Administrative Forum
Message Board
Views: 370 | Replies: 9
Is it legal/ethical to downgrade your own filling to an alternate code? Ya know like the insurances do. Here's the situation. Patient has very limited humana plan. Pays for 1 exam, 1 set of BWX's, 1 filling per year. She needs MIDFL on #24 because it broke. So common sense says its a D2335
April 19, 2016
Claims Processing
Message Board
Views: 224 | Replies: 7
Of course Copay has to be collected. No questions about that. But sometimes OON offices elect to waive off differential on exams etc. As an OON office in California, I am curious to know the legal implications of writing of differential. Lets say insurance caps the NP visit ( covered at 100
July 26, 2023
Front Office Discussion
Message Board
Views: 152 | Replies: 6
At my office, I offer free dental care to my employees, their spouses, and any MINOR children. But several spouses and some children are covered under dental insurance plans for one reason or another. Is there a legal way to still bill the family member's insurance and making the treatment free
June 08, 2024
Practice Management & Administrative Forum
Message Board
Views: 2233 | Replies: 41
Good evening! Any advice would be greatly appreciated. Currently on ADA GW Disability and LIfe insurance. Also just starting seeing chiropractor the last 5 months or so. Currently working with life insurance to increase from 250k to 1M due to new baby on the way and many young friends tragically
January 13, 2018
Disability Insurance
Podcast
... Insurance coordinator, treatment coordinator. What's the lump sum? You're not a hygienist. You're not an assistant. You're not a dentist. What are you? Lisa: I am an office manager. I don't think you would offend anyone by calling them an office manager, but I heard this when I was at the inaudible 00:04
November 19, 2015
by howard
Message Board
Views: 73 | Replies: 2
hi, Townies I have a unique condition, I would like to know which insurance I send a claim and how to do it? Patient has insurance A in last month and I did crown preparation forher inthe end of last month and sentimpressiontolab. then patient changed job and have another insurance B ( Insurance
November 17, 2017
PPOs and HMOs
Podcast
Get MORE from PPOs? Learn from the Insurance Coding When do PPO fee schedules not matter? The world of PPO insurance is messy and complex. Some may wonder if its designed like that intentionally. But if your practice
January 13, 2016
by OpenADentalOffice
Message Board
Views: 333 | Replies: 8
I'm new at working with dental insurance. What are the rules regarding writing off or waiving the patient portion. In other words, are there any discounts that can be given to insurance patients if the work is submitted for insurance Technically, it is insurance fraud. If you charge someone $100
November 16, 2018
Dental Insurance for Dentists
Message Board
Views: 125 | Replies: 3
Question: Where is the ADA when insurance companies start mis-applying the ADA code set and start bundling procedures? For example why do insurance companies get to decide that 4 bitewings and a panorex can be combined and called a full mouth series. Why can an insurance company print on an EOB
February 22, 2014
American Dental Association
Message Board
Views: 656 | Replies: 22
$ from March 2015. It will be a full 2 years from the date of service in 8 days. At least in my case, the pt still comes to my office so we will resubmit to the correct insurance company, but I'm not even sure if the new insurance will accept a claim from service performed 2 years ago. ^I would
March 03, 2017
Claims Processing
Message Board
Views: 1374 | Replies: 40
This month I got a letter from the ADA and it said that it was time to re-attest in the CAQH ProView. One of the insurances that I participate with had me recredential through CAQH. Apparently the ADA wants to making it easier to sign up and participate with as many insurance companies as possible
March 26, 2018
Just Plain Bitching and Moaning
Message Board
Views: 489 | Replies: 19
so freaked out and to know how to say it for the next pissed off patient. Thanks its called inflation and HIS insurance hasnt kept up with it.One of the bigger negatives about participating with insurance plans. As the plan coveragescontinues to decline,you can choose to die a very slow business
November 16, 2017
Coding Q&A
Message Board
Views: 379 | Replies: 13
Hey DT, I've been listening to podcasts and reading information on all things business dentistry and recently came across a podcast discussing insurance reimbursements, coding, etc. From someone who doesn't know much, what are some resources you've found to be helpful in learning
June 30, 2025
Dental Insurance for Dentists
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: 168 | Replies: 6
