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Message Board
Views: 239 | Replies: 8
the prices with a discount plan if I am only contracted with them as Insurance? They are not paying a dime for any of her services, so I consider that non-covered and she should pay the UCF. Doesn't seem like a discount plan with a Leased or even an owned network would provide any advantage to a patient
November 27, 2018
Claims Processing
Message Board
Views: 184 | Replies: 6
Patient needs dentures and full EXT- We would take the impressions for the dentures first which will take 3 weeks to come in her insurance becomes effective 7/1/16. Can We take the impressions now and bill on the seat date after the effective date of the insurance? I have never been
July 16, 2016
Patient Finance Plans
Message Board
Views: 119 | Replies: 8
on that day that were received by ecentral. Is there a way to trace if there were other claims that were sent to the batch processor but were never received by e-central? I tried running an aging report and the insurance claims to process report but the claims that I knew about were not on them. I have
September 20, 2016
Dentrix
Message Board
Views: 368 | Replies: 6
get this a few times a year, fortunately there is usually a new insurance that the parents forget to tell us about. I haven't had to give back any large amounts for treatment procedures but there have been plenty of exam/prophy/fl payments that I had to reimburse the insurance company for. If you
February 10, 2025
Pediatric Dentistry
Message Board
Views: 1024 | Replies: 18
If a practice is out of network, is the practice required to collect the balance unpaid by insurance? Or can the practice choose to waive whatever amount the insurance didn't pay? From my understanding you must attempt to collect. Waiving the fee is insurance fraud. It's illegal. You must make
February 09, 2019
PPOs and HMOs
Message Board
Views: 465 | Replies: 14
i wanted to get an idea from anyone or the management gurus on this board about getting insurance payments via: electronic funds transfer (EFT) we tried it with metlife a few years ago and it was a nightmare to reconcile the payments into the bank with the payments in my software. it was much
March 07, 2022
Claims Processing
Message Board
Views: 478 | Replies: 19
We received a predetermination back for a patient for a PFM bridge teeth 28-30. On the Pre D the company stated they won't cover the D6750 or D6740 but will downgrade it and cover a base noble metal bridge instead. On the Pre D it stated that if 6750 or 6740 were completed that: 1. Insurance
October 07, 2016
PPOs and HMOs
Message Board
Views: 804 | Replies: 17
Does anyone know someone with both DDS and JD (attorney) degrees ? This is directly to my post regarding this incident. Long story short, last year, this particular insurance company didn't pay most of my claim because they found that I have been placing implants on patients with pre-existing
July 12, 2024
Legal Issues
Message Board
Views: 371 | Replies: 29
So I need some input here. I am in the process of acquiring an office and getting credentialed with insurance companies. Of course I am not completely credentialed yet because the process takes quite a while, but I have been working on it for over a month. Me and seller currently have
April 24, 2026
Billing
Message Board
Views: 587 | Replies: 18
always handled it: While we are not in-network with any insurances, all insurances will work with our office. We will file a claim on your behalf, and for most insurances the insurance check will be mailed to our office. We like to do what is called a pre-determination, where we send our exact
November 09, 2021
Going Out of Network
Message Board
Views: 85 | Replies: 1
I know this has been partially covered in other posts but none answered the specific question of renting a space. I am about to buy a practice where I will lease the space. I will have personal disability insurance Life insurance assignable to bank to cover note Malpractice insurance I those
January 14, 2020
Practice Management & Administrative Forum
Message Board
Views: 60 | Replies: 1
TLDR: Hygiene wants front desk to check every insurance before scheduling a cleaning as difference insurances have different clauses(every 6 months/2x a year/etc.) and front desk was taught via Front Office Rocks to schedule 6 months and a day. Who is right? My hygienists and front desk are trying
January 03, 2020
Ask a Dental Consultant
Message Board
Views: 95 | Replies: 3
