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Message Board
Views: 155 | Replies: 4
for the treatment they need.Any insight into this new insurance problem would be appreciated.Thank you I have noticed a general tendency for insurance companies to make it much more difficult to file any kind of SRP or perio related claims. Much stricter rules, more and more documentation required. They know
August 21, 2019
Coding Q&A
Message Board
Views: 74 | Replies: 5
For those that have Dentrix. How do you post your office fee on the ledger but still get accurate treatment estimates? If I put a delta fee schedule in for a patient I can estimate their portion with the treatment planner but then it also posts the insurance fees to the ledger (I'm not talking
October 22, 2024
Billing
Message Board
Views: 380 | Replies: 14
patients to pay their bills if they see you did your best. They'll know the insurance refused to pay for benefits they're owed. Case 2: fracturelineis considered a dirty word when writing narratives or clinical notes. UHC overturns most of these denials once you question their integrity
December 02, 2022
Claims Processing
Message Board
Views: 447 | Replies: 12
, these should not affect your time at all. Start sending it all with the original claim and then you avoid the denials and delays. As for the licensure. Do understand insurance is not saying whether you can do the SRP or not, they do not have that authority. They do however have the ability to set
January 09, 2024
Claims Processing
Message Board
Views: 134 | Replies: 2
Has anyone else noticed Denial letters from Guardian for crowns and inlays. We have not changed anything that we do or diagnose, but they are denying most of the claims. We are recommending to our patients that they complain to their employers or their HR Departments, and file a legal claim. I am
April 30, 2022
Claims Processing
Message Board
Views: 3539 | Replies: 105
… I wish he could have recorded them.Mark! I have no words for the evil that represents!There is a special place for these silly insurance companies. The situation is getting worse but my wife (14 years of experience and rarely a denial that sticks) contents that a few situations described
July 01, 2015
Front Office Discussion
Message Board
Views: 264 | Replies: 6
Hello Townies Please help!! I am in network with Cigna. Did dentinal desensitizers on patient. It is a covered service. Sent photos of teeth with narrative..Denied!!!!! Sent a second time with a journal quote about minimally invasive dentistry recommended tx.... Got a second denial from Cigna
July 07, 2021
Claims Processing
Message Board
Views: 387 | Replies: 9
, the payment was $0.00, and Aetna dental should pay. Now you have to waste time on a medical claim, and hope your clock doesn't run out. That Sucks. When I've had this happen to me, usually I get a check from their medical insurance carrier for the amount that would have been covered. Most likely they also
November 17, 2022
Claims Processing
Message Board
Views: 776 | Replies: 18
I usually submit for claim 1)perio chart 2)narrative 3)x-rays 4) clinical photos I wonder if clinical photos is over doing it bc i hear it may give insurance extra reason to deny. What do you submit for scrp with metlife or other insurance companies? Thanks. bw's and perio probes with nea fast
June 17, 2014
Claims Processing
Message Board
Views: 147 | Replies: 3
for any number of reasons that the insurance company indicates on the Explanation of Benefits (EOB). These denials must be appealed by following each individual insurance companies appeal process which is usually on their website or more conveniently on the back of the EOB. Follow the process
January 08, 2016
Claims Processing
Message Board
Views: 134 | Replies: 3
Sometimes I wonder... Care to discuss? Well, my answer would be insurance. Only because theircoverage of benefits is pretty straight forward. It's either a covered benefit or not. Beyond that, if it is a covered benefit, you have toknow if there's an alt. benefit, frequency, and limitations. If you
September 16, 2017
Practice Management & Administrative Forum
Message Board
Views: 154 | Replies: 2
of writing off and having to fight with UHC for payments for services rendered.<br/><br/>I have 90 days until I'm termed. I was not planning on sending out a letter as I feel most people will think we don't take there insurance and will just leave. I'm planning on just reviewing
June 09, 2020
Patient Communication / Education
Message Board
Views: 571 | Replies: 12
to contact my state insurance commissioner and file a complaint That's what I'm saying. Total douche...I will adamantly argue that United Healthcare tops the list although UC is quite a...Yes the only insurance company that lowers fees. The insurance company I have ever dropped.Insurances are crazy
March 02, 2016
Claims Processing
Message Board
Views: 67 | Replies: 2
