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Searching: insurance denials
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Message Board (37849)
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Message Board
Views: 175737 | Replies: 8045
500K+ for a 40% stake in a practice? Fwiw, things are great here post partnership. I still practice like I always have. Nothing about the office has changed except we get more help on insurance denials, IT support, marketing, more user-friendly mobile website, etc. One of the best things has
November 15, 2019
Practice Management & Administrative Forum
Message Board
Views: 237 | Replies: 8
I had to fire my insurance lady - poor attendance. Got help wanted ads out but slim pickings these days. Im going to be doing the posting! Yay me. Does anyone know of any any resource like a book, webinar, pod cast to help me learn. You know info about write offs, denials, resubmitting claims
September 14, 2020
Dental Insurance for Dentists
Message Board
Views: 299 | Replies: 9
that they produce. You want them to be paying attention to whether or not firm financial agreements are in place, the office has proper records and documentation to get reimbursed, the employees are collecting money at time of service, promptly writing good narratives for claim denials, etc... Insurance
February 26, 2021
Practice Management & Administrative Forum
Message Board
Views: 158 | Replies: 6
When and how are we, as dentists, going to stand up to the absolutely abusive practices of the insurance companies in delaying reimbursement for procedures done. Not only is this a financial issue, but it also puts us at the battle front with patients, and makes us look bad. Yes, I'm venting here
April 22, 2020
Claims Processing
Message Board
Views: 373 | Replies: 14
to call myself to ask to speak with the dentist who made the original decision as my last (3rd) attempt. -What are some tips when contacting insurance companies regarding denials? -Can Delta Dental deny my request to speak to the consulting dentist? Do I have legal right to speak to consultant
August 23, 2019
PPOs and HMOs
Message Board
Views: 584 | Replies: 20
years, absolutely dirtbag tactic! 2) The code for a retainer is similar to a maryland bridge for what you describe. D6545 - for your tooth #6 The reason for the denial is a posterior cantilever is not considered a stable restoration, and almost no insurance pays for unstable or uncommon treatment
August 26, 2024
Claims Processing
Message Board
Views: 359 | Replies: 14
? is adding the are billing etc just to much extra work for them and overwhelming? Are you saying this just simplifies the job for them and keeps everything running smoothly as you dont have to worry about appeals denials and complicated insurance stuff? finally what happens if one of your patients
June 16, 2024
Practice Management & Administrative Forum
Message Board
Views: 405 | Replies: 10
I am sure this topic has been discussed heavily in the past. Our office has been seeing increased number SRP denials by insurance companies.I would like to see how you would handle such a patient in your office. A typical case would be a younger individual (in their 20s) presented with generalized
January 09, 2019
Claims Processing
Message Board
Views: 275 | Replies: 6
mail addressed to me. 3. Trash, including advertising, etc. I take all insurance and patient related envelopes, open them, and separate contents into two piles: 1. Payments 2. Denials, pre-auths, and insurance newsletter that keep the front updated on whatever the content is. I take 1. Payments
November 07, 2017
Ask a Dental Consultant
Message Board
Views: 321 | Replies: 15
this comes down to three aspects: 1) Estimate better 2) Document better for less denials from insurance 3) Collect money sooner (at the minimum, at the beginning of the appointment) Now once the source is fixed, then focus on the cleanup that won't be continuing. Yes, your team is right, calling
December 11, 2024
Billing
Message Board
Views: 437 | Replies: 13
what were your measurments. What is the CAL? because that is far more important. The biggest reason I ever see SRP claims denied is a perio chart with just pocket depths and nothing else. These are no brainer denials. Learn what insurance wants, and you will get claims paid.Didyousubmit
November 14, 2018
PPOs and HMOs
Message Board
Views: 2210 | Replies: 90
a path to do higher quality dentistry. I think the vast majority of FFS dentists are simply offices that want to profit more with less constraints (insurance denials, etc). There is a natural side effect of profiting more on a case that allows a dentist to use higher priced labs and equipment
June 05, 2024
Marketing
Message Board
Views: 2443 | Replies: 92
