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Message Board (37851)
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Message Board
Views: 469 | Replies: 22
Patient opted to have a 4 unit fpd ontist said one of the tooth needs to come out. Couple weeks later, we received a check from the insurance for rpd instead of fpd. W.. T.. Hnow patient has a balance of $700 and very unhappy. Can insurance even do that? After the endodontist said one
April 29, 2014
Restorative Dentistry
Message Board
Views: 433 | Replies: 10
I just read an article in Dental Economics which states that the Affordable Care Act is predicted to decrease the amount of people with dental insurance by 50% in the next 3-5 yrs. When it comes to dentistry, I thought the ACA would help dentistry by mandating kids under age 19 to have dental
November 03, 2014
Dental Insurance for Dentists
Message Board
Views: 282 | Replies: 14
What exactly is the difference, if there is one, between the terms UCR, MAC, in- network, program and acceptable fees? UCR is your rate, what a normal cash patient would pay. MAC is the maximum allowable, the maximum an insurance company will pay for a service. If youre in network, the MAC
April 14, 2022
Claims Processing
Message Board
Views: 1876 | Replies: 73
Okay, I always hear about offering 5%-10% discount on cases to patients if they pay for the treatment plan up front. How many of you all are also giving this same discount to the insurance? To make numbers easy, if you've got a $1,000 case that the patient pays up front for a 10% discount
October 01, 2016
Practice Management & Administrative Forum
Message Board
Views: 820 | Replies: 22
A patient came in with her family and had some work done. She stated she didn't have insurance at the time and paid cash. A few weeks go by and she calls the office and tells us she found out she actually had insurance that we're in network with and wants a refund. Am I required to give her
November 08, 2016
Practice Management & Administrative Forum
Message Board
Views: 186 | Replies: 19
what is the protocol for taking the in network adjustments when you are in network with both 1st and 2nd carrier, especially when they are the same insurance carrier ? If you are in network you agreed to a fee schedule. You are owed that amount of the service you provide regardless of the method
May 16, 2025
Claims Processing
Message Board
Views: 400 | Replies: 25
for the morning crowd. Here's the link: Of course there are different fee schedules when you are in network you agree to lower fees. Same thing with Hospitals. Different fees charged for same procedures based on insurance coverage. In fact here in NJ guy who had no insurance sued (and won) to have
September 13, 2017
Medical / Health Insurance
Blog
You receive a pamphlet or dental savings card in the mail, but you don’t remember signing up for the insurance. What’s the deal? Maybe you already have dental insurance, and if so, then why do you need an additional dental plan? Are dental plans the same as or a replacement to dental
May 13, 2015
by jasonsteel
Message Board
Views: 507 | Replies: 12
and the insurance company. I don't want to send Pre Auths on everyone. I am asking because a friend's kid came in for fillings and the coverage was really bad. I'd like to write off the balance....but not badly enough to commit fraud. You must try to collect, even out of network. And why
February 15, 2016
Claims Processing
Message Board
Views: 883 | Replies: 21
Folks need your advice... I recently received a letter from the insurance company MPE EBS, Inc. requesting all of the money back on claims that were paid back in late July/early August. This included claims on a partial, fills, cleaning etc. for both a husband and wife. When checking eligibility
December 02, 2015
Claims Processing
Message Board
Views: 167 | Replies: 3
Hi,I am a new practice owner. I have been trying to figure out how to track adjusted production in dentrix. I would like to submit UCR to insurance but post an adjusted production amount to the ledger that would depend on each patients insurance benefits. Currently we submit to insurance and also
May 01, 2019
Dentrix
Message Board
Views: 231 | Replies: 8
02-28-25 Arizona Dental BoardHighlights The standard of care requires a written consent form for scaling and root planing. If you give a discount to the patient, then the same discount must be applied to the insurance carrier. For example, 50% off the patient portion means accepting one-half
March 04, 2025
Implant Controversies
Message Board
Views: 96 | Replies: 0
