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Page 20 of 817
Message Board (37849)
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Message Board
Views: 169 | Replies: 7
miss is that it's not really the physical number of patient's that matter. if cigna patient's consume say 35% of your chair time, but cigna patients (along with insurance payments) only account for idk... im just making it up as extreme to show the example... 10% of your gross revenue, that's
March 13, 2024
Claims Processing
Message Board
Views: 274 | Replies: 15
spelling and other stupid things, but I think having a dedicated team whose jobs are to fill out claims and appeal denials etc make it a lot more valuable than trying to figure it out on your own. Medical insurance reimbursements make up about 20% of our group's collections as a whole so he has
November 18, 2019
CE Comments / Suggestions / Events
Message Board
Views: 349 | Replies: 19
on the often delayed pre auth.. Do you and your staff a HUGE favor.... QUIT playing the insurance game of pre auth.... Figure out what the approximate co pay cost will be for your patient, get good x-rays and IO pics, and get to work... To an extent but I don't 100% agree. I absolutely preauth any implant
September 21, 2016
Open Dental
Message Board
Views: 1065 | Replies: 14
. I'm forseeing a lot of denials, downgrades and confusion. That and I'm doubting it will be worth the extra time on the front end submitting clinical data to get these paid. I know for a fact that corporate offices (and a lot of private ones too) are GOUGING insurance companies on 4341/4342
November 27, 2016
Periodontics
Message Board
Views: 637 | Replies: 26
since I have them for my life and disability. Ever since the new President took over at Metlife there seem to be a growing trend for them to try to sell off there lossy fee schedule to other insurance company's. So far Guardian and Ameritas and this is just the beginning. . If you are OON
September 14, 2024
Claims Processing
Message Board
Views: 225 | Replies: 8
as everything checks out your good.Cautious optimism.Yes that is a good sign...When I did my startup I was denied by 4 banks before I found one to do the loan...Stay positive and it will happen.Well... it's not an immediately denial so, that's good. Right? It's also not an immediate approval
September 04, 2019
Practice Start-Up
Message Board
Views: 3485 | Replies: 96
seek forgiveness. I used the numbers from my tax forms, which was a few hundred more than my first application with Chase, which was hell. I'm expecting a denial and reapplication like the first time. Smaller banks have been much better based on people I've spoken to. Chase went live on Tuesday
January 27, 2021
All Things Coronavirus (Covid-19, SARS-CoV-2)
Message Board
Views: 89 | Replies: 3
requires it. These requirements can change from year to year. Medicaid makes the rules and they decide whether or not to follow them. I have seen more medicaid GA denials in 2022 then in previous 15 years , even kids with abscessed teeth and eight bombed out primary molars w/ F1 behavior. This is in Texas.
May 24, 2022
Pediatric Dentistry
Message Board
Views: 778 | Replies: 24
is denial really. So if we accept assignment of benefits, file for our patients and the insurance checks come to our practice that's not taking their insurance?I always tell them no and I explain the reason for why we are not and then they say thank you and leave. From now on I am going to say no and I
December 19, 2017
Ask a Dental Consultant
Message Board
Views: 1431 | Replies: 30
I need to know how to Bill for CBCT... ed, it is impossible for you to do this on your own. or nearly impossible i still don't know how it works and i don't care how it works as i use a third party to medical insurance companies you simply don't exist you can't just send claim. you have to go
November 06, 2016
Cone Beam CT Imaging
Message Board
Views: 658 | Replies: 29
a refund after the insurance pays. I try and quote worst case scenario in all cases. With sedation you MUST get approval for worst case because you cannot add any treatment. I only say that if I want half the tooth to crumble away while I'm prepping it. never fails. Actually, that's a safe
February 04, 2021
Going Out of Network
Message Board
Views: 840 | Replies: 28
seeing the patient. Insurance companies dont stiff patients only dentists. 1) I would look for patterns on what types of treatments you are getting denied on. Solve that if there are any patterns. Crowns and SRPs are the major items for many, and there are ways to prevent almost all denials on those
December 01, 2022
Claims Processing
Dentaltown Magazine
Narratives and the right photography improve insurance acceptance for indirect restorations and restorative foundations by Part 1: SRP In Part 1 of this series, Dr. Dominique Fufidio, FAGD, covered how to improve your chances for insurance reimbursements for scaling and root
October 2023
by Dr. Dominique Fufidio, FAGD
Message Board
Views: 17741 | Replies: 1414