Anyone hear about or have thoughts about cyber insurance? Or insurance salesperson came in yesterday to review our office insurance coverage. She mentioned a new insurance: cyber coverage. I'm not sure of all the details, but basically, if there office is hacked, they will pay any fines
February 20, 2019
Practice Management & Administrative Forum
Message Board
Views: 204 | Replies: 5
In NYC, there is an insurance called DC37 which is crap and I take it. I don't mind it for as long as it brings me volume and fills in spots where otherwise would be empty. and patients are decent (none of this Medicaid BS) and the work is usually approved and patients accept because they have
September 02, 2015
Medical / Health Insurance
Message Board
Views: 124 | Replies: 0
all we don’t want to scare away patients labeled as the most expensive dentist in town nor do we want to be the cheapest either. Dental practice experts and the ADA concur that it is wise to bill the practice standard fees on all claims being sent to insurance companies. This is assuming
May 14, 2015
Front Office Discussion
Message Board
Views: 640 | Replies: 19
woman, so I found it very inappropriate to consult them about my bills before speaking with me about the balance.They also gave my parents inaccurate estimates and recommend a procedure to my mom that she didn't need. They lied my parents and told them a procedure was fully covered by insurance
January 19, 2016
Marketing
Message Board
Views: 325 | Replies: 9
I noticed that there is a variance in the UCR from different insurance companies and even within insurance companies that are plan specific. I came across Udell Webb at the beginning of my career through Howard Farrah. If I remember correctly, he stated that we dentist send in our FFS rates when we
April 04, 2022
Claims Processing
Message Board
Views: 815 | Replies: 33
If I were to 'forgive' the balance of my employee's immediate family members for preventive services after insurance pays (we are a FFS office), would I classify that as an adjustment on their account or a write-off? Is this considered unethical in some way? Basically the net result
January 11, 2016
Ask a Dental Consultant
Message Board
Views: 297 | Replies: 11
I'm an associate and I've been paid based on collections in the past. How does a business calculate adjusted production for an associate? I understand what adjusted production IS, but with all of the insurance contracts a PPO office could deal with, what are the actual meat and potatoes of how
September 28, 2021
Practice Management & Administrative Forum
Message Board
Views: 839 | Replies: 34
Can we charge patients for lab fees when we are in network with insurance companies? Humana dental only pays $579 for a denture! the patient pays zero as the procedure is covered at 100% This is exactly why you should stick your middle finger up and refuse to do PPO removables. Why anyone would do
August 31, 2023
PPOs and HMOs
Message Board
Views: 298 | Replies: 8
the tooth until she could do the implant. We got her in quickly, took the impression.... and then never saw her again. We have called, sent letters... nothing. Yes, I know we should have collected her portion that day but for some reason we didn't. Insurance paid their portion, there was a writeoff
January 22, 2015
Legal Issues
Message Board
Views: 202 | Replies: 8
If a patient has a wait period for crowns, does insurance waive that wait-period if a RCT is performed? I have a patient who recently signed up for a self-plan (PPO) that includes a 1 year wait period for crowns. However, I recently (yesterday) performed #19-RCT and my OM has informed me
July 15, 2020
PPOs and HMOs
Message Board
Views: 145 | Replies: 7
We saw a NP recently with 2 dental insurances. The primary insurance is one we are Out of Network. His secondary is an In Network plan. So, we billed to his primary insurance out normal office fees and they paid at 80%. We then sent to the secondary insurance and they cover at 100% of our
October 17, 2018
Claims Processing
Message Board
Views: 226 | Replies: 10
Not sure if this topic have been discussed. How is it fraud when providers submit /alter codes for procedures we didnt perform while Insurance companies do it consistantly (not talking about composite downgrades.) Eg: On occasion we take 4BW and 3 or 4 PA for anteriors if there is a need for TX
November 21, 2019
Coding Q&A
Message Board
Views: 190 | Replies: 9
I'm aware that insurance only pays you for a prosthesis once every 5 years, so I don't want to bill a provisional code obviously? How do you guys charge them until insurance approves a permanent prosthesis, like a bridge? (that's what's happening in my scenario right now anyways..) If insurance
January 08, 2020
Coding Q&A
Message Board
Views: 145 | Replies: 6