wondering: - Do offices handle anything differently when a patient specifically requests a copy? - Do you charge a fee for providing a copy, or only bill the patient if insurance denies coverage? - Do you inform patients upfront that insurance may not cover the x-ray, or only address it if a denial
October 22, 2025
Patient Communication / Education
Message Board
Views: 423 | Replies: 12
much at all. certainly not into the dentin. I sent the patient a copy of the pre-approval denial and encouraged her to call her insurance and scream. She bought a plan with 4000 annual limit and no copays specifically to fix those front teeth. I learned my lesson with UHC and I don't ever expect them
January 30, 2024
Claims Processing
Blog
In our last two posts, we discussed the importance of knowing when to file a disability insurance claim, and explained that certain actions dentists take before filing can make collecting benefits more difficult or even result in the denial of a claim. In this final post in this series, we
August 01, 2018
by Edward Comitz
Message Board
Views: 241 | Replies: 1
desk /insurance coordinator deal with insurance on the phone all day. Watch them verify benefits, handle denials, send out claims. This will get you familiar with insurance. Then talk to business owners about payroll and business management. Running a dental office from a business side is no different
December 28, 2014
Financing School and Loan Repayment
Message Board
Views: 110 | Replies: 6
planning is smooth as you don't have to figure out what the pay, copay etc. Treat pt than insurance policy 2. Less number of quality patients 3. You don't have to wait 4 weeks to get paid from the insurance 4. NO down grading 5. No denial of claimsMany times, you can get around the PPO fee
February 04, 2014
Claims Processing
Message Board
Views: 134 | Replies: 2
I had a patient with very worn down upper complete dentures, and she needed a replacement badly. So I made a new complete denture for her, and Metlife rejected it saying she has a missing tooth clause and they will not cover any teeth missing prior to signing up for the insurance. Is it worth
February 13, 2014
Claims Processing
Message Board
Views: 250 | Replies: 5
. They're probably covering their bases and putting it into their database for future use in this brave new world....Are you sure it was an office calling and not the patient trying to get the info to send in a claim on their own??? Years ago I had a patient get a blank insurance form (in the olden
July 22, 2015
Claims Processing
Message Board
Views: 354 | Replies: 6
Definition (received with denial). They had the film of a large, deep amalgam on #3. About 3/4 the width of the occlusal and additional decay on the distal. After I removed all of the amalgam and decay, there was a big ol' hole left. Surprisingly, they paid for the crown. I got to do the buildup
April 02, 2016
Delta Dental
Message Board
Views: 2840 | Replies: 74
....and the insurance company is also speaking to their client in that same sentence pitting them against your claim of needing a build up. They are clever. But fortunately you were just taught how to read between the lines.There is difference between the term denial and not a covered benefit
November 18, 2018
Delta Dental
Message Board
Views: 369 | Replies: 18
denials. I have never had an automatic denial for anyone under 30. Look at your documentation- send a letter with your claim if you need to. Make sure your sending a clean claim. Best of Luck. Mr. Patient, your insurance company kinda sucks. They are all about refusing treatment as it puts gas
January 19, 2016
Claims Processing
Dentaltown Magazine
the rationale behind an SRP denial when a patient has signs and symptoms of inflammation and periodontal pathology. What qualifies as “medically necessary”? Why is insurance benefit reimbursement for SRP claims so challenging and seemingly complicated? While periodontology instruction
September 2023
by Dr. Dominique Fufidio, FAGD
Message Board
Views: 420 | Replies: 2
policies through National life of Vermont, they were great. 1 policy through Priincipal Life (newest policy) made me jump through too many hoops and I did not bother.I have had clients been denied by second/third tier insurance companies, even companies with big names associated with them. Overall
June 06, 2018
Practice Acquisitions
Message Board
Views: 753 | Replies: 32
. Extracted #9 same day and prepped for FDP 8x10. Let her heal and she came in for final impression about 6 weeks later. After impression appt, she got an EOB (I'm assuming) and so did we of insurance (United health care PPO) saying they are denying the bridge and downgrading to partial for reason
January 10, 2020
PPOs and HMOs
Message Board
Views: 132 | Replies: 1
take the tooth out on Monday, bring them back Wednesday, and we can all pretend this is smarter.' That is the joke. It is also the tragedy. Because when you slow down and really look at what happened, the denial usually is not random. It is not even mainly about whether the graft was good dentistry
April 21, 2026
Coding Q&A
