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Message Board
Views: 2239 | Replies: 76
, I am filing a complaint with the state insurance board. I do not have a contract with UC. We spent lots of time on these frivolous denials, and I've heard I could bill for my time and my office managers time and the myriad of copies that costs money as well. Could someone tell me which codes
July 15, 2017
PPOs and HMOs
Message Board
Views: 178 | Replies: 4
particular wording on the appeal?I am thinking how the heck do I know when she developed her 5mm pockets?Do I try to call the reviewing...What insurance company? You usually have to write an appeal first before they let you talk to a dentist reviewer. All the other denials have to do
August 26, 2015
Claims Processing
Message Board
Views: 800 | Replies: 20
for wasting time with a pre-denial. The bigger problem is the illegal use of disallows by insurance companies. Very large onlay fractured. UHC dentist denied the crown stating that a four surface amalgam is sufficient. The consultant works in Beverly Hills and consults as a side gig. Hee hee. Im having
January 21, 2022
Coding Q&A
Message Board
Views: 3400 | Replies: 160
. This is Dental Insurance V. 2.5.1 beta Bet not. They have attorney's on staff to figure out this kind of stuff. Shad, your post above might be more accurate. This might be testing the water. What they can get away with. Damn. How to we fight this crap. Great documentation and still a denial that basically
June 18, 2014
Claims Processing
Message Board
Views: 86 | Replies: 2
Anyone have an airtight OCS insurance narrative they use for predetermination of benefits? I've got a denial one, would that help? Maybe you could connect the dots?I have plenty of thems. Thanks tho
September 17, 2019
Pediatric Dentistry
Message Board
Views: 335 | Replies: 10
Metlife Insurance 12/16/2013- Did Fillings and SRP's on a patient 01/28/14 - Inquired about Claim 02/14/14 - Denial Letter received , Rebuttal Letter sent same day. 03/17/14 - Narrative and appeal letter sent again as they did not recieve it 04/21/14 - In Processing it seems 05/14/14
October 14, 2014
Claims Processing
Message Board
Views: 552 | Replies: 20
pictures on all teeth needing crowns. Sadly insurance companies do not trust your clinical judgement as a rule of thumb. It looks like it is missing an MOD restoration. Did you send in an intraoral photograph? Was this denial in response to the initial claim or appeal? If you have not appealed yet
March 12, 2022
Fixed Prosthodontics
Message Board
Views: 450 | Replies: 8
insurance rep states they don't cover it, sounds like Delta will want a denial letter. So, you bill, get a denial letter and move on from there billing Delta.What a PIA huh?Suzanne This is happening more and more frequently. I am a dental practice management consultant with a specialty in training
December 30, 2014
Coding Q&A
Blog
, and more tasks at once. These pesky administrative tasks feel daunting when you are working alone or with a very small team. Running a small healthcare business is not aneasy feast. Especially when you have to manage the. Ah, the elephant in the room. You face multiple denials, rejections from payers
August 19, 2023
by FFD419
Message Board
Views: 189 | Replies: 5
have a buddy that did a pre-auth for implants insurance came back and asked for size and brand anyone ever have this happen? Sounds like a cash flow strategy (delay payment) or a gamble that you won't reply (pre auth denial)My guess would be wanting to,weed out the mini's from the traditional...+1
October 23, 2014
Implantology
Message Board
Views: 331 | Replies: 9
patient that was seen for Exam, x-rays, cleaning and a two surface filling. Total charges of $366. 1.We filed to BCBS Medical- a portion of preventative services was paid by Medical - $88. A denial letter was sent to patient for the remaining procedures. Remaining balance of $283. 2. BLBS
November 14, 2020
Claims Processing
Message Board
Views: 297 | Replies: 8
. All they are is benefits checks, not whether insurance WILL pay. (Some states have passed laws that make PreD a requirement of payment, but still not widespread). You should almost never have a denial for a crown or BU, if you do have challenges here, preD aren't going to solve them. You need
March 03, 2023
Coding Q&A
Message Board
Views: 1249 | Replies: 73
insurancecompanymoney I don't know what is. Just say F.. you to all insurances. That's what we did and we are much better off as a result. What makes you believe they are telling the truth? Why will they ever admit to denials based on AI only? Of course they're doing it, it's cheaper Btw, I really