insurance coordinator says it will get denied after looking at the photo and X rays. She said there's no decay in the BW. I never worked with insurance claims before because I've been working as an associate dentist so I have no idea. Other doctor already reviewed it said the same thing. What do you
October 25, 2024
Claims Processing
Message Board
Views: 69870 | Replies: 1147
alcohol consumption. Ensure that the commercial host has its own liability insurance. Monitor your employees for signs of intoxication; Refrain from hosting an open bar and offer non-alcoholic beverages; Issue a limited number of non-transferable drink tickets; Close the bar early before employees
March 30, 2018
CE Comments / Suggestions / Events
Message Board
Views: 62613 | Replies: 9426
, compared to those who have never, have vastly different points of view. As health professionals, this is what matters. To the nevers, Only A Dentist resonates. Some, such as Spencer, seek the more arcane means, by which to feel secure. Denial, by any other means... If dental therapists were just
February 27, 2023
Ethical Issues
Message Board
Views: 713 | Replies: 20
experienced this before and if so what should I do about this? How many of your patients are Metlife? Could you keep a good number of them if you stayed OON? This may be a perfect time to go OON and reduce your dependence on the network. Hell yes!!!! I think the concern here is insurance fraud
January 21, 2025
PPOs and HMOs
Message Board
Views: 513 | Replies: 16
Just wanted to clarify some differences between OON and FFS and highlight some pros vs cons between the two as it seems nowadays more and more dentists are reevaluating their insurance participation and whether it is worth it. Feel free to chime in with what you've personally noticed too to help
September 08, 2024
Going Out of Network
Message Board
Views: 163 | Replies: 4
Could I get some advice on an individual, agency, book, etc. that offers as a service reading and understanding the language in an insurance contract before it is signed? This may include pointing out areas/clauses that could potentially be negotiated. Thanking you in advance. The ADA does
November 05, 2017
PPOs and HMOs
Message Board
Views: 94 | Replies: 7
Dear Townies! I am writing a narrative to insurance. Please comment on how can I make it better so the insurance pays for the tx! Here's the scenario first: #12 - has two separate existing restoration MOD and Buccal #12-B restored 11/2015 due to recurrent caries On 05/2016 BWXs updated
May 27, 2016
Claims Processing
Message Board
Views: 313 | Replies: 3
I am sorry, I know this has been discussed and letter samples provided, but I just can not find them. Would anyone be so kind as to shar a good letter you sent to patients/ Thank you! From Dr O's archives: Dentist is dropping insurance contract, or ending PPO agreement Dear John Doe, After much
February 13, 2020
PPOs and HMOs
Message Board
Views: 250 | Replies: 1
Dental insurance isnt a scam but its also not insurance How we pay for going to the dentist is supremely screwed up. By Emily Stewartemily.stewart@vox.com Oct 16, 2023, 6:00am EDT The thing about dental insurance is that it isnt really insurance its more like a half-helpful discount plan
November 06, 2023
PPOs and HMOs
Message Board
Views: 238 | Replies: 4
We do participate with insurance. How can we legally do adjustments for friends and family? I would like to do it as a credit adjustment with an explanation in the notes. Any comments? Check the rules with each of your providers.Example from Delta: I was once told by a lawyer to bill your family
June 09, 2017
Ask a Dental Consultant
Message Board
Views: 204 | Replies: 2
Asking for a friend... Anyone have a good malpractice lawyer in Texas they can recommend? Please PM me, thanks! I went through a lawsuit. I didn't pick my lawyer , she was picked by my malpractice insurance. The oral surgeon that was sued with me, his lawyer was picked by his malpractice
May 02, 2018
Legal Issues
Message Board
Views: 786 | Replies: 21
Ok not exactly but here it is. I have 4 full time staff. 2 have been with us for 5 yrs , the other 2 less than 4 months. When the new staff members arrived, I started hearing talks of offering health insurance through the office. This week couple of them asked me about getting health insurance
March 02, 2019
Medical / Health Insurance
Message Board
Views: 808 | Replies: 23
In March, my front desk turned in her two week notice. She said she was taking a job closer to her home. We spoke with our health insurance guy to see what we needed to do, like paperwork for COBRA, etc. He said she had the option of keeping her current health insurance for three months, if she did