I have no idea how he will pay for his legal expenses. Family help or not, he has other options.You seem upset about this, but a lot of people with medical conditions (and their families) who were screwed by the insurance companies want Luigi to be free. What would you say to them
December 13, 2024
Dental Insurance for Dentists
Message Board
Views: 154 | Replies: 2
I apologize if this has been answered in the past (I'm sure it has). Lately, we have been getting a flood of denials for SRP on legitimate cases of periodontitis. I'm talking cases with clear radiographic bone loss and even sometimes radiographic calculus. If delta denies SRP, are we able to bill
April 07, 2017
Delta Dental
Message Board
Views: 930 | Replies: 57
per employee Time Wasted on Insurance Verification and Claims 15-30 minutes per patient 20-40+ hours per week per staff member (often 50% of their workweek ) 27-35% of claim denials caused by verification errors Overall dental claim denial rate: 15% Staff Cost Reality Average full-time front-desk
April 08, 2026
Artificial Intelligence
Message Board
Views: 880 | Replies: 33
them we were going OON because we were tired of literally fighting to get paid.Senseless claim denials, repeated requests for the same information, magically missing electronically submitted claims, denied pre-authorizations...I can't work for the insurance company AND work for my patients, so I've
September 09, 2022
Going Out of Network
Message Board
Views: 1385 | Replies: 52
an incident where Metlife downcoded 4 surface incisal angle to 3 surface anterior But if you dont react then they will have firmer grip in the future Downgrading,downcoding, alternate codes,missing tooth, you should have an insurance division as part of the Dental practice Adding surfaces
October 12, 2011
Claims Processing
Message Board
Views: 2210 | Replies: 73
will thrive. I say the opposite. We are bleeding a slow death. My OH today is 65%. Great on 1 mil collections, Im doing well for myself. Guess what happens in ten years? Rent increases, insurances scale back reimbursement 10%, more denials, more competition... in 10 years, I will have to work 10
November 10, 2018
Alternatives to Dental Insurance
Message Board
Views: 17741 | Replies: 1414
with using Cigna? Any major issues with not paying for big things etc? He's being manipulative, he's creating false equivalencies on purpose, because that's what people like this do, then he tells you to lighten up about it. He's pretending that you and the insurance company are the same thing
January 09, 2025
Dental Insurance for Dentists
Message Board
Views: 60 | Replies: 2
Hello I received from a dental consultant an information regarding an outside finance opportunity: Flex Chex. Basically, they are different than Care Credit, asking for a bank account and a source of income. No credit denial, just based on ability of the patient to pay. The office receives full
October 10, 2016
Practice Management & Administrative Forum
Message Board
Views: 539 | Replies: 32
full prophies one week apart. Thoughts? That's one reason I bring all NP in through me not hygiene. So we and the patient know what's needed and what the charges will be. That aside we call it a double prophy. We submit to insurance for a 1110 and the patient pays out of pocket for a 1110
June 03, 2019
Practice Management & Administrative Forum
Message Board
Views: 1491 | Replies: 21
killing yourself. be patient and watch all 1:23 mins. pretty much sums up where medicine has gone with insurance driven practices. Normal 0 false false false EN-US X-NONE X-NONE
July 05, 2019
Mental Health, Well-Being, and Stress Management
Message Board
Views: 989 | Replies: 26
your location or zip code? Doesn't surprise me with Guardian. I bet 90% of my denials were from Guardian last year crown wise. The insurance game to me is getting worse and worse, really wish the general public was more educated on dental insurance. Free Luigi Our patients received the letter
November 08, 2025
PPOs and HMOs
Message Board
Views: 159 | Replies: 2
in network w/ UCC b/c we participate in the DentiMax network. So we're paid the awful UCC fee, not the DentiMax fee, and have all the usual denial problems of being an in network provider w/ UCC. It's a great back door way for UCC to continue to screw you even when you're out of network. I don't get how that's possible. Or this
February 24, 2019
Claims Processing
Message Board
Views: 312 | Replies: 5
SEE PHOTO GOT DENIAL THAT RESTORATIONS WERE NOT MEDICALLY NECESSARY!!!????? That's true . . . she ain't gonna die if she don't get 'em filled! Well one thing is for certain, she needs to quit drinking Mountain Dew while she is wearing her...She has Invisalign in the presence oframpant decay
December 09, 2017
Ethical Issues
Dentaltown Magazine
Insurance Practice Section at Comitz Beethe in Scottsdale, Arizona. Comitz primarily represents medical and dental professionals in overturning denials of their disability claims, and therefore has much experience in disability insurance coverage and bad-faith litigation. To learn more about
September 2015
by Edward O. Comitz, Esq. and Patrick T. Stanley, Esq.