or other HMo medical insurance which seem to reduce chances also so maybe a different area with better indemnity insurance will have better resultsWhether or not an insurance pays for a procedure is not the fault of the billing company you use. The reality is that deductibles have gone through
September 22, 2016
Medical / Health Insurance
Message Board
Views: 253 | Replies: 8
So we are looking at becoming out of network with a few insurances. Some of these insurances only give the assignment of benefits to the patient such as Delta. We have decided we want to treat these patients as if they were cash patients. The problem is we give discounts between 5-10% depending
June 19, 2018
Ethical Issues
Message Board
Views: 34 | Replies: 2
hi, is there a report to run to tell which insurances have paid what in dentrix? So that when i get 1099's from them i can compare with dentrix for accuracy? thanks The following is from support KB Article # 56462, Report For Payments By Insurance Company For Certain Date Range For G4 and above
February 06, 2014
Dentrix
Message Board
Views: 323 | Replies: 6
) in mind. At this time I am accepting upgraded procedure(s) at my doctor’s recommendation that could promote a more stationary restoration or the cosmetic look I desire. I do understand his recommendation to upgrade the procedures are above and beyond what is covered by my insurance company
September 18, 2014
Claims Processing
Message Board
Views: 1274 | Replies: 52
Yep. There was. I think it is your choice how to handle it. I have had times when I write it off because I would rather keep the patient, and we made the error. Other times we insist on payment. All estimates are based upon the information you have from the insurance company. WIthout complete
November 05, 2016
Ask a Dental Consultant
Message Board
Views: 61 | Replies: 0
Dentaltown just added to its library the following course! Part II: What Every Dentist Needs to Know About Filing a Disability Insurance Claim byEd Comitz, Esq. and Derek Funk Esq. In this second part of a disability insurance claim series, attorneys Ed Comitz and Derek Funk answer common
September 12, 2024
Dentaltown Online CE
Message Board
Views: 85 | Replies: 3
Patient has a primary insurance (Delta PPO fee schedule) that only covers basic procedures, 0% coverage on crowns. Patient also has a supplemental secondary insurance (Delta Premier fee schedule) that covers major procedures at 50%. Our office is in-network with both Delta PPO and Delta Premier
August 12, 2017
Claims Processing
Message Board
Views: 678 | Replies: 24
Sorry for the newb question...but what's the exact procedure to bill insurances OON...any tips/guidelines? File insurance exactly as you would in-network. The difference is how you collect. You'll need to find out which insurers will assign benefits to you, and which won't. For those who won't, you
October 28, 2016
PPOs and HMOs
Message Board
Views: 426 | Replies: 10
Quick question Some insurances will only cover bitewings once a year but they will cover PAs. I have a patient coming in and insurance won't cover bitewingsbut covers PAs at 100%. Is it wrong to take the PAs and charge out for PAs because insurance will only cover bitewings once a year?Parents
July 17, 2017
Pediatric Dentistry
Message Board
Views: 202 | Replies: 7
I admit I have not been able to figure this out, so I am hoping that someone will be able to enlighten me on the following matter: Why do dental boards and Insurance Companies try to control coding and billing and fees charged to patients for dental care? On the flip side, an Emergency Room
May 25, 2018
Practice Management & Administrative Forum
Message Board
Views: 604 | Replies: 11
I am out of network with an insurance and the patient has reached their max this year. We are doing a denture and the patient is paying out of pocket since insurance is maxed. If I have her sign a HIPAA/HITECH form that says she doesn't want us to submit this denture to her insurance, is that legal
May 30, 2023
Claims Processing
Message Board
Views: 5117 | Replies: 74
getting I trouble with insurance? Can I just have him pay a separate lab fee? I charge a flat fee for the whole case. $6,000/ $8,000 whatever. That is the fee for your procedure. I let the patient know that. That is what they pay. Then submit to ins your codes with their fees for their fee
January 12, 2017
Coding Q&A
Message Board
Views: 117 | Replies: 4
I just wanted to rant a little bit. I have a patient with recurrent decay around an existing crown placed by another dentist in 2007. Her insurance has a 10 year replacement clause...fine. The only catch is that her policy was not in force in 2007. 10 year replacement for any crown, period
December 15, 2015
Claims Processing
Message Board
Views: 160 | Replies: 2