July 13, 2017
Staff Management Issues
Message Board
Views: 1595 | Replies: 36
don't take your insurance and Your insurance will cover everything (big bill comes later). Obviously we want a out of network patient but we don't want to deceive them and stick them with a big bill. On a lot of these insurances it seems hard to predict ahead of time what they will pay and some
March 31, 2019
PPOs and HMOs
Message Board
Views: 1103 | Replies: 40
the lines of, The price of doing business has gone up and insurance reimbursements have stayed the same or gone down. Any other pearls?Chances are that the plans you are dropping are already sharing panels with the plans you are keeping. You might find that it is a no brainier and should have done
December 16, 2015
Equipment, Acquisition & Practice Expansion Financing
Message Board
Views: 1293 | Replies: 59
What are the highest maximum allowable fees you have seen as OON for each of these procedures, and with which insurance? The highest I have seen is: D1110 adult prophy. My UCR is 250 and it was not over the Maximum Allowable Fee for Cigna. D0210 FMX. My UCR is 300 and again not over the maximum
February 07, 2024
Claims Processing
Message Board
Views: 278 | Replies: 14
Hi all, Up to this point, my office has not charged our patients for the second exam of the year. Most of our insurances do not pay a second exam, if they do, we collect it, but if they don't then we write it off. I am looking to change this policy to collecting for the second exam starting
January 11, 2018
Practice Management & Administrative Forum
Message Board
Views: 140 | Replies: 3
In April of2017I started an Invisalign Full case (D8090) on a patient. We area FFSoffice. The patient took assignment of benefits. We just finished the case this month, approximately a9 monthtreatment. When checking out the patient asked when her insurance would finish reimburse her. She said
January 19, 2018
Orthodontics
Message Board
Views: 102 | Replies: 2
I am an in-network provider with Delta. I did a Buildup and Crown on a patient and Delta paid us the correct amount without any issues and the patient has a $0 balance with us. The patient had that insurance as her primary insurance. She also has a 2nd Delta policy under her husbands insurance
June 03, 2014
Claims Processing
Message Board
Views: 278 | Replies: 5
Treatment planned a full mouth rehab. Patient accepted treatment estimate of my fees without consideration of insurance benefits. Insurance says they need more info to approve coverage of a few of the crowns. My question is if they do not approve say 7 of the 28 crowns , does the patient just pay
November 20, 2020
Claims Processing
Message Board
Views: 182 | Replies: 3
Has anyone had success with disputing the allowed amount by the insurance? The dentist feels that insurance has not set the allowed amount per the geographic standards. He wants to dispute the allowed amount as it is about 1/4th of his UCR fees. Are the insurance companies subject to regulations
July 11, 2023
Claims Processing
Message Board
Views: 293 | Replies: 10
I am a OON office that bills patients insurance and accepts assignment of benefits for them. I am seeking some practice management help to improve things to avoid patient upsets over copay, deductibles and OON status. My practice was started from scratch and as it grows slowly, I am finding more
December 17, 2021
Ask a Dental Consultant
Message Board
Views: 360 | Replies: 10
I have a 3rd party company handling my insurance for the time being and we're trying to ease off their services due to increased cost. That means I'll be delegating the task to my assistants and front desk. We don't know the first thing about submitting claims to insurance, which procedures
April 10, 2017
Claims Processing
Message Board
Views: 560 | Replies: 23
have a patient where her insurance covered 75% of her partials. after 3 adjustments she came back and said she doesn't want them. I stupidly refunded her what she paid. However, now i'm wondering if i'm obligated to refund the insurance company (humana if it makes a difference) thanks Technically
August 05, 2022
Claims Processing
Message Board
Views: 208 | Replies: 11
Hello,Occasionally we have secondary insurances (we are out of network with the exception of Medicaid) that essentially ignored our claim and primary insurance payment EOB and pay their full amount which results in an overpayment by the secondary and a credit on the patient's account.I dont feel
September 02, 2024
Claims Processing
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