Message Board
Views: 319 | Replies: 20
That wouldn't help. Remember, ADA codes only define the code. Insurance companies have ALWAYS defined how policies REIMBURSE for services. Now, the not billable to members BS is a load of crap, and thankfully Texas just made that illegal this year. Other states will hopefully follow suit, as that was a very
July 28, 2023
Claims Processing
Message Board
Views: 474 | Replies: 15
-hours work, fewer chart audits, and better compliance. Economically, AI will streamline the front desk. Dynamic scheduling, follow-ups, insurance claims with supporting images and radiographs will be handled faster and more accurately than any human team. Denials will fall. Recare will tighten
September 12, 2025
Artificial Intelligence
Message Board
Views: 1374828 | Replies: 39855
coverage to help with the $700 lab bill. So, we do the bridge, and get a denial from the insurance company for frequency. Checked with insurance, and Cigna now has an 84 mo frequency on crown and bridge. So the assistant comes to me and asks if she is responsible for the lab fee- which she knew
January 05, 2010
Just Plain Bitching and Moaning
Message Board
Views: 930 | Replies: 57
is wasted. #1 answer was time spent trying to verify insurance benefits. Excited to see the launch of your product! We are working hard. Our benefits eligibility is basically done and quite a few have real time info which means you can confirm plan on the phone and not waste a follow up call to confirm
May 06, 2026
Artificial Intelligence
Message Board
Views: 680 | Replies: 23
some success with this type of appeal, what verbiage did you use? Thanks! Frustrated! Teeth with cracks are not going to get coverage by insurance companies. To most insurance companies, teeth must be symptomatic. Cracked tooth syndrome, probably gets covered. I have teeth that have been cracked
November 19, 2015
Claims Processing
Message Board
Views: 2448 | Replies: 84
them that they have deep pockets, I will testify and ERISA does not protect them. They usually agree. When insurance companies refuse to pay for sleep studies send them a Wickline Letter. This is a formal protest per the Wickline decision of your inappropriate denial of patient care This give them
November 07, 2019
Sleep Apnea / Snoring
Message Board
Views: 184 | Replies: 1
(or the endodontist) were not able to get to the apex, or else you may be at risk of getting a denial on your crown claim. They suck. And it seems like they actively seek to find ways to suck even more each and every day.