October 24, 2023
Practice Management & Administrative Forum
Message Board
Views: 171 | Replies: 2
Hi, I have a young startup and have a billing question- when a patient has used all their benefits and is maxed out, would you still bill any work they have done to insurance? In general I'm asking about all services, but in this instance the patient prefers to have 3 cleanings per year
February 18, 2020
PPOs and HMOs
Message Board
Views: 531 | Replies: 11
evidence of calculus and the patient has 4-5mm pockets it should be approved. Many times you need to appeal. Some procedures are red flagged by the insurance companies. Scaling and root planing is one of them because it is an abused procedure and the insurance companies are wise to it. As long
December 29, 2014
Periodontics
Message Board
Views: 303 | Replies: 9
Insurance has been such a pain in the ass lately. They denied this claim because of poor prognosis. See the claim attached. I couldn't figure out how to post other than attachment because of file type. Existing crown had to be replaced. Lots of other restorative planned, but from picture you can
July 10, 2017
Alternatives to Dental Insurance
Message Board
Views: 575 | Replies: 28
, but are the insurance companies going to pay it? No, they're still not paying it, and it should be taken into consideration so you can collect from your patients upfront during the visit instead of waiting for the denial and chasing the patient for it. In conclusion, the providercannotprobe and diagnose
February 13, 2023
Claims Processing
Message Board
Views: 432 | Replies: 17
I have a patient that we did 4341s on three separate appointments. He was born in 1987. Insco denied all 4341s. We have him on a 4 month 4910 and insco is denying that too. How do you deal with this in your office? Let me guess, United Concordia.Insurance company and reason for denial would
May 02, 2018
Periodontics
Message Board
Views: 265 | Replies: 5
a denial from United Concordia. 1. If claim is denied by Dental Advisor or Reject Code starts with Q = Send EOB (not new claim) with requested information to appeal address. Will not accept NEA, must print any attachments and mail with EOB request. Appeal Address: United Concordia ATTN: Dental Advisor
December 13, 2017
Claims Processing
Message Board
Views: 351 | Replies: 17
shouldn't even be having this conversationWhen I get these ridiculous denials I request the name, address and state license number of the consultant so I can report them to their and my state board for insurance fraud, negligence, improper diagnosis, and whatever other violation I can think
August 11, 2015
Claims Processing
Podcast
was scanned EOB entered into ledger correctly Correct adjustments were made Denial noted, correct action taken Other pending claims reviewed Family ledger reviewed Statement sent Hillary goes through her process of how to perform an insurance audit and how often you should be auditing your numbers. Major
May 03, 2018
by Jordon Comstock
Message Board
Views: 450 | Replies: 10
This morning, my office manager informed me that our office has been receiving a noticeable increase in denials for patients that recently switched insurance companies.... ex. BCBS to Aetna... or ... MetLife to Guardian. For example, a patient had an FMX taken 2 years ago with Company A, but now
January 12, 2021
PPOs and HMOs
Message Board
Views: 566 | Replies: 5
estimate or a denial that goes into the details of why it is not covered, and I'm pretty sure the insurance contracts don't go into it either. Also each plan within an insurance group is different as well This info exist on book form: Coding with Confidence by Dr Charles Blair. He's got everything
April 22, 2020
Dental Insurance for Dentists
Message Board
Views: 122 | Replies: 4
with their physicians about the possible side effects and alternate ways to treat anxiety, depression or pain. This study may possibly lead to a reason for denial of dental implants from insurance companies for lack of long term prognosis based on medical history? Anyone seeing denials for dental implants
May 17, 2016
General Health
Message Board
Views: 704 | Replies: 7
issues with claim denials? Check the claims going out for proper NPI numbers. Do you know the easiest way to update NPI #'s when adding an Associate once I add the NPI 2 with insurance companies? We have had an associate for a year and it just became an issue because we have a new Associate coming
November 26, 2019
Claims Processing
Message Board
Views: 175 | Replies: 4