satisfaction but I highly doubt people are happy drilling 3 modl 4 mod 5 do and then fighting insurance denials and dealing with staff problems If you didn't want to be a business owner then dental school, with today's debt load, just isn't worth it. Zooming out a little though, most of what makes
October 02, 2025
Practice Management & Administrative Forum
Message Board
Views: 485 | Replies: 15
. The insurance dentist isnt agreeing with you because he doesnt have to, because you are not submitting the proper information. He probably didnt even look at anything besides the fact your probing depths werent deep enough to make it over the hurdle. Youre an easy denial. The insurance dentist isnt
July 08, 2021
Periodontics
Message Board
Views: 170 | Replies: 3
a buildup (which DDMN did pay) and: a) leave it as a buildup and there would be no additional fee from you, other than your co-pay or b) do the buildup and make a provisional crown to make it last as long as we can, and there would be a good chance that insurance will not pay because the denial
June 16, 2020
Coding Q&A
Message Board
Views: 1374826 | Replies: 39855
thinking of just having a DISMISSAL stamp made...I seriously already bought one that says WTF for the office manager to use for insurance denials. Holy crap... you ARE on a roll! I just don't get many of those kinds of crazy patients. And, I surely wouldn't tolerate them. You yell at my staff, you're
February 08, 2013
Just Plain Bitching and Moaning
Message Board
Views: 1264 | Replies: 31
, everything from understanding insurance, avoiding denials, improving treatment acceptance, avoiding EOB mistakes, scheduling perio, etc. etc. Monthly live training and Q&A sessions Day to day Q&A through the site, which is utilized often. Forms and FAQ library Secondary Insurance calculator Non-covered service law database and quick interpretation sheets Does this work with Medicaid?
April 25, 2023
Removable Prosthodontics
Message Board
Views: 3129 | Replies: 105
-posting payments -processing EOBs -answering phones during and outside of business hours -scheduling -rescheduling -dealing with cancellations/no shows -insurance denials -pretx estimates -handling patient questions about billing
April 10, 2019
Practice Management & Administrative Forum
Message Board
Views: 62 | Replies: 1
Patient has Cigna and we are trying to authorize for wisdom teeth extraction. Cigna Dental says we need to bill medical (I believe it is with Cigna as well, since they gave us a different Cigna address to mail it to). I'm also not sure when they say medical if it is government sponsored. How do we...
September 17, 2016
Claims Processing
Message Board
Views: 199 | Replies: 10
think we need to educate patients about the fact that we are looking out for them and their oral health - The insurance company is not. I carry on as usual with scheduling but I always send a pre determination because it only takes a couple of seconds. I'm looking for down grades and denials. Why
January 02, 2020
Claims Processing
Message Board
Views: 419 | Replies: 11
have 5 or 6docs allcompeting to get their numbers up so corporate stays happy with them. That's what you get. And technically I don't even think these are one surface resins. More like a sealant or at best a preventative resin restoration, but that doesn't pay as much so......Not sure if you get the denials from insurance after sealing perfectly clean molars only to have them state the teeth have had an OBL resin placed already
October 05, 2018
Pediatric Dentistry
Message Board
Views: 240 | Replies: 3
Info pt. gave us for insurance showed it wasn't in effect, denial, pt owes $225. Pt was chased after, finally received payment from her months later. She then gives us updated insurance info. The claim is paid, a mistake was made and payment was supposed to go to her, didn't happen. Insurance
July 11, 2015
Claims Processing
Message Board
Views: 439 | Replies: 12
, denials, pt denials, etc, etc, etc, that doing srp just didn't make any sense for ME. If a patient has perio, I inform them and refer to to a perio that takes their insurance. IMO, depending on your area and reimbursements, dicking around with SRP will only bring grey hairs and minimal returns. I have
September 28, 2020
Practice Management & Administrative Forum
Message Board
Views: 334 | Replies: 13
told The Post. Patients arent the only ones using AI to their advantage doctors are also reaping the benefits, leveraging the high-tech smarts to push back on insurance companies when denials leave them with uncollectible debts. Bryan Rotella is an attorney whose practice specializes
March 09, 2025
Billing
Message Board
Views: 5385 | Replies: 275
now have the power of choice. Tired of insurance denials? Drop your worst plans, since you already have an abundance of accepted treatment. Don't want to work evenings and Saturdays? Since you now have enough patients who are saying YES, cater to the ones who are happy to see you during business hours
