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Page 16 of 817
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Message Board
Views: 155 | Replies: 2
Just got a rejection/denial on a crown claim. Existing crown on #2 was replaced due to mesial recurrent decay, obvious both clinically and on BWX. Principal Life states that: The services submitted are not medically necessary. Benefits are only allowed if there is evidence
August 06, 2024
Claims Processing
Message Board
Views: 1751 | Replies: 44
do I do this from a practice management perspective. I know I have to write a certified letter to the insurance company and 60 or 90 days later it will take effect, etc. What do I do to UCC patients? Do I pull a dentrix report of who they are and then write them a letter? And say what? I'm about 7
December 14, 2018
PPOs and HMOs
Message Board
Views: 519 | Replies: 18
problems that need fixing). If you are getting even 1% crown denials, you are doing something wrong. Call Unlock the PPO. Ask them how they can help. I used them for my start up last year and they got me very decent fee schedule for the insurances I am in network with.
February 16, 2023
Claims Processing
Message Board
Views: 442 | Replies: 12
I bought an office a few months ago and so far its been a complete crap show in regards to the front desk. All the staff are great and work hard but they never did any insurance verification, breakdowns or even billing through e-claims. My normal day operation is having one assistant start the day
February 05, 2023
Front Office Discussion
Message Board
Views: 491 | Replies: 18
I am just venting here. Why do Medicaid patients always ask about implants. They ask in a confidence as if they have million dollar dental insurance. I don't find that with PPO or self pay patient. I mean they do ask about implants but they always ask about other options and they always ask if it's
September 07, 2023
Medicaid and Welfare Issues
Message Board
Views: 428 | Replies: 22
a pa of the tooth from 2012 (tooth is needing a build up), ins. would have denied build up on crown stating not current enough xray! Any suggestions on how to get them to pay at least the bitewings? Its not that the practice needs the money, but that insurance is not doing our patient right
October 27, 2016
Claims Processing
Message Board
Views: 277 | Replies: 5
we are in network with most PPO's. With the past 2 weeks three insurance claims have come back with the following (and not from the same PPO company): 1) three unit bridge with recurrent decay, decayed tooth needed unplanned ext/nonrestorable, and treatment turned into 4 unit bridge. No way
May 17, 2016
Coding Q&A
Message Board
Views: 717 | Replies: 18
tab or do batch claims. And it can pull all the patients from your schedule for insurance verification and benefits data. And auto input it into open dental. Does anyone here use this, and can you share your experiences? thsnks in advance! We have open dental and use EDS as well. They integrate
January 06, 2025
Open Dental
Message Board
Views: 318 | Replies: 14
that credentialing is location specific but insurance does like playing games so I was wondering how to systemically approach going out of network with all the insurances that I am in network with...? Does someone offer this service like Sandy's Unlock the PPO or five lakes PPO and is it even worth it or should I
December 04, 2019
PPOs and HMOs
Message Board
Views: 619 | Replies: 18
Hello everyone! Announcing the first ever medical billing course held by CODE! We have been billing medical insurance on behalf of many practitioners in over 30 states. We are doing an all day course on either November 14 or November 15 (just one day). The course will be for just one of those
February 18, 2016
CE Comments / Suggestions / Events
Message Board
Views: 404 | Replies: 8
to insurance company so I get paid for the crown. I show the photos to my patients to get paid for the build ups. The system sucks but it is what it is.From now on, if you have the intraoral camera in the op, snap a photo before you do the build up and after. This will strengthen your case vastly
December 12, 2014
Delta Dental
Message Board
Views: 395 | Replies: 13
. This is a preauth baby I wouldnt PRE AUTH. Why wait 6 weeks to get a denial. How will that help the patients periodontal condition? Either way, the patient needs SRP. If your guardian fees are, lets say 150/quad, AND you have any concern that insurance wont pay, then just charge the pt the in-network full
July 08, 2022
Front Office Discussion
Message Board
Views: 755 | Replies: 24
