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Page 21 of 817
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Message Board
Views: 116 | Replies: 3
to contact Metlife about it? thank you very much! What was the basis of the denial? Your preD or EOB should State the reason..... Gr8eobstatedasbelow: Benefits for a core build-up will be determined when submitted with a cast crown restoration. Please submit this core build up with either a claim
January 17, 2018
Claims Processing
Message Board
Views: 1032 | Replies: 53
After waiting since 2022 when I filed, I actually just got notification regarding one of the Quarters I summitted for just last week. It was a denial letter basically stating I don't qualify since there was not a mandated government shut down for us. I assume based off of this, I will get denied
November 10, 2024
Taxes
Blog
of anger and denial. This anger and denial is then expressed with hostility, resentment and antagonism. A few years ago, I did some posts on Dentaltown about the future being group practice, I found myself mostly defending my position, arguing back, and a lot of disparaging words were directed at me
April 05, 2017
by Dr. Marc B. Cooper
Message Board
Views: 12071 | Replies: 397
+1. It's legit. Is the 3.75% interest I pay on the EIDL loan tax deductible? The email I got said I have to accept the final disbursement within 30 days. Of course I received a denial email notification. They said I hadnt suffered enough losses to allow me to take a loan. Thanks,wanted
July 01, 2020
Coronavirus (Covid-19, SARS-CoV-2)
Message Board
Views: 797 | Replies: 28
and not the patient. This is the way that offices can improve themselves, acknowledge the problem is the first step to fixing the problem. Just writing it off as a PITA patient is a form of denial. Brad, Thank god for great new patient flow... However, the jury is out on HIPAA damage violations
June 01, 2014
Legal Issues
Message Board
Views: 1374828 | Replies: 39855
molar and extraction of the adjacent third molar, (at my request) at my periodontist's, office, gets a denial from the insco,, the insco saying that the third molar didn't need to be removed, she then calls our office, saying that since I was the one who'd requested the services be done, it's my/our
December 20, 2016
Just Plain Bitching and Moaning
Message Board
Views: 13958 | Replies: 230
. AOB denial is also a tell that the insurance companies don't believe in their own value proposition. If you think about it, this whole game is two parties battling each other to adopt a mindset. The insurance company is telling the dentist he's just a commodity and the dentists tend to believe
July 26, 2022
Going Out of Network
Message Board
Views: 984 | Replies: 16
. Our experience is that medical will bump the claim back stating they need a denial from dental or copy of EOB form dental ... so you still need to send it to dental insurance and deal with them first. However the oral surgeons and specialists send many claims to medical if patients do not have dental
November 02, 2015
Claims Processing
Message Board
Views: 207 | Replies: 14
and submit electronic insurance claims and noticed that our claim forms had the wrong physical and mailing address. This leads to denials and reimbursement checks being sent to wrong addresses So yes this effects billings and collections ina very negative way especially when you file a lot
April 16, 2016
PracticeWorks
Message Board
Views: 481 | Replies: 14
all of my sealants as well. I was just denied a claim on a pt where I brought them in for sealants and did all the premolars and 3 or so 2nd molars. The reason for the denial was because there was no narrative. I call stating that they don't have anything in the manual about needing narratives
December 04, 2015
Pediatric Dentistry
Message Board
Views: 1630 | Replies: 68
Alright, I figured out how to log not Delta's toolkit...holy shit, how is anyone a preferred provider for Delta? They don't pay at all. Anyways, I was able to see how to verify and preauth some procedures, thank you all. I am having my FD go through the schedule and call each patient's insurance
May 09, 2022
Claims Processing
Message Board
Views: 1436 | Replies: 36
to no avail, so I just dropped their asses. Even if you do negotiate a better fee, you still gotta deal with their denial of tons of claims and magically ID numbers that don't match up, etc. They won't. Don't do it, IMO or if you do, realize you are in for a demoralizing experience with UC. Lowest fees
March 23, 2019
PPOs and HMOs
Message Board
Views: 335 | Replies: 13
during the day so if you don't have an extra PC at the front desk, you'll need to get another tower/monitor or a laptop. TASKS THAT ARE EASY TO WORK REMOTELY: -Insurance Verification: nothing additional needed other than a shared login in sheet with passwords for your portal -Aging/Denials/Appeals
December 20, 2022
Practice Management & Administrative Forum
Message Board
Views: 198 | Replies: 5
it was even worse than what most of us think is going on. I know they screw up claims all the time and deny stuff just as a stall tactic. But, I thought they at least knew teeth numbers and surfaces. You at lleast need to know that!I am surprised this is not done by computers. They actually have humans adjudicating simple... saving from erroneous denials obviously offset additional employment costs Delta downgrade all ceramic crowns to...