December 02, 2017
Claims Processing
Message Board
Views: 645 | Replies: 20
that share that knowledge even to help the office. Most claims denials are due to poor/lack of documentation by the provider/office. This problem won't be solved by outsourcing.....bad data in won't get great results. My recommendation is learn more about insurance yourself, then you can be better
December 09, 2021
Claims Processing
Message Board
Views: 1419 | Replies: 30
in the hands of insurance companies over the course of their careers. or they will submitt and fight denials and write appeals. Doing dental billing I see this everyday. If the supporting documentation is not textbook then it gives a claim examiner reason to deny the claim. It is a protracted war
June 25, 2017
Claims Processing
Message Board
Views: 1499 | Replies: 34
all the time but to get top dollar for your services without dealing within insurance (beyond filing the claim for the patient or at least giving them the means to file it on their own). It's hard to pull off. Hard, but not impossible. It is getting more diificult due to the amount of debt that new
September 14, 2015
Dental Insurance for Dentists
Message Board
Views: 1876 | Replies: 71
of pts who have copays on preventative who don't fuss. I don't see that becoming an issue. At least not in my area where offices collect copays. I like pts with insurance, they get more work done and feel happy when they find an office willing to do a little work to accurately estimate copays
December 06, 2018
Legal Issues
Message Board
Views: 183 | Replies: 5
guys run into this? Parents in denial about their children possible being on the SN spectrum? How would this have changed your treatment? Mom's probably thinking Stick with teeth , Champ I came across this quite a few times when I worked at children's. One was a 16 year old , non verbal but mom
February 12, 2021
Pediatric Dentistry
Message Board
Views: 6743 | Replies: 240
is a Delta Pt. I pre-Auth these to see if insurance would cover. Delta came back with denied saying it was cosmetic. So at that point my full fee plus cosmetic lab fee was in effect. Delta cant come back and state otherwise Bc I have their denial letter. I usually get $600-800 per crown for delta ppo
February 20, 2021
Delta Dental
Message Board
Views: 1796 | Replies: 53
a trend among insurance companies -- delta has been doing this too (another thread). The way it's going it's possible they will end up forcing dentists to roll up diagnostic xrays into cost of exams and procedures as a industry wide practice. And FREE x-rays promotions aren't helping the cause ( I
July 13, 2015
Claims Processing
Message Board
Views: 1030 | Replies: 31
Payment for this crown #19 was denied by Mutual of Omaha. The reason stated in the initial denial letter was Service not payable on teeth with guarded, questionable or poor prognosis. When we tried to appeal they sent another letter stating that their DDS reviewer denied it based on prognosis
July 03, 2023
Claims Processing
Message Board
Views: 2282 | Replies: 52
Can anyone recommend a company that does insurance verification? We are pretty detailed to be proactive so looking for a company where we can customize the questions. Any suggestions and how do you like it? Thank you in advance for your feedback? Look up Stella desk. They are fantastic
November 25, 2015
Practice Management & Administrative Forum
Message Board
Views: 3171 | Replies: 79
plan worth paying for. Discount card plans are even worse but mainly for the dentist. Now how are discount plans worse for the dentist? Assuming the same fee schedule as insurance, I would actually rather work with a discount plan than insurance. Patient pays you immediately, no claims, no denials
March 11, 2014
Practice Management & Administrative Forum
Message Board
Views: 139 | Replies: 4
ON THE PRE-TX EOB THAT AN ALTERNATIVE BENEFIT HAS BEEN APPLIED. IN HER CASE IT JUST SAID ZERO FYI THE TOOTH WAS EXTRACTED WHILE SHE HAD THE INSURANCE POLICY SO NO MISSING TOOTH CLAUSE LOOPHOLE THANKS Pat, make your life easy. Just tell the patient the implant is not covered and it is one her. You
October 30, 2017
Claims Processing
Message Board
Views: 592 | Replies: 29
I am new to insurance and claims. I have yet to submit a claim to a medical insurance. What is the process for this? Thank you!!! Good luck. We have never gotten payment on our handful of attempts.They never pay. Even if they do it'll take a year and a 100 hours of your offices time. Screw US
January 09, 2019
Claims Processing
Message Board
Views: 297 | Replies: 7
states that insurance companies should not deny benefits that would otherwise be payable solely on the basis of the professional degree and licensure of the dentist or physician providing treatment, if that treatment is provided by a legally qualified dentist or physician operating within the scope
June 16, 2017
Pediatric Dentistry
Message Board
Views: 885 | Replies: 15
If anyone could post what a day in the life of someone in this position is like and what the pay range would be, it would be appreciated. What comes to mind is reviewing radiographs for the approval or denial of procedures such as crowns, maybe from at home if possible. I am sure there is more
July 01, 2022
Claims Processing
Message Board
Views: 1002 | Replies: 23
/ study which showed some caries can be treated with silver diamine flouride, rather than with the drill. Hmm. Might there be a day when Delta will require pre-auths for all restorations -- and issue denials for cases where their consultants deem SDF would have been sufficient? Could PRM providers
April 13, 2024
Delta Dental
Message Board
Views: 17741 | Replies: 1414
the society with harmful chemicals etc) Americans (per capita) began spending more money on healthcare and living shorter lives for it, meaning they got less for their money. The rest of those countries (if I'm not mistaken) have some form of universal basic health insurance for its citizens
December 07, 2024
Dental Insurance for Dentists
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