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Message Board
Views: 274 | Replies: 11
to the State Insurance Commisioner... Bruh! I was so mad at a frivolous denial one time, that I wrote the above on an EOB and sent it back. Got it thanks thats what I figured. By the way, the build ups were most likely denied because they were submitted on the same date as the crown code If the plan pays
March 24, 2022
Claims Processing
Message Board
Views: 1201 | Replies: 36
. Thinking about selling it and practicing in a more rural area. Just tired of the PPO denials and dual insurance crap.Do you have alot of nurses as patients ? I feel for you :) Not to hijack the thread but i hear this sort of statement a lot. Just wondering, exactly how rural do you have
November 12, 2016
Ask a Dental Consultant
Message Board
Views: 319 | Replies: 3
(signs and symptoms) not only the denials doesn't make sense, but it borders malpractice, incompetence or ill-intention from the reviewing dentist. As a result, and based on the fact that lately Principal Insurance is denying claims more frequently (which later, on appeals, they pay) I informed Zzzzz
February 24, 2020
Social Media
Message Board
Views: 303 | Replies: 5
written processing policies from more than one major insurer state that patients under 25 will be denied SCRP benefits without X, Y, and Z present and a detailed appeal. An initial pre-d denial is simply a place to start negotiations with the insurance plan for payment. Triple check the correct
May 03, 2017
Coding Q&A
Message Board
Views: 1747 | Replies: 79
one reason BY FAR for SRP denials has nothing to do with x-rays or perceived bone loss, it is lack of adequate documentation. I get cases sent to me almost daily for SRP denials and 99% of the time the documentation is the issue. For good or bad, many insurance companies see SRP as a highly
May 03, 2022
Claims Processing
Message Board
Views: 3143 | Replies: 103
with root canals. Do you get denials from insurances? You must also be aggressive with your crown diagnosis. probably all mod premolar/molars you would suggest a crown?Most big cases are cash pts.(thus carecredit) we just offer PPO fees to them. single crowns arent done a whole lot. main tx is bridges
January 15, 2014
Practice Management & Administrative Forum
Message Board
Views: 325 | Replies: 7
I'm a conservative dentist, really don't recommend treatment unless it's necessary. So it really grinds my gears when insurances deny my claims. Recently purchased an intraoral camera to help with denials as well. So #19 hadbuccal caries. Needs new crown. The build up doesn't look great
November 07, 2017
PPOs and HMOs
Message Board
Views: 317 | Replies: 8
these out of control insurance companies (yeah, right). They might get a slap on the wrist, if anything at all.1. The medical director will be fired. 2. Aetna will now have a paragraph explaining why the claim was denied maybe with the name of the M.D. who authorized the denial but don't hold your
February 12, 2018
Medical / Health Insurance
Message Board
Views: 1134 | Replies: 62
Ive been having issues, like many others here, with UHC denials. Mostly buildups and SRPs, but we have had increased success using Dental Insurance Guys tips from his book. Win, right?! Then, we got hit with this onePatient had bridge for 20+ years #7-#10 with pontics at #8 and #9. #10 completely
March 11, 2024
PPOs and HMOs
Message Board
Views: 598 | Replies: 27
I've had the unfortunate luck this year of getting GA denials the day before the scheduled surgery center visit for insufficient documentation to support GA. These have been for 2-3 yr old full mouth rehabs. I feel the documentation is sufficient from my standpoint but insurances want
May 15, 2014
Pediatric Dentistry
Message Board
Views: 1073 | Replies: 25
solely to the amount of infection. I gave the tooth a questionable prognosis due to lack of any other complicating factors. I have seen the patient since and she has had complete resolution of symptoms. I would like to appeal this denial. It seems unfair and unreasonable to tie the insurance payment
August 02, 2018
Delta Dental
Message Board
Views: 306 | Replies: 3
So I have been collecting crazy sheet the insurance companies have sent me over the years. since I am out of network with most insurances, I decided to start displaying the crazy sheet letters they have sent me. I call it my insurance wall of shame. Any time a patient asks me why don't you accept
February 04, 2025
Office Decorating
Message Board
Views: 142 | Replies: 7
I have a patient who had a Scaling and Root Planing in 2015. Has been really good about coming in regularly for Periodontal Maintenance every Recently the patient changed insurances to MetLife and the new insurance company says they will only pay for Perio maintenance if Sc/RP has been done
June 13, 2019
Coding Q&A
Message Board