this thread on topic) Thanks! So with coding, there is really only one correct way to do this. First, you need to understand downgrades do NOT affect you, downgrades only mean insurance is paying less, therefore patient pays more. EOBs are often wrong or misinterpreted with this concept. You have
February 12, 2025
Coding Q&A
Message Board
Views: 457 | Replies: 16
. If someone comes in for LOE, PA and BWand I extract a bad tooth, I only am allowed to charge insurance for EXT? This seems to be couterintuitive especiallyifa patient need of an extraction and is in major pain. I don't get the logical. If I had to go to the medicaldoctor they ask
May 17, 2016
Practice Management & Administrative Forum
Message Board
Views: 141 | Replies: 3
and dying by the schedule density on Thursday afternoon. Benefits are where the structure really shows its value. Full medical and dental coverage for the clinician and dependents. Malpractice provided. Life insurance, disability options, and a retirement stack that includes a safe harbor 401k
November 12, 2025
Associates Corner
Message Board
Views: 499 | Replies: 9
that Medical Carrier is primary for that procedure and dental is secondary. That aside. You have two choices. One is to submit the claim using the correct medical codes to the medical carrier and wait for payment or denial and then submit to the secondary insurance which in this case is the dental
September 11, 2019
Claims Processing
Message Board
Views: 613 | Replies: 11
to get more reimbursement from insurance plans. So its either they increase their fee schedule, you drop them to decrease your demand for employees, or you take a pay cut. Its astonishing how many dentists opt to take home less money when faced with this decision. If they reduce your fees,inform them
October 12, 2021
PPOs and HMOs
Message Board
Views: 484 | Replies: 10
on prep date, you may have to call insurance company and advise them of the seat date.Build ups are not always covered on prep date either. Hope this helps. Thanks Rhona!Here are my thoughts. 1. We submit electronically with Renaissance LLC and use NEA fast attach. 2. Somewhere I have narratives
July 31, 2014
Front Office Discussion
Message Board
Views: 2097 | Replies: 68
I challenge all of you to show when the insurance companies actually increased your payments There's a reason i call them the MAFIA Premiums go up without fail payments to you go down without fail What am I missing here? you're missing nothing...everything is getting tighter and tighter... I
December 03, 2021
Practice Management & Administrative Forum
Message Board
Views: 274 | Replies: 9
for the whole fee, how do you guys handle this situation? I've never had an insurance deny strip crowns as esthetic and unnecessary before, but I'd like to avoid this problem in the future. Do you do a preauth for every GA case? (yes I know preauth doesn't always avoid this denial) Do you code
February 06, 2018
Pediatric Dentistry
Message Board
Views: 754 | Replies: 26
Has anyone else received a letter from their State BCBS stating that non-state employee plans will all reassign AOB to the patients now? So Delta Dental pulled this and now BCBS is trying their hand at it. doesn't surprise me one bit, except that the insurances haven't tried this sooner. just
December 25, 2024
Going Out of Network
Message Board
Views: 819 | Replies: 17
with insurance verifications. Many times on patient days we don’t have time to verify patients for future dates because front desk girls are busy with the patients in the office. So then the insurance gets backed up and we end up using our 2 back staff floaters in addition to the front desk check in girl
March 09, 2016
Pediatric Dentistry
Message Board
Views: 1141 | Replies: 33
We have been getting more and more verylegitimate scaling and root planing insurance claims rejected by Delta of Michigan. Many of these were pre-determined and 'approved' before doing the procedure, then they reject the claim. Needless to say, this is a big source of frustration to us
May 09, 2017
Delta Dental
Dentaltown Magazine
by Charles Blair Each day dental practices must file dental claims for the procedures performed there. Selecting the proper dental code is important when filing any dental claim, and proper insurance
June 2015
by Dr. Charles Blair
Message Board
Views: 292 | Replies: 9
changed. They love to deny things left and right for unfounded reasons (perhaps to meet an auto-denial quota??). The fee schedules are all screwed up. For the 1st month or so they kept paying us on the wrong fee schedule. We've had to resubmit countless claims. It's become like a 2nd job
March 13, 2015
Pediatric Dentistry
Message Board
Views: 752 | Replies: 5