Per our office policy, all patient's sign a financial policy stating that if the patients does not have active dental coverage on the date of service or presents any dental insurance, our office does not have to bill their insurance a claim after the date of service. I am practicing in Texas and I
March 27, 2018
Claims Processing
Message Board
Views: 44 | Replies: 0
Just coughed up $700 for a bunch of backed up bills from the insurance dental billing clearinghouse. Question is: why should I pay to submit insurance claims? It should cost nothing to fill out an online insurance claim form and send it electronically to the insurance company. For basic services
August 27, 2024
Claims Processing
Message Board
Views: 403 | Replies: 14
We have had a nagging issue that no one seems to have an answer for. ES17 Scenario: A new patient calls and makes his first appointment for exam and prophy , xrays etc. This appointment is placed on the scheduler but no insurance information is entered into data at that time on the phone
October 12, 2015
EagleSoft
Message Board
Views: 238 | Replies: 5
We are running into an issue where some of the insurance companies for which we are a provider for, are setting are fees according to their fee schedule, even though the patient may only have preventative coverage. Is this legal for them to do that? Would it be very difficult to renegotiate
January 18, 2015
Claims Processing
Message Board
Views: 2127 | Replies: 59
I am seriously considering getting out of the business of providing health insurance for my staff. The increases are too much. They gripe about it not being good enough, etc etc. And with obamacare currently imploding it seems like this might be the best time to bail out. Is it possible to attract
October 14, 2016
Pediatric Dentistry
Message Board
Views: 14342 | Replies: 7242
died mysteriously within an eight-day period - were funding al-Qaeda and had advance knowledge of the 9/11 attacks (61-65). 35. The Commission's denial that it found any evidence of Saudi funding of al-Qaeda (65-68). 36. The Commission's denial in particular that it found any evidence that money
August 29, 2007
Politics - DO NOT Enter if easily offended
Message Board
Views: 83967 | Replies: 22054
out a true weakness in another person (even though that is NOT what KP was intentionally trying to do to me personally by his mention of someone not strong in his/her convictions). Anyway often this really hits a nerve... Gut reaction is sometimes: *denial/anger, then remorse (for getting upset
July 26, 2004
Religion & The Spiritual Side of Dentistry
Message Board
Views: 2266 | Replies: 150
. Yes... orthodontic treatment can affect the anatomy of the airway. What is the sense in all of this denial and disparagement of doctors trying to advance the knowledge of physiology?? Why would anyone try to block that?? It also begs the question; What is ideal? In the American Civil War
November 17, 2016
TMD and Occlusion
Message Board
Views: 89 | Replies: 6
How many of you are apart of the American Dental Assistants Association? I encourage all DAs to look at this membership seriously - there are so many FREE CE courses, liability insurance, chances to become a published author and so much more. As a member for 4 years, I encourage any and ALL
October 26, 2018
Dental Assistants
Message Board
Views: 929 | Replies: 33
and each contract. You may have already agreed to file all claims with your insurance company PPO or DMO, so you need to read your contract.The HIPAA privacy rule allows for any patient to waive notification to their insurance company of any procedure done so long as the patient pays the den tests
April 17, 2015
Coding Q&A
Message Board
Views: 528 | Replies: 13
I am OON with Humana and United Health Care. These insurances have very low fees, including all the NP fees (exam, FMX, prophy, etc.). Typically, when a NP call who is OON, we underestimate the insurance reimbursement by 10%-20% in order to avoid sending statements and send refund checks instead
October 17, 2015
Claims Processing
Message Board
Views: 847 | Replies: 24
Do you accept my dental insurance? *I hear this question MANY times a week. I would like to share with you the nine sentences I use to maximize my success and sanity
March 24, 2022
PPOs and HMOs
Message Board
Views: 2996 | Replies: 95
I have this problem and I hope somebody will help me solve it. I have some blue-collar patients without dental insurance and I might attract some more. To be honest, I don't know how to price my initial exam. I used to do a free initial consult. On the one hand, I'd like to decrease