Views: 2338 | Replies: 100
now and each year, they come to their senses. It's certainly scheduled to drop back to $25k, and I would suggest people make their end-of-year purchases based on that...but it's definitely not set in stone. Hope this helps. I give it away if the insurance comes back with a denial due to frequency
January 23, 2014
Digital Radiography
Message Board
Views: 206 | Replies: 8
that it is never a problem. They rarely question extractions, and when they do you can report the infections, root fractures, and/or denial of root canal options. Insurance is extremely easy in F/F w/ Ext cases, no need to estimate anything, their max is their max.The reason insurance matters is because
July 06, 2014
Removable Prosthodontics
Message Board
Views: 315 | Replies: 14
Lately aetna has been denying srp claims because they need length of appointment mentioned in the chart notes. Is anyone else encountering this problem? That wouldn't be a denial, just a request for more information. Insurance has been doing this for years in many areas, along with amount
April 15, 2024
Claims Processing
Message Board
Views: 399 | Replies: 11
operating procedures for how to conduct the billing of dental insurance for each practice. 5. The dental billing company should vet the dental billers on their platform. 6. The dental claims specialists should promptly follow-up with denials. 7. The dental billing company should aim to get
September 25, 2023
Billing
Message Board
Views: 121 | Replies: 0
Timely filing should not stop you from chasing that insurance claim payment! When timely filing is the reason for claim denial it is always prudent to appeal the claim. Even if the contract that you have with the insurance company says that no claims will be paid after 3 months, 6 months or a year
September 08, 2015
Claims Processing
Message Board
Views: 131 | Replies: 4
agains the plan limitations (like annual maximum, or frequency limits, or non covered benefit) you will also get denials that can not be overturned. Another denial might be due to out of network provider where the insurance does not pay anything to the out of network provider. Int hat case the claim
June 12, 2019
Ask a Dental Consultant
Message Board
Views: 2216 | Replies: 52
is yes, there are some dentists that have cheated or frauded the system. The natural insurance response is to start requesting more documentation. (You may not like this, may not agree, but it is the world we live with) SRP are a good example, the most common reason for denials I have seen is poor
February 15, 2024
Claims Processing
Message Board
Views: 221 | Replies: 5
So sick of this crap, we have been having a slew of denials for GA (in office IV). Our notes are clearly indicating the patient will not tolerate treatment without GA they won't sit in the chair, wont take rads, etc. We keep getting denials from one particular medicaid plan here. They basically
December 07, 2017
Pediatric Dentistry
Message Board
Views: 342 | Replies: 6
had three denials recently- all United Healthcare- all different...Depending on your state, there may be a law that says medical insurance has to cover for dental cases. I had a few denials when I first opened and then sent a letter stating the law (I googled it to see if my state was included
February 04, 2014
Pediatric Dentistry
Message Board
Views: 7172 | Replies: 81
day in my face...I didn't do it...we do it...insurance companies have blanket denial policies on inlays...why in the Fuck do we even have an ADA code for them? and why did I learn how to do one in dental school? Why does my operative dentistry textbook have a few chapters on how to do them? Why does
May 25, 2018
Practice Management & Administrative Forum
Message Board
Views: 85 | Replies: 0
from different insurance companies. The first case I can see, severely worn dentition and crowned due to functional issues, but the second was tooth #19 with large DO amalgam and significant erosion to the point where the amalgam was the highest point on the occlusal surface.
July 05, 2017
Claims Processing
Message Board
Views: 384 | Replies: 12
this treatment plan to submit to private insurance to approve coverage. Included in the pre-authorization letter is a disclaimer that the treatment plan is an estimate and will likely change after taking radiographs. Perhaps a worst-case-scenario treatment plan will help with approvals? The only
January 11, 2017
Pediatric Dentistry
Message Board
Views: 140 | Replies: 2
to 79% of Gross production. Does anyone else see this trend?? Do you have fee schedules set up for each plan? Who is making the adjustments... manual by insurance coordinator or through the software? You should have a contract that spells out the accepted fee's... so anything other than denials.... I don't get it... and denials should always be appealed! Janndid you increase your fees ?