So Ive been thinking lately about private practices and dental insurance companies. Obviously a lot of us are frustrated by the way things are going in our field, especially in our dealings with insurance companies. Ideas have been floated in the past. Many have been shot down since we are limited
March 30, 2021
Alternatives to Dental Insurance
Message Board
Views: 163 | Replies: 4
For years my staff has used an excel spreadsheet to help them calculate write offs when a patient has two insurance companies. Today they went to use it and a formula has been deleted! This is the spreadsheet: Write-Off Calculator
September 26, 2017
Claims Processing
Message Board
Views: 258 | Replies: 2
I leased space from a dentist 13 years ago. I built up my own practice. I do take a lot of insurance. He is a dentist that has been practicing for 36 years and only takes delta dental premier. I bought his patients and the building and he would like to work 2 days a week. I would like to bring
November 04, 2015
Partnerships and Associates
Message Board
Views: 60 | Replies: 2
Our provider was in-network with an insurance company until the beginning of 2026. He did a filling for a patient toward the end of 2024, when the policy was in-network. He has now done a filling on that same tooth in 2026. When the policy was in-network, that would have been an unchargeable amount
April 10, 2026
Claims Processing
Message Board
Views: 304 | Replies: 9
coordinator. We are not having big issues with non-payment. The Financial coordinator says with the complexity of insurance she is not confident her estimates are correct and is often not collecting at time of service--she then sends a bill. Larger cases are supposed to have signed financial
September 10, 2014
Front Office Discussion
Message Board
Views: 907 | Replies: 22
the difference? our office called the insurance and they said they will not tell us ,but there is an ada code. appreciate any help! According to my NDAS book, there is only D5899 or D5999 - both are described as used for a procedure that is not adequately described by a code - describe procedure
April 30, 2015
Coding Q&A
Message Board
Views: 2349 | Replies: 83
Sometimes we check insurance and it says 70% coverage, but comes back as less. Or fillings are downgraded. How do we get more accurate estimates? The insurance website will list coverages that are wrong? Send a pre-authorization. It will give you accurate coverage, and is usually available 1 week
October 03, 2022
PPOs and HMOs
Message Board
Views: 327 | Replies: 27
no response. So here come claims for other patients. All of them with paid benefits until the page where they show the outstanding "balance" due and how those benefits were applied to the balance. So I file a complaint with my state insurance commissioner. They can't do anything because UHC is not domiciled
October 22, 2025
Claims Processing
Message Board
Views: 1307 | Replies: 53
Hello, first time posting and I just graduated Dental school and have been getting alot of emails about taking advantage of all the insurances I will need down the road but could save money when I sign up as a student (approx. 30%). I will be doing a one year GPR so I know I wont need it right away
May 27, 2021
Financing School and Loan Repayment
Message Board
Views: 174 | Replies: 5
Hi guys, Im dumping my association dues and a good insurance company with them. Aside from shopping around for quotes, a lot of these companies are not like medical or auto insurance with big famous well known names. How do I know once I pay my premiums that they will honor their part? Whether you
July 16, 2019
Dental Liability Insurance
Message Board
Views: 46 | Replies: 6
Pediatric patient with prior active Medicaid coverage; now also covered under parent's dental ins. Although the Medicad is the prior effective date AND in the child's name, would private insurance be the primary? Guessing Uncle Sam would rather have private ins go first, from COB standpoint. Yes
June 28, 2022
Medicaid and Welfare Issues
Message Board
Views: 273 | Replies: 8
porcelain, etc. Anyways, the patient has good insurance… no annual maximum, no deductible, 100% preventive/diagnostic, 100% perio, 100% basic, 80% major, etc. Insurance will supposedly pay 80% of crowns. The only catch is, I doubt they will pay for crowns that are purely esthetic, which would
February 17, 2015
Claims Processing
Message Board
Views: 301 | Replies: 10
Hello! I left my first associate job, who provided me malpractice insurance. Now that I am joining a new private practice, I need to get my own insurance. My question is: IF there is a claim/file/investigation made against me for the work I did in the previous job, do I contact my malpractice
November 19, 2021
Legal Issues
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