coverage does not go up. They reduce rates and increase denials. How can we protect ourselves and our profession from this slander?And please dont reply you cant or theres nothing you can do. There is a solution for every problem. Honestly I put less blame on the ad agencies and insurance companies
April 10, 2021
Alternatives to Dental Insurance
Message Board
Views: 95 | Replies: 6
, claims, appeals, denials and much more. The website is: Does your firm charge a monthly fee or do you charge a percentage of collections/production, etc? How do you differ from NEA? ThanksFeel free to call me at (912) 856-5805 to discuss how we charge, work, and how we differ from NEA. You can
August 08, 2018
Claims Processing
Message Board
Views: 90 | Replies: 3
see us, That gets confusing. PPO will only pay after denial from DMO. Ahh, the lovely world of having two insurances. Patient's think they'll be covered 100% and never owe co-pays. Unfortunately, insurance companies don't see it that way due to the Coordination of Benefits Clause. Don't bother trying
January 10, 2020
PPOs and HMOs
Message Board
Views: 192 | Replies: 3
and getting reimbursed. Thanks. I've been looking at Delta processing policies for the new codes by state, and so far, all the ones I've looked at will not cover it. If you're in a state allowing you to charge UCR for non-covered services, please charge your UCR fee. For other insurances, it won't
February 13, 2023
Oral & Maxillofacial Surgery
Message Board
Views: 244 | Replies: 6
to arrive which should have the reviewing committe's members details whom came to this decision. Any advice? Thanks in advance. Bill the patient or write it off. There are no other options. Thank you for the response. Is it because it is a federally funded insurance plan? Bill the patient and let them
July 17, 2018
Claims Processing
Message Board
Views: 3421 | Replies: 113
with insurance companies making a blanket denials for any inlay...no matter what. Inlays are not covered benefits, therefore the patient doesn't want them as they don't trust anyone at this point, not you or the insurance company, they trust the system and the system doesn't cover inlays. Dentists do
February 20, 2019
Restorative Dentistry
Message Board
Views: 129 | Replies: 2
I am in the process off a startup and I was wondering if anyone recommended the Administration with Confidence book by Charles Blair, DDS. I was hoping to have some suggestions for narrative to minimize denials. I plan to purchase his Coding with Confidence Book. I appreciate any feedback or other
March 04, 2020
Coding Q&A
Message Board
Views: 907 | Replies: 12
prognosis was uncertain.<br/> Pre-opFinalPost-opPre-op BWWhat have you written in your appeal to trump this?<br/>This is the first denial which threatened my clinical judgment and treatment plan like this. I've been angry about it and I feel undermined. They have introduced fear in my
October 11, 2016
Restorative Dentistry
Message Board
Views: 483 | Replies: 10
providers to your patients? But that wasn't bad enough, it seems. The ADA also objected to Delta Including unsolicited and unsupported medical opinions from insurance company dentists who were not involved in the treatment in its denials of payment. Think about that - a company dentist who
September 04, 2017
Legal Issues
Message Board
Views: 567 | Replies: 43
believe this resulted in denial of this BU along with some others lately as my OM just informed me. What do you think? I am not trying to say who is right/wrong or point fingers, only to begin/continue a meaningful conversation about coverage benefits and their stipulations. note to self
February 03, 2021
Claims Processing
Message Board
Views: 5265 | Replies: 91
. On top of that dealing with mean, rude, entitled patients that if they don't get their way threaten and throw a fit until they do. Wifespends a lot of her day just calling insurances to deal with denials,Or sending claims or answeringPhones, she can hardly get to the accounting which
October 15, 2018
Practice Management & Administrative Forum
Message Board
Views: 353 | Replies: 8
to submit a claim in order to receive a denial, or get in writing that they do not pay for dental extractions. It is a stalling tactic used by the dental insurance. I still run into it once in a while.I swear I was going to start this thread today! We've had to do it for a few patients before. Not a big
October 18, 2018
Claims Processing
Message Board
Views: 187 | Replies: 3
We had a denial for 2 quads from delta. In the past with other companies they always inform us the patient is responsible and this EOB stated that the patients owes nothing. Can we not legally bill the patient for receiving the services. Delta had no information on verifying that we could only do 2
September 07, 2016
Claims Processing