January 20, 2017
Practice Management & Administrative Forum
Message Board
Views: 64 | Replies: 0
Okay, this is a new one for us but according to the billing experts becoming more common. What is going on here? Have any of you experienced these denials recently. We are looking into it. From the insurance billing trenches: Okay guys, this has seriously got to be the most insane denial I've
September 23, 2016
Claims Processing
Message Board
Views: 2079 | Replies: 55
I know I'm just banging the drum here, but here are a few of the lastest UCCI restorative denials. I even had a well respected insurance guru speak directly with a higher-up dental advisor at UCCI after he sent him the attached photos. Below is the advisor's response. Keep in mind
December 29, 2015
Claims Processing
Message Board
Views: 2176 | Replies: 69
. Most of the time, talking to a real person may be the only way to get your questions answered. Insurance companies are in the delay and denial business. Takes some investigation sometimes. And stubbornness. And stern wording.so you spend your admin days chasing claims? Are you the dentist or one
March 13, 2019
Front Office Discussion
Message Board
Views: 1196 | Replies: 57
billers on their platform. 6. The dental claims specialists should promptly follow-up with denials. 7. The dental billing company should aim to get the practice's outstanding insurance at zero or trending towards zero. 8. There should be ongoing communication between the denial billing specialists
June 28, 2023
Dental Insurance for Dentists
Message Board
Views: 124 | Replies: 2
of my previous 15 years in the industry. That doesn't even include the normal claim denial game that one must play when P&R reviews a claim. These are the latest issues which I am bringing to the attention of The Texas Department of Insurance and was wondering if we are an isolated case
March 15, 2019
Claims Processing
Message Board
Views: 817 | Replies: 21
they then submit the claim to medical insurance 99.9% of every one of my claims get denied at first the cool part code does not charge me for that. the real battle starts after the denial. code gets on the phone and fights. they fight like dogs because they don't get paid until the claim is paid
March 26, 2015
Claims Processing
Message Board
Views: 1989 | Replies: 64
policies to cover forced shutdowns/slowdowns due to COVID. We filed a claim in March to get a denial in writing. If the SB passes we will get an extra percentage due to being denied at first. I'm not holding my breath that this bill will pass. The insurance industry is too strongly represented.
September 05, 2020
All Things Coronavirus (Covid-19, SARS-CoV-2)
Message Board
Views: 408 | Replies: 6
and not practicing. Could that be the case?Do you have any recourse with a narrative or is that it? I've seen offices that are in network requiring payment in full with the patient receiving the reimbursement from the insurance company. Seems like it would take the risk of rejected claims off
October 03, 2014
Coding Q&A
Message Board
Views: 443 | Replies: 16
) by denying the re-submission as well. Submit what you did. Yes, it is considered unbundling. You can always appeal frequency denials and ask for the alternate benefits of 4 BWS and 2 PAs. Delta will always deny it and say its unbundling. Other insurances will allow alternate benefits
May 05, 2022
Claims Processing
Message Board
Views: 316 | Replies: 12
monitor your outstanding patient balances so you can see if anything is out of alignment there as well as if your team is collecting copayment on DOS or not. -Insurance Aging helps you monitor whether or not denials/appeals are being worked as can also indicate whether or not you have any blockages
July 20, 2023
Front Office Discussion
Message Board
Views: 1246 | Replies: 58
At the end of the day, unless you are Ok to write off the balance due from the insurance in case of denial or encounter any adverse event regarding the case . Patient you treated as a CUSTOMER will revert back to the patient and you become the Dentist or provider again I have never seen a Malpractice
October 24, 2015
Ask a Dental Consultant
Message Board
Views: 357 | Replies: 14
This is another what would you treatment plan for #2 and #3 Thanks Bump I placed crowns/crownlays on these teeth back in february and the patient's Ins denied the claim three times. I sent this picture, an xray, and a narrative. They would not give a reason for the denial other than they need
September 28, 2015
Restorative Dentistry
Message Board
Views: 295 | Replies: 13