hygiene rooms and CAD/CAM dentistry. Almost like using the Apple Store model of business but still giving patients a special atmosphere to your office. In regards to insurance, they stress on NO pre-determinations and just writing off denials (which don't happen often), especially with perio which
May 10, 2014
CE Comments / Suggestions / Events
Message Board
Views: 86 | Replies: 1
Dental organizations nationwide and results in insured patients routinely paying higher bills for out-of-network care. The legal claims include breach of fiduciary duty and improper denial of benefits under federal law, and the plaintiff is seeking damages as well as court orders requiring changes
March 12, 2026
Delta Dental
Message Board
Views: 33 | Replies: 1
notes. Verifying insurance. Classifying images. Useful, but limited. The next phase is orchestration. Instead of optimizing isolated steps, AI begins coordinating the entire workflow. Documentation gets validated in real time. Imaging is checked before it causes downstream errors. Eligibility
May 01, 2026
Artificial Intelligence
Message Board
Views: 573 | Replies: 25
even if denial is an age limitation. That is not my interpretation. Straight off the PDA website it says: According to the Act, if a dentist signed an agreement with an insurance carrier, the dentist is obligated to accept the insurance carriers allowance even if the insurance carrier does
November 13, 2023
Delta Dental
Message Board
Views: 286 | Replies: 10
Hi, New owner here and starting to learn about the pain with dealing with insurance companies. I recently started getting a few patients whose crowns have been denied by Delta stating that they do not cover crowns when tooth structure is missing due to bruxing. The occlusal table is severely worn
July 19, 2024
Claims Processing
Message Board
Views: 660 | Replies: 25
requests a fax and uses it update coverage books and give estimates. They are running into problems with a large increase in EPOs. On the faxes they don't say it (they say PPO), but on the claim denial it states the patient has to go in network for any benefits at all. I don't know much about
October 22, 2014
Dental Insurance for Dentists
Message Board
Views: 569 | Replies: 15
? It seems crazy high to me. Notably we are an OMFS group in a semi-rural area. We are already booking consults into April and definitely have the ability to drop some of these. MetLife and Aetna in particular have to go. Delta and UCC account for 70% of our dental insurance patients. I just wanted
December 14, 2022
PPOs and HMOs
Message Board
Views: 211 | Replies: 5
First time in a long time I have had a claim denied for SRP. I was curious if any of you have had success writing a narrative to appeal the denial. Is there any magic wording to get this approved? Patient presented with moderate horizontal bone loss and significant subgingival calclus
July 25, 2024
Claims Processing
Message Board
Views: 1116 | Replies: 24
would treat them but I could not use their insurance benefits? Or is that concerned illegal, and if I decide to treat I have to accept Delta fees? I've never known the answer to this and would love to know what the rules are. If you are in network with Delta then you have to accept their fees
July 30, 2020
Delta Dental
Message Board
Views: 96 | Replies: 7
manually adjust this.If that does not work you need to submit an appeal with a narrative. Just call them. We get the automatic denial if we bill PA on save day as RCT. Their system is setup to do this. Because working xrays are part of procedure so guessing same auto denial. So anytime we do limited, PA
January 13, 2020
Endodontics -- The ENDO Files
Message Board
Views: 448 | Replies: 8
and methodically trying to work through a problem. Example: an insurance denied a patient's treatment plan. It did not appear that the reason for denial was customary. It is likely that something went wrong on our end, or in the insurances end...and my goal was to determine that had happened, and if perhaps
October 01, 2017
Endodontics -- The ENDO Files
Message Board
Views: 326 | Replies: 6
. Brian, Why not increase 10% like the old Kodak study advised. According to Kodak if you cut fees 10% you would have to double your work load… Overall dentists in PPOs are seeing what fee reduction with delated insurance payments cost in increased OH. We increased fees, but are prepared
January 02, 2014
Practice Management & Administrative Forum
Message Board
Views: 17741 | Replies: 1414
the insurance system but no way should this guy be celebrated the way he is. Book review this guy wrote earlier in January. And you thought he was popular before Suspect in UnitedHealthcare CEO shooting taken into custody after being recognized at McDonalds, named by authorities as Luigi Mangione, 26