Message Board
Views: 103 | Replies: 0
Anyone have a good narrative I can take a peek at to help write a narrative for fibroma removal on the lateral border of the tongue. Insurance is requesting additional info even though pictures and path report were supplied. Thanks in advance. I just don't want to leave anything out that may allow delay or denial of this claim. Pat
January 17, 2017
Oral Pathology
Message Board
Views: 481 | Replies: 7
, this kind of denial crapola from carriers is causing people to risk losing teeth. IMHO, if they had to pay a few malpractice claims on this sort of BS, perhaps they'd reconsider their nonsense... or not... So today did a big ass BU with Forte and Fusion with a wide greater curve. The plan
March 20, 2017
Delta Dental
Message Board
Views: 913 | Replies: 33
can train new staff yourself or have one of your other staff fill in temporarily. Train yourself first. Seriously. If you have Dentrix, you can call them and they will walk you through how to create/send/receive claims. Learn how to log in to all the insurance websites. There are youtube videos
November 30, 2022
Practice Management & Administrative Forum
Message Board
Views: 2153 | Replies: 91
the check themselves. My recent policy change is to send a bill to the patient the moment we get a denial from insurance. Of course the patients don't like that, but it's makes my position clear that it's their problem to solve and their bill to pay if insurance doesn't. I'm OK with losing a patient over
September 28, 2021
Claims Processing
Message Board
Views: 99 | Replies: 1
Can anyone contracted with Florida Combined life/florida blue a subsidiary of BCBS chime in. I am debating whether to be contracted with their PPO ? Input regarding Fees, Claims, Denial , asking to return funds after one year etc--------- ( I know these are traits of all insurance companies) Thanks Anyone
February 26, 2014
Claims Processing
Message Board
Views: 219 | Replies: 6
it because patient said it was fine by him and he does have some missing teeth too. But I was wondering what rationale is the insurance expecting.They have paid zero dollars for his SRP and the patient will not pay if the insurance doesnt.Thank you ! This is common place denial. Never do 4 quads in one visit
February 09, 2022
Claims Processing
Message Board
Views: 341 | Replies: 5
Do you suspect PPOs don't even look at your patient's health? We all know they do it but for their medical director to admit it is astonishing.Yea. Not shocking at all. Definitely already knew this by some of the denials I've received. I had a patient that received SRP 5 yrs agothrough Aetna
February 11, 2018
PPOs and HMOs
Message Board
Views: 555 | Replies: 20
. They always pay it after you jump through thishoop. You have to send the letter attn: Dental Advisor Unit.Drop them. Insurance safe getting ridiculous They are doing it for OON providers too, participation has nothing to do with it.We are getting ready to drop UC. They've been getting ridiculous
January 27, 2016
Pediatric Dentistry
Message Board
Views: 99 | Replies: 5
for unilateral. We are always fighting them for Space... Man what a PITA. Is AZ Medi paid by 3rd party companies? In NC the state still manages it but they (I think) just voted to farm it out to 3rd party, for-profit, companies to manage. I think that's when the denials start.yep, not just one either. seven different plans for us to fight with. We are often explaining to the reps how their own insurance works.
January 26, 2016
Pediatric Dentistry
Blog
April 6, 2020 Dear Dental Insurance Companies, The COVID-19 crisis has closed dental practices across the country. Our dentists need your help and they need it now. You have been playing games for too long with your customers as well as dentists with low fees, outdated frequencies
April 06, 2020
by Davy Clay
Message Board
Views: 388 | Replies: 11
on out of pocket. 3) give the patient the option of paying the copay for scaling and root planing, which the insurance is willing to pay for, and have them come back regularly so that this would not be a problem in the future. No, this is not usually the case. These denials happen when pts have been
April 04, 2015
Periodontics
Message Board
Views: 1374826 | Replies: 39855
replacement. WHen I examined her the fractured porcelain was deeply stained and I knew the porcelain had fractured long ago. In the process I lost the patient who threatened to file a law suit for supporting the insurance company. Who cares? . Denial is thick. Deeper than the river in Egypt. Ed
October 07, 2014
Just Plain Bitching and Moaning
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