February 17, 2016
Delta Dental
Message Board
Views: 248 | Replies: 2
popping up delaying treatment and getting paid takes anywhere from 30-90 DAYS! Anyone else experiencing this? I'm in PA btw. THANKS. They are denying fillings, or just crowns? We had a problem with crown denials for a while and started sending photos and narratives with each case, which really
October 03, 2014
Claims Processing
Message Board
Views: 69 | Replies: 2
it if you're in-network. They'll say you have to write it off, and the patient is not responsible. To appeal this denial or down coding, your clinical notes need to state why the frenectomy was necessary. You'll need to describe how it was a stand-alone procedure, which required notable effort
August 11, 2022
Oral & Maxillofacial Surgery
Message Board
Views: 57 | Replies: 1
. Keep a spreadsheet for the effective date for each carrier. Some will process in 3 weeks and others can take 2 months. You'll need to have your aging team keep a watch our for any claim denials that result from the change so they can resubmit accordingly. Always happy to share what I we see other offices doing that works but I would always recommend consulting your account and/or tax lawyer.
January 18, 2023
DSOs Dental Group Practice, Multi-location Dental Practices, and Dental Su
Message Board
Views: 393 | Replies: 8
cans of pop a day. Your patient probably doesn't think of Gatoraid or sports drink or fruit rollups or raisins as sugar. Denial. Or lying.I can't stop laughing. Made my day! I don't know what I'd use to restore those. Got any ideas???Nice endos there doc!! ;)Had one of those today. He was stable
January 23, 2017
Restorative Dentistry
Message Board
Views: 352 | Replies: 4
but in noticing I'm getting more denials on crowns than ever before. Especially Delta Dental. Wearing me out.The consulting doc said they are the patient's advocate and said that's why he decided to call. Then he said he's denying benefits. Good friend to have.With advocates like this... I LOVE Metlife
January 22, 2015
Claims Processing
Dentaltown Magazine
number into a form on the Internet. No, not denial forest, you stupid phone. I meant dentally incorrect. Answers: 1.Pawns 2. Casbah 3. August 4
August 2014
Message Board
Views: 4678 | Replies: 244
Yep. And I'll tell you what I think is really unfair. A patient with a few problems, maybe needs an endo on a tooth and a few fillings and they are very much depending on insurance to help pay for things. For them doing the endo means they cannot do the fillings or they don't have the means to do
February 16, 2017
PPOs and HMOs
Message Board
Views: 328 | Replies: 8
with MCNA on the govt plan was a joke (and an expensive one). It's a lot of BS with a lot red tape, BS denials.... The only regret I have is not dropping it sooner -- would have worked less and suffered less overhead. On the upside, MCNA has a decent management portal so that your claims can be denied quicker. At least they are efficient with their denials.
April 03, 2014
Medicaid and Welfare Issues
Message Board
Views: 581 | Replies: 15
Hi all, Just curious if large solo practices or DSO's bill patients if insurance didnt cover as expected for amounts $100 or less for preventive services ( IN network) I have been practicing for a while but lately getting screwed left and right for amounts of $100 or less for prev and diagnostic
July 19, 2019
Practice Management & Administrative Forum
Message Board
Views: 12816 | Replies: 1922
tissue. I can only approve, if you send data. If I do not approve coverage, it is logical to send adequate data on your next try.Fredone of these is the insurance company.... the other, the dentist who accepts assignment of benefit.can you guess who's who?? So now we are using the logic of trying
February 18, 2008
Ethical Issues
Message Board
Views: 16242 | Replies: 259
. Sanchez was aware the Medicaid Program does reimburse the cost of root canals and bridge work but chose not to inform the patients of this or told them that those were not covered and instead required them to pay cash. During this same time period, Sanchez billed a private insurance carrier
February 20, 2017
Legal Issues
Message Board
Views: 725 | Replies: 27
Any one else having issues with United Concordia? This is insane! They have a Dentist Advisor on staff who is denying payment because there is no decay evident on the x-rays. Really? Other than dropping the insurance, what other options should I consider. I'd love to take their advisor to peer
June 01, 2014
Claims Processing
Message Board
Views: 99 | Replies: 1
, but I smell a denial coming if not worded correctly. thanks I'll try and post x-ray when im at office Monday sorry for multiple post. forgot to click follow this topic Is there a way to delete one of these?