January 24, 2025
CE Comments / Suggestions / Events
Message Board
Views: 510 | Replies: 18
will go away. In the meantime, he asked how to prove denial. That's how you prove denial. In medical insurance with multiple coverages, you submit copies of the EOB with each claim when submitting to the 'next' insurer in line to show/prove to them what's been covered, denied, paid, not paid
August 13, 2014
Claims Processing
Message Board
Views: 1804 | Replies: 142
I mentioned earlier are for these reasons: immediate patient education, protection from disgruntled patients, shutting down insurance denials, and better yet for your/staff own education in studying what you missed the first go round and what you might do different. Here's my take on this. A lot
August 22, 2025
Ideas To Make Your Practice Grow
Message Board
Views: 668 | Replies: 11
Hi Everyone, We recently got set up to submit to our patients medical insurance for Arrestin. We've gotten mostly denials. I would like to add and antibiotic adjunct to our SRP protocol. Arestin is just so darn expensive especially since our patients would need multiple sites medicated. I read
March 16, 2017
Periodontics
Message Board
Views: 3057 | Replies: 97
that is dental insurance. I do not do treatment based on insurance coverage or denial. Call dental insurance what it is, a pyramid scheme with a businessman sitting at the top that pits patients and dentists while they laugh all the way to the bank. Dont get me wrong, I have nothing against
November 06, 2016
Restorative Dentistry
Message Board
Views: 644 | Replies: 28
that will be in the four digits pretty easily costing thousands and thousands of dollars, he said. Dentist says claim denials are happening more often. Claim denials from insurance companies are happening more and more, Ross said, especially as the claim processing system is becoming more automated. Sometimes
February 23, 2025
PPOs and HMOs
Message Board
Views: 142 | Replies: 3
Every few months, a headline screams that AI is breaking health insurance, or cracking dental insurance, or destroying private practice. It makes for great clicks. It also makes for lousy calibration. Dentists are hearing more stories about denials, documentation requests, and automated reviews
February 25, 2026
Artificial Intelligence
Message Board
Views: 114 | Replies: 4
some light on this particular question. Thanks, Mary B. Most insurance policies specifically exclusive cosmetics or electives from reimbursement. Flippers, by their name sake, are more cosmetic in nature than functional. Hence you will find many policies that would not pay them, Delta or many other
March 09, 2026
Dental Insurance for Dentists
Message Board
Views: 417 | Replies: 15
. For a locator denture, there are almost multiple codes, many of which are not utilized, to help with getting the fee high enough to make sense. Know of any template denial of insurance paperwork I could use ? You can find a free copy here: Knowing is pretty much the full battle :). So many creative ways to make your patients and office happy with these challenges from insurance companies by arming yourself with knowledge.
January 19, 2022
Claims Processing
Message Board
Views: 233 | Replies: 13
. Better documentation on the office side ends most denial problems. Understanding how insurance works and what it will and will not pay for solves the rest. Waiting for money....yeah sure that is an issue for the first couple of months, then the cash flow is consistent and it really isn't much
November 05, 2023
PPOs and HMOs
Message Board
Views: 295 | Replies: 7
Sharing this from my blog. Not sharing a link as I don't want to get in trouble with the mods. The business of billing claims is alive and well as dentists, and their teams struggle to get paid for their hard work. I get questions frequently regarding the travails of denials for gingivectomies
August 19, 2023
Claims Processing
Message Board
Views: 559 | Replies: 6
A new law in California bans health insurance companies from using AI to deny care or coverage. This is a major win for patient advocacy and puts decision-making back in the hands of humans, where it belongs. Why it matters: No more automated denials without human review. Patients' care decisions
February 10, 2026
Billing
Message Board
Views: 1151 | Replies: 57
It is vital the patient understand the dentist and patient are partners, not opponents, working together against the challenges and restrictions often presented by insurance companies. The patient must be brought to a point where they recognize what is likely to happen if they do not move forward
March 01, 2026
Claims Processing
Message Board
Views: 17741 | Replies: 1414