Message Board
Views: 3326 | Replies: 158
they? Make up pocket depths? Fake X-rays? Inquiring minds want to know. Hey I got a great idea, we should start a seminar The out-of-pocket paid upcharges probably cover the claim denials and bring in more than the insurance would have paid for an adult prophy. I interviewed at a Medicaid place
August 07, 2023
Future Planning General Discussions
Message Board
Views: 851 | Replies: 21
and small endo access. And in most our cases root canals are done due to extensive decay where half of the tooth is gone. We do root canal and crown prep on the same day and it saves us time dealing with insurance BS. P.S. When I started personally supervising all claims/denials I decided to buy Charles
April 14, 2016
Endodontics -- The ENDO Files
Message Board
doing that is in any way a benefit to the patient? Pay more to get less? 2) Denials - I am sorry, but it is not an INSURANCE company's job to police dentistry, period. Yet that is what they seem to do every day. It MIGHT be different if they were truly doing it from a platform of helping
May 09, 2017
CE Comments / Suggestions / Events
Blog
with, the insurance company has a team of in-house doctors, attorneys, vocational experts, etc. working collectively behind the scenes, exploring any weakness that can be used to justify denial of the claim. Then, when the insurance company conducts an on-going, full-scale investigation, it catches them off-guard
January 02, 2018
by Edward Comitz
Message Board
Views: 512 | Replies: 19
Composite of #28 fractured off incisal-buccal. Tooth has large existing MODB composite (see pre-op IO and PA): I did crown #28 for pt because how on earth am I expected to fill that with composite? Insurance denied crowndue to Xrays not showing the tooth deterioration to appear to be over 50
August 08, 2023
Claims Processing
Message Board
Views: 671 | Replies: 28
Tooth #21 to be used as an abutment for a cast metal RPD so it is getting a distal occlusal rest. Also, that is a fracture on the distal lingual line angle, not just a scratch on the mirror. Insurance denied payment of crown and says patients owes zero Is this a another case
July 25, 2023
Claims Processing
Message Board
Views: 79 | Replies: 3
I have a patient who got a root canal and a crown 6 months ago and now the tooth has fractured. It needs an extraction and an implant. Will the insurance pay again for the implant crown for that same tooth if its this recent?Patient has cigna ppo and has coverage for implants.TIA for any help
May 04, 2023
Claims Processing
Message Board
Views: 86 | Replies: 2
ability to do so. Moreso regarding what are your pedo offices charging to insurance when you take pan BWs. Should we fight the denial and say its fine for them to downgrade but shouldn't outright deny it? Have you written a narrative? If not I'd try that first. I think they deny that because it could/would be abused by the mills. I didn't know there was a separate code for PAN BWX vs intraoral- I would just send the typical BWX code.
April 11, 2024
Pediatric Dentistry
Message Board
Views: 194 | Replies: 5
....) It is a long and informative read....but the real easter egg is at the bottom - where the journalists are requesting REAL WORLD details about denials and other bad faith activities conducted by the insurance corporations. Give it a read - then make sure your team has not fallen into the habit
January 16, 2024
Claims Processing
Message Board
Views: 214 | Replies: 4
Remote Sourcing A common question asked of me is, How do I get core buildups covered? We are frustrated with so many claim denials for this service. Theshortanswer is proper clinical evidence of the need and adequate execution of the procedure as described by the ADA CDT current code for a core buildup
September 29, 2023
Coding Q&A
Message Board
Views: 137 | Replies: 4
. Is every state different for the major insurance companies? I know Delta is different in different states. We started Monday 6/1 so I will post as soon as I see. We have not decided to send all through insurance. I started with a simple in house code and told patients they had to pay
June 03, 2020
Coronavirus (Covid-19, SARS-CoV-2)
Message Board
Views: 425 | Replies: 9
it will help those of us involved in dental insurance, do you think that the insurance industry has realized that we have reached the tipping point insofar as the numbers of dentists (debt load, competition) and have embarked on an unprecedented course of claim denials, fee reductions etc. because
July 05, 2014
Claims Processing
Message Board
Views: 579 | Replies: 23
it. Insurance appeals do not need to be about venting your displeasure with the denial; keep it to the processing policy they used to deny, and refute that. It will help the appeal get processed faster. Please make it your own. Thanks a lot for taking the time to do this! Can I use this to appeal the Pre-D? Yes! Use it for any SRP downgrade. Your hygienists and patients will appreciate it. Good luck, UDent!