January 28, 2018
PPOs and HMOs
Message Board
Views: 979 | Replies: 27
a problem.This is what is wrong with deferring to INSURANCE coding as proper treatment for your patients. Scaling alone is adequate for plaque and tartar removal. Root planning along with scaling adds NO benefit without removal of sulcular epithelium in conjunction. Scaling and Root Planing is NOT definitive
April 30, 2018
Hygiene Discussions
Message Board
Views: 934944 | Replies: 348121
of my KH story was that even nothing can accomplish your goal of destroying your opponents. I mean.if the suspects are people disgusted to exasperation with insurance companies Im afraid were all gonna get hauled in. LOL. Its like the priest with me in confession when I was a bit wilderFor
December 05, 2024
Politics - DO NOT Enter if easily offended
Message Board
Views: 1271 | Replies: 52
the ADA would truely represent us.....but we have watched them roll over every time.... i'm just venting.......am i the only one with reduced collections since it's the end of the year and insurance is holding checks to show a larger profit.......i have a mailbox full of denial letters
August 13, 2014
Delta Dental
Message Board
Views: 82 | Replies: 3
you receive payment or denial from Medical you can then send to the Dental plan as secondary. Be sure to attach a copy of the EOB from medical as well as the path report. This makes sense, thank you!
March 03, 2022
Oral & Maxillofacial Surgery
Message Board
Views: 281 | Replies: 9
Direct Composite Crown using Greater Curve matrix bands Delta dental denial due to poor prognosis LOL Fantastic work and documentation! Nice work. Do you have any pictures of what it looks like when you remove the matrix? This is the dental equivalent
July 25, 2025
Restorative Dentistry
Message Board
Views: 3400 | Replies: 160
The reason, Bob is not too far off on questioning the treatment is that those same consultants many on here bemoan as be part devil look at claim after claim of overtreatment every day. just as we are bias about the evils of insurance they are bias about the overtreatment. Regardless
June 24, 2014
Claims Processing
Message Board
Views: 2004 | Replies: 86
same here. If a tooth needs a crown, it probably has enough tooth structure missing to do a buildup, otherwise it would probably just be a filling in my hands. exceptions to this are things like cracked teeth and circumferential decay, those usually dont need buildups. As the insurance company
January 26, 2024
Claims Processing
Message Board
Views: 62613 | Replies: 9426
to contains a reiteration of frequently made statements but does nothing to rebut any of the factual information I have posted over the last two or three days. Please let me enlighten you. The insurance industry is infamous for claims delays and denials. They watch over billables like a hawk. They can
July 04, 2021
Ethical Issues
Message Board
Views: 3171 | Replies: 82
insurance will reject the pay,and moreso doctors get on board with that.Who is really thinking what is the best for the patients ?best way drop them and then they will learn.hopefully.I think that the CDA had a lawsuit against United as we speak .And that is the reason .Denials on most claims.Sometimes
October 20, 2017
Periodontics
Message Board
Views: 408 | Replies: 11
occurred and the teeth are exhibiting some wear. We contacted his insurance provider (Aetna) and they claim that because he has had his immediate denture for more than three years they consider it a definitive denture and is therefore subject to their 5 year replacement criteria and therefore he
September 25, 2014
Claims Processing
Message Board
Views: 1031 | Replies: 29
to associateships, get beat up by corporate drones/office managers. Go ownership, get beat up by insurance companies. Has anyone here ever gotten to actually speak to the dentist that denied this claim? I've tried several times, but can't have myself or staff wait on hold for hours and of course they never
September 11, 2017
Restorative Dentistry
Message Board
Views: 224 | Replies: 7
their appointments. That should keep less of them from calling in and tying up your phone lines. Consider outsourcing some part or all aspects of dental insurance. From verifications to filing claims to insurance AR follow up and working on claim denials. Lastly, you can always tap into a dedicated