individual.That is all. Absolutely. This is the response of a composed and rational individual. I get so frustrated with insurance companies for some of the denials and shenanigans they pull. It's ridiculous. And most of us operate on relatively low stakes matters like SRP and crowns. I can only
December 05, 2024
Dental Insurance for Dentists
Message Board
Views: 3156 | Replies: 84
insurance, get the denial, then we can bill the dental. These are all from plans purchased on the exchange. What a joke! They admitted it will never cover these items but we must always bull the medical first. Waste of time and energy for the dismal reimbursement we get. The worst part is it is mostly
December 27, 2016
Medical / Health Insurance
Message Board
Views: 446 | Replies: 11
this their denial to the state insurance board for review. If the master plan has a downgrade clause you are out of luck. No one typically has access to the specifics of the master plan except the insurance company and purchaser of the plan (employer).It is stacked in the insurance companys favor.Gr8
July 30, 2020
Claims Processing
Message Board
Views: 309 | Replies: 16
for these problem insurance companies that want to waste our time and theirs. Don't wait for the denial to appeal, that is a waste of time. Just send your remark notes with the original claims. No, I am not defending insurance at all. Just recognizing we need our own 'counter-tactics.' Anticipating
February 26, 2026
Claims Processing
Message Board
Views: 546 | Replies: 10
reimbursement only!!! And one final thing to think about....what is easier and less time consuming for you? Someone paying their bill in cash day they come in, or having to file insurance, deal with claims/denials, wait for your money 30-90 days? Insurance patients really should pay more because it costs
December 28, 2015
Claims Processing
Message Board
Views: 340 | Replies: 1
of billing 4 bitewings yearly because the plan will pay for them is becoming obsolete as more and more insurance companies are sending denials back for lack of evidence based data. Each insurance company and every state has differing views on what is acceptable for dental charting. The rules are stricter
October 28, 2015
Claims Processing
Message Board
Views: 612 | Replies: 19
eligible for a crown. So out comes the poison pen. This letter is in response to your denial of insurance claim. I have sent photographs of the tooth in question, # 3, clearly showing a large fracture on the distal marginal ridge of the tooth. The fracture line in addition to the fact
October 21, 2014
Claims Processing
Message Board
Views: 536 | Replies: 13
mentions attachment loss first.You have it,you take pictures of it, no insurance should deny anything.It gets very sad when doctors diagnose by insurance because they are afraid of denials or they are scared of losing the patient. Bone loss on bite wings is one sided. I read an article one time on how
April 19, 2015
Periodontics
Message Board
Views: 4178 | Replies: 109
scope users are welcome to contribute! Now, imagine being able to grab an intra-operative shot of every tooth treated and not worrying when an insurance denial occurs, which appears to be happening more frequently lately! Dino I think it would be more convincing if the debris field was cleaned up
October 28, 2013
Microscopes
Message Board
Views: 156 | Replies: 3
is likely your perio chart, a vast majority of offices do not fill out a complete chart, which is a major reason for denial. This is a case that should go in a book of how insurance companies defraud patients and dental practices. Resubmit again with a proper narrative and ask for a human to review this. It likely was an automatic denial, no human laid eyes on this xrays
February 06, 2026
Delta Dental
Message Board
Views: 473 | Replies: 12
, but most of my patients are regular folks. I don't make more money than when I was in the insurance world, but I get paid something for everything I do. With insurance, there are so many denials for legitimate claims that it made my head spin. The insurance world is about running the hamster wheel faster
May 25, 2017
Medical / Health Insurance
Blog
denial, and seek to wear the policyholder down until the policyholder gives up or settles for much less than they are entitled to under their policy. In a 60 Minutes interview (also discussing Unum’s egregious denial practices), former California Insurance Commissioner, and current U.S
November 01, 2017
by Edward Comitz
Message Board
Views: 123 | Replies: 4
We have a patient that requested we submit a pre-determination for a crown on #31. Grossly open lingual margin, recurrent decay, the works in terms of it being medically necessary. Our office submits the pre-d on January 1, 2026 when benefits renew and we just got this as the denial reason
February 18, 2026
Claims Processing
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