November 08, 2014
Ask a Dental Consultant
Blog
Join me on this week's episode of T-Bone Speaks for my discussion with Sandi Hudson from about how to negotiate with PPO insurance companies. Sandi is the co-owner and founder of Unlock the PPO, which specializes in analyzing the relationship between dental practices and PPOs
July 03, 2018
by tagarwalnc
Message Board
Views: 190 | Replies: 14
/Getty Images that the upcoming federal budget will announce the government's plan to tax employer-provided health and dental insurance have generated considerable buzz in Ottawa. It would be a significant change that would affect millions of Canadians and involve
December 24, 2016
Canada
Message Board
Views: 184 | Replies: 5
A had a few new patients in January from other Dental Offices which offered them discounts on their cleanings because they had no Dental Insurance. One of the offices offered patients without insurance a fee of $99 which included 2 cleanings and 2 exams for the year plus initial x-rays. The other
February 06, 2015
Dental Insurance for Dentists
Message Board
Views: 70 | Replies: 5
Im trying to see my (nearly) exact AR for my practice. I can pull the Insurance aging and the Patient aging report. Would it be as simple as adding the 2 together? How do patient credits affect the patient aging report, will it make it lower than what can actually be collected? In other words, if I
May 02, 2024
Billing
Message Board
Views: 711 | Replies: 36
I had a new pt come in last week. He needs some work done and has insurance. His wife came in today and has no insurance and needs RCT#4. Our office fee is $1100 but she's asking to pay her husbands negotiated insurance fee of $762 for her endo that she will pay outright. What would you guys do
August 22, 2017
Practice Management & Administrative Forum
Message Board
Views: 473 | Replies: 7
I am looking at purchasing a business owners policy for my practice i recently bought from my dad. I have a quote from Bankers Insurance Group for $3280/year which includes some features below. general liability $1,000,000/ 2,000,000 Business personal property $420,000 Also included
May 12, 2019
Practice Management & Administrative Forum
Message Board
Views: 197 | Replies: 0
What kinds of horrible things have you seen that people have done in the name of dental insurance? Patients won't take care of themselves, dentists over or undertreat. (Edit) Sorry - no longer hotlinking images from DentalBuzz. But you can still see the article from my signature file.... Why
January 25, 2018
Ethical Issues
Message Board
Views: 411 | Replies: 3
Hello, So I have recently tried to sign up for the office overhead expense insurance offered by the ADA/Great-west financials. I already have some of their other products like personal disability and life insurance. I went through the underwriting process and now I'm hit with a rider telling me
August 07, 2017
Practice Management & Administrative Forum
Message Board
Views: 286 | Replies: 3
I am a par dentist with two different insurance companies. I am considering going non par with all in the near future. If/when I do this, is it legal/ethical to tell my existing patients that I presently par with that I will give them a 10% prepayment discount? Just wondering. Thanks I don't
June 22, 2014
Ethical Issues
Blog
I have a question about possible unethical practices by dental insurance company(ies). I just recently had a patient call my office to have her records sent to another office stating: You participate with my insurance but you are too expensive. My staff asked several questions about being too
October 21, 2016
by dwalin18
Message Board
Views: 391 | Replies: 10
form would have a place to write in the following: Total Fee $_____ Less Estimated Insurance $_____ Patient Estimated Co-pay $_____ While discussing this with the Financial Coordinator, she brought up the scenario of how to fill it out when we are in-network
May 21, 2015
Front Office Discussion
Message Board
Views: 821 | Replies: 44
. Your insurance will probably cover $2K, the cost of a single implant. Do you still want to do it? I've been out of the game for a long time now, so I may be missing something here, but 20K for U/L implant supported dentures seems high. What kind of dentures are these? Does MetLife pay for those
September 23, 2021
PPOs and HMOs
Message Board
Views: 873 | Replies: 22
predictably without opening his vertical and leveling his occlusal plane. His lowers touch the lingual tissue of the uppers.He is not concerned about cost since auto insurance is paying for it. Since the difficulty of this case comes from his preexisting Cl III occl and collapsed bite, how do I decide