April 29, 2021
Front Office Discussion
Message Board
Views: 204324 | Replies: 100239
political disservice. Hell, this polls so strongly in his favor, he should be talking about it more. Not less. Rapid Response 47 @RapidResponse47 3h 81% of Americans say crime is a major problem in large cities. Democrats are in denial. President Trump
August 27, 2025
Politics
Message Board
Views: 426 | Replies: 18
all of a sudden, I probably wouldn't even be ok with 6 months. I'd want a new pano. Not a new PA. My issue with this thread though is the underlying implication that if its not covered, its not needed. And if its needed, it should be covered. We all know that isn't true with other insurances. Why
June 24, 2015
Claims Processing
Message Board
Views: 364 | Replies: 12
remember correctly and his malpractice insurance paid it. Still, just goes to show how f--ked up this profession is. I Rx antibiotics after every surgery. I know it's not needed. I tell patients exactly that and that I don't care if they fill them or not. Most don't fill them.Why get yourself stressed
December 15, 2017
Just Plain Bitching and Moaning
Message Board
Views: 763 | Replies: 9
will often raise a red flag or denial if it is observed that the practice is using cut and paste for clinical notes so always take custom notes for each patient to insure accuracy of creating the medical necessity of the treatment. Who of you is using SOAP notes and what are your thoughts
May 19, 2016
Claims Processing
Message Board
Views: 38 | Replies: 1
Has anyone had luck with insurance covering implants? Just asking Yes. Easily 50%+ of our patient base has coverage for implant placement, with some of the expected qualifiers (missing tooth clause, etc.). The office I work at always files a pre-treatment estimate or verifies online the patient's eligibility for implant placement. The coverage percentage in 2004 was significantly lower.
June 26, 2019
Implantology
Message Board
Views: 113 | Replies: 4
I am needing to send a letter to several insurance companies telling them we no longer want to be in their network... any ideas or sample text is greatly appreciated! I don't like to beat around the bush. Here is one example. To whom it may concern, Sincerely, Kjhuskey You do not need
July 11, 2019
Alternatives to Dental Insurance
Message Board
Views: 321 | Replies: 17
Let me preface this by saying I never had this issue in 30 years and the patient involved is my office managers brother. I am a PPO Mellife particating dentist. The patient has secondary insurance through a union that I'm out of network with.I did 6 crowns all of which were approved by Mefife
June 05, 2019
PPOs and HMOs
Message Board
Views: 159 | Replies: 7
for Aetna is demanding a refund, $2000.00, stating that the insurance is an ERISA program which supersedes State lawand therefore since he was not covered I have to refund the monies. Also patient has canceled phone number and turns out his home address is false. We do have his Medicare info. etc. I
January 23, 2017
Legal Issues
Message Board
Views: 197 | Replies: 4
I am buying an office they are in network with most insurances so I guess I have to go in network too. Unlock PPO does not do transitions so let's go to the next. Unitas, Lakes somthing? What have you guys use lately?Thanks Feedback on Unitas please?So I just went through this. I went through
June 07, 2019
Practice Acquisitions
Message Board
Views: 207 | Replies: 6
This might depend on the insurance contract, but overall is it allowed to continue taking an insurance and seeing the established patients but not taking any more new patients for that insurance? Thanks for any insights! Yes. Just change your profile with that insurance and you will be able to say
March 02, 2023
PPOs and HMOs
Message Board
Views: 810 | Replies: 49
. Endodontist called me requesting I don't bill as pulpotomy because he gets endo denial from insurance if pulpotomy was coded.D3222 partial pulpotomy for apexogenesis - permanent tooth with incomplete root development assuming open apex Is that indefinitely or within a time frame? I agree with kiddent
October 11, 2019
Pediatric Dentistry
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