December 10, 2024
Dental Insurance for Dentists
Message Board
Views: 957 | Replies: 11
I need some advice as to how your offices complete insurance breakdowns for a pedo office . It really seems as though it is a time consuming task, and I wanted to see if anyone has a more efficient way of doing it. For new patients, sometimes it could take 45 minutes to complete the breakdown
October 05, 2015
Pediatric Dentistry
Message Board
Views: 3171 | Replies: 82
insurance, results in lower out of pocket costs (20% of $400 vs one uncovered cleaning) steve I used to believe so as well. As I am sure this has been discussed many times, a pre-authotrization means literally nothing. I routinely get denials on pre-authorized procedures. Or am asked to write
November 06, 2014
Periodontics
Message Board
Views: 5621 | Replies: 280
). No claims. No denials or rejections. No pre-existing exclusions... and so on. People feel like they need a plan. QDP fills that need. Mike That was your ah-ha moment? Edit for inflammatory remarks. Three new members today. Thanks to all. Most of all, the conversations have been all
April 01, 2017
Claims Processing
Message Board
Views: 6417 | Replies: 269
denials? Would this make your application an overly expensive one, compared to normal marketing investments? You are discussing the cost of acquisition. Could that also be the insurance mantra, a false narrative? If everyone is reducing their fees equally to attract patients from the same market pool
April 06, 2015
Dental Insurance for Dentists
Message Board
Views: 3734 | Replies: 100
out on patients & taxpayers, through the dysfunctional Medicaid program. It rarely works in situations w/ conventional dental insurance, because patients have skin in the game (a co-payment). Once the corporate Medicaid provider or small business cheat has round-housed, every possible child
November 29, 2014
Legal Issues
Message Board
Views: 559 | Replies: 22
might want it, but if the insurance company pays for patient's wants, then the CEO might not be able to afford his new jet. A CEO needs a jet.I agree, this is a poorly worded denial. If it isn't a covered benefit, then it isn't a covered benefit. That doesn't make the insurance company or the claim
September 11, 2017
Coding Q&A
Message Board
Views: 132 | Replies: 8
Hello guys, Onboarding a new hire/ treatment coordinator without dental background. great at customer service. trying to shorten learning curve and faster, effective onboarding. 1. any resources to get best insurance estimate for treatment presentation? tired many services and not much luck. one
April 10, 2024
Practice Management & Administrative Forum
Message Board
Views: 3658 | Replies: 116
often we get funky denials. There are way too many plan specific insurance clauses which in the end DO NOT pay for the core build-up. Especially in provider practices.That's really not the case though. A bit of resin placed to block out an undercut versus a buildup of an endo tooth are two very
November 30, 2016
Claims Processing
Message Board
Views: 434 | Replies: 12
months old (I am not participating and have no contract with them). Do they think the pockets resolved on their... That sucks Jay. It's always something with the insurance companiesWow that is bizarre....just like asking for pre op photos at random....a total scam by making up rules after the fact
January 26, 2017
Periodontics
Message Board
Views: 1258 | Replies: 62
what they can do to reduce or avoid denials for treatment and some the usuals want to bash and flex which is of little actual value in getting claims processed. Edit: I misread the message got another thread asking about aveloplasty not covered with exts. DIG(dental insurance guy) can you answer
December 23, 2023
Claims Processing
Message Board
Views: 135 | Replies: 1
Care Facilities are unable to take X-rays due to medical conditions; they cannot keep their head still or bite down sufficiently to take x-rays. California has cut the pay of Medicaid providers to treat periodontal disease in nursing homes by more than 50%, resulting in a denial of access to oral
January 26, 2021
Medicaid and Welfare Issues
Message Board
Views: 424 | Replies: 12
prices. National network of 113,000 unique dentists it is bullshit. Is is even legal to offer discounts? fortunately, i don't think most patients go to their insurance website or pay much attention to what their coverage is, they usually just count on our offices to tell them what their insurance
October 10, 2017
Dental Insurance for Dentists
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