correction +1 to Paf Insurance LIES all the time. EOBs are WRONG very often. It really depends on the reason. What was the procedure, and what was the reason for denial? Is the procedure being disallowed because it is part of another procedure? Is the procedure being denied, and the EOB is just wrong
February 21, 2019
Claims Processing
Message Board
Views: 17741 | Replies: 1414
predatory policies of insurance companies) and is a political loser for anyone to make it go without replacing it with something nearly universally accepted as better. Surely, the USA can figure out something reasonable between free healthcare for illegal immigrants and tax paying hard working American
December 05, 2024
Dental Insurance for Dentists
Message Board
Views: 1871 | Replies: 57
treatment is done with correct documentation. Crowns are another great example, we never get true denials on crowns.I understand you are stating what the insurance company's rationale in denying the claim, but it seems to me that in the case I submitted a FMD with anesthetic vs. SRP
August 27, 2019
Claims Processing
Message Board
Views: 143 | Replies: 7
Need help of all the EXPERTS out here...on DT. Insurance company - Horizon Blue Cross blue shield of NJ. Background - did three unit bridge and claim was intially denied asking for an FMX.Send that multiple times but they keep sending the same templated eob denying asking for the same info over
July 31, 2024
Claims Processing
Message Board
Views: 10421 | Replies: 529
are talking about. Brilliant move on their end. If they can somehow spend their resources to educate people about a discount plan, I think it could chip away at the dental insurance beast. At the very least, the competition could allow for the insurance companies to re-think their denial and non
March 10, 2014
Ideas To Make Your Practice Grow
Message Board
Views: 17741 | Replies: 1414
to be shot because his insurance company denies claims for $850 MRI and is withholding healthcare from people for money The next thread: only hacks stay in network, patients should be able to afford $5000 for implants out of pocket, get paid what you're worth! And if they don't pay in full then don't do
December 05, 2024
Dental Insurance for Dentists
Message Board
Views: 161 | Replies: 2
on a different part of the tooth, but it was less than the 24-month frequency, is there a way to appeal that denial or are we stuck with the final write-off? You can try appealing it. Have intraoral photos as additional proof. Insurance says it won't pay because their records indicate benefits were previously issued for the same tooth and/or related procedure at the same dental office You would probably have to redo the filling for no charge. This
May 12, 2017
Claims Processing
Message Board
Views: 304 | Replies: 5
procedures are correct and submit claims with proper supporting documentation -save a copy of the transmission report and check report for any -post all insurance checks or EFT payments received that day and deposit Weekly -work denials and appeals Monthly -run an aging claims report/open claims report
November 11, 2022
Front Office Discussion
Message Board
Views: 110 | Replies: 5
, that this does not happen for existing non medicare dual complete patients. Please help! You could file an appeal as outlined in the denial eob you received. I have been successful going that route.However, I have found that those on Medicare are not afraid to get scrappy with their insurance plans. Punt
February 08, 2024
PPOs and HMOs
Message Board
Views: 217 | Replies: 8
copayments at time of service. So, you can learn not just billing, but also the nuts and bolts of insurance verification and estimating. It is not hard. Time consuming, yes, which is why I pay my staff do it, but I know how it is done. I've got access to all the websites. I've got the lists of phone numbers
June 11, 2024
Billing
Message Board
Views: 139 | Replies: 5
So, we sent a prior for a partial denture. There is zero coverage from the insurance, but instead of billing out at $1000, they say our plan max is $400. Can they dictate that even though its not covered? Not quite sure how to proceed, especially given that the $400 will barely cover the lab
June 02, 2018
Coding Q&A
Message Board
Views: 198 | Replies: 7
SR/P over 2 visits with local. Any advice on what to say in a appeal? nothing to be said in the appeal. why even bother. It is a shitty policy. Advise the patient that their insurance only covers the treatment if you allow the disease to ravage their mouth to the point of non-reversible damage
November 10, 2020
Claims Processing
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