July 24, 2017
Ethical Issues
Message Board
Views: 1296 | Replies: 25
The front desk ALWAYS checks a patients insurance and their break down of benefits BEFORE the patients arrives their appointment. The fee schedules have already been loaded into the computer. Here's how the front desk links the fee schedule and their benefits (this is super important in order
July 22, 2015
Front Office Discussion
Message Board
Views: 497 | Replies: 15
Is it considered insurance fraud to not collect a patient portion if they are utilizing an insurance the practice is not in network with? Example: Employees spouse has insurance through their work and needs treatment. Can a practice submit to their insurance and write off the patient's portion
April 27, 2023
PPOs and HMOs
Message Board
Views: 373 | Replies: 20
I've read a lot on these forums how not collecting copay = fraud and I'm curious about a specific situation. I am a completely OON office. During a NP exam I take 4 BWX (D0274) and a PANO (D0330) for, lets say, a total charge of $180. I file the claim with their insurance and the insurance
November 08, 2017
Claims Processing
Message Board
Views: 281 | Replies: 6
So, over the years we have had patients ask us to commit insurance fraud (usually changing the date so that their procedures are covered). Our answer has always been no and explained the definition of insurance fraud to the patients and explained how what they are asking us to do is to commit
August 12, 2014
Staff Management Issues
Podcast
First of all, Quality Care matters! We believe dental insurance was an inspired effort to encourage the public to seek dental care and receive routine preventative care. Unfortunately, dental insurance has become increasingly difficult to manage within the dental practice. Too often do we
May 26, 2017
by Jordon Comstock
Message Board
Views: 395 | Replies: 12
Sorry please dont slap me.When you sayyou are a FFS practice does that mean you accept cash onlyor does that also mean you take INS alsobut out of network so you collect copays upto your UCR fees? For me it means that I am paid 100% by the patient prior to treatment.All insurance reimbursement goes
May 15, 2019
Ask a Dental Consultant
Message Board
Views: 316 | Replies: 26
Say, 4 years after a crown was done the tooth needs an implant. A 30 year old RCT failed and could not be re-treated. The waiting period on crowns is 5 years. Now, the insurance person claims, when we send a pre-d for an implant, the amount they paid for the crown will be deducted from
March 27, 2019
PPOs and HMOs
Message Board
Views: 154 | Replies: 7
Hello, Can anyone tell me if they use code D0351 Digital 3D Images and if any insurances will pay for this diagnostic procedure? Thanks Mark Hi Mark, I've seen little success with the D0350, not to sure about the D0351. The D0350 typically denies as a non-covered procedure.I use that code all
September 11, 2018
Coding Q&A
Message Board
Views: 125 | Replies: 15
I already purchased pre-paid state college plans for my kids and have been contributing to a 529 as well. This year I'm considering starting a Roth instead of continuing 529. My advisor is recommending a Life Insurance with Living Benefits instead of Roth or 529. Anyone familiar with this product
April 13, 2017
Life Insurance
Message Board
Views: 211 | Replies: 8
We are searching for a more efficient way to provide pre treatment estimates for our patients and to shift the responsibility for estimates from our office to the insurance company. Today, we call the patient's insurance company to obtain patient coverage based on their insurance plans. We can
March 12, 2019
Claims Processing
Message Board
Views: 516 | Replies: 27
Has anyone considered opening a satellite office that does not take insurance (assuming your main office do take insurance) and send patients from main office to satellite office to do more expensive procedures such as invisalign, veneers, implants, etc? I think most of us know that insurance fees
October 07, 2018
Practice Management & Administrative Forum
Message Board
Views: 193 | Replies: 8
Hi I was looking to cover some staff members that dont have medical insurance esp now .. any feedback would be appreciated I do not. Not in the budget. So we have a very specific insurance policy. We do provide insurance but we do not offer a stipend if you get insurance from your spouse or if you
May 15, 2020
Staff Management Issues
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