March 11, 2026
Coding Q&A
Message Board
Views: 651 | Replies: 12
, but now she is really upset because she thinks we are tacking on extra services to her bill. I thought adding services together was called BUNDLING and wasn't allowed? Call the insurance compnay and tell them the build up was done on the prep date and give them the seat date for the crown
April 21, 2014
Claims Processing
Message Board
Views: 17741 | Replies: 1414
for insider trading? Didnt United have the most claim rejections/denials? LOL why are you so angry? He relates more with the rich guy than the guy who is unhappy with the system and wants to bring about change Not quite the John Q figure. This thread was interesting to say the least years ago
December 10, 2024
Dental Insurance for Dentists
Message Board
Views: 248 | Replies: 2
(though not easy) is just to be aware of histories. If you know they're not eligible for Pano or FMX, but they are for bitewings, and you still want the pano, is to just take the pano free of charge and only submit the bitewings to insurance. Then you won't trigger the automatic conversion to FMX and resulting denial of payment for the FMX code (and by extension, the bitewings). Thanks!...
July 12, 2017
Delta Dental
Message Board
Views: 104 | Replies: 5
(D0470) on the day of an exam and subsequently bill for an appliance (like a partial or denture), so long as the initial records are documented as strictly diagnostic rather than procedural. To avoid "unbundling" denials, your clinical notes must show the records were used to evaluate the patient's
March 10, 2026
Coding Q&A
Message Board
Views: 391 | Replies: 8
First off, I am a network provider for this patient's insurance.... Pt has recurrent decay around old composite #10 - MF surface. Just interproximal but breaks the facial surface. We replace that filling and insurance covers appropriately. At the patient's next exam many months later... new decay
June 26, 2015
Claims Processing
Message Board
Views: 226 | Replies: 4
Hello! So I got my first rejected claim. I called the insurance company and told the rep that I was going to slap the Insurance dental consultant back into dental school.... but aside from my irrational anger, she told me the claim was submitted without a narrative. Seems like a great place
February 05, 2020
Claims Processing
Message Board
Views: 127 | Replies: 2
at scheduling when the patient may need to move or budget funds. You really need your FD staff to have some rules and make them confident when asking for it from the patient. I'll respond to the last part first: IF your team is verifying insurance and ensuring your fee schedules are up to date, the should
January 10, 2023
Practice Management & Administrative Forum
Message Board
Views: 254 | Replies: 6
amount of debris, there was no other reason for her swelling. I irrigated it with chlorohexidine and she seems to be fine now. How do I code this for insurance? Of course, code 4342 comes back from insurance denied. Thanks! 4342 is the proper code for 1-3 teeth. Did the ins co give a reason
September 23, 2014
Periodontics
Message Board
Views: 101 | Replies: 7
What's the ADA code? Will the insurance pay for it ? The codes are D9938 D9939 for creation and placement (separate codes). Almost no chance insurance will pay anything. In general insurance does not pay for cosmetics or most temporary treatments Why not use D8680? When to Use D8680 dental code
January 14, 2026
Removable Prosthodontics
Message Board
Views: 249 | Replies: 5
a narrative for this? Is anyone else running into this? If there is no decay and the tooth is asymptomatic, there is no objective need for a crown. Has the pt fractured other teeth? Without a valid need, I agree with the denial. It's up to the patient to decide if they want to pay out
March 18, 2020
Claims Processing
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