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Searching: insurance denials
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Message Board (37849)
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Message Board
Views: 225 | Replies: 2
I have just acquired a practice and need to know what the protocol is for claims processing and credentialing. The original owner Doc is going to be working part time and there will be a new associate in the practice. The new associate has been credentialed with insurances in the past
August 06, 2017
Claims Processing
Message Board
Views: 439 | Replies: 9
I have been a participant with United Healthcare for several years now. I find there fees on the low side. They also give me the hardest time with claims. They are far worse then any other dental insurance company I have dealt with. They seem to deny crowns for almost every time we submit
December 06, 2017
PPOs and HMOs
Message Board
Views: 230 | Replies: 4
Anyone hear about this medical billing company in Orange,Ca? They claim to preauth, bill, and collect from medical insurance and Medicare on general dentists behalf for implant/grafting for 10% of collections. Sounds pretty shady to me. I m thinking to sign up. Does anyone have experience? From my
July 28, 2021
Medical / Health Insurance
Message Board
Views: 102 | Replies: 5
HiPredetermining for crown.So if patient has 4mm pocket depth in 2 locations and 3mm in all other in the same tooth. Would u write statement on Perio condition as wnl or not wnl.To insurance for approval? I don't write anything.Don't help them do their work.Send in your complete perio charting
November 08, 2019
Claims Processing
Message Board
Views: 152 | Replies: 5
I moved and my license renewal form wasn't forwarded properly. I renewed as soon as I became aware that my license has expired. I'm getting $1000's of dollars of claims denied from insurance companies. Can anything be done to get these claims paid? J Appeal the denial with an explanation and maybe
December 01, 2018
Claims Processing
Message Board
Views: 218 | Replies: 6
to a supervisor? Have the elevated the claim status to urgent? As long as there wasn't a previous denial or request for info that was never received, most insurance reps are pretty good about understanding that an overdue claim needs to be processed and elevated. This is unacceptable from both your end
January 25, 2017
Claims Processing
Message Board
Views: 573 | Replies: 26
Happy new years! Just acquired practice and the OM retired with owner. She was not available to train anyone. Who do I hire for dental billing? Title? Who bills insurance and patients in your office? And makes sure everything is current? I need to hire someone but don't know how or where to look
November 23, 2025
Practice Management & Administrative Forum
Message Board
Views: 175 | Replies: 5
much you all charges? Thank you Depends on why: Most often you have the scenario that these things are covered, just downgraded. Meaning when you do a porc/composite insurance will pay based on metal/amalgam. If you are in-network, you charge the patient up to the in-network fee of the procedure you
August 23, 2019
Coding Q&A
Message Board
Views: 315 | Replies: 7
a way for the insurance company to hold onto money for a little bit longer.yeah number #1 reason for denial for bridge is missing tooth clause. They will deny if pt is missing teeth on opposite side as well. they rather cover partial denture in that case. also if there is incomplete endo or bone loss
December 19, 2014
Restorative Dentistry
Message Board
Views: 943 | Replies: 63
.... why know the plan terms? It provides you the knowledge to 1. improve your treatment plan acceptance when patients expect to pay less out of pocket because insurance will pay towards treatment 2. avoid unexpected claim denials/anticipate claim denials and collect upfront 3. verify that the patient
February 04, 2021
PPOs and HMOs
Message Board
Views: 131 | Replies: 7
What recourse do we have with an insurance company giving us the run around saying they've not received materials from us when clearly they have and we've sent them multiple times? Do state insurance commissions do anything about these matters any more? It's been a while since we've experienced
August 22, 2019
Dental Insurance for Dentists
Message Board
Views: 171 | Replies: 4
What do you all do when a patient comes in with an insurance you are networked with, but their secondary one you are not networked with? We have in the past been lenient with this, and we have filed these secondary claims. They seem to be more of a pain than they are worth! Can we just collect
February 02, 2016
Claims Processing
Message Board
Views: 220 | Replies: 8
HiAny recommendations for a good accurate insurance verification out there. Not looking for breakdowns but only to verify if a pt has coverage or not.Thanks ClaimX by ExtraDent does a great job and is fairly cheap. It pulls your entire schedule with one click. Integrates with most softwares.Wow
October 18, 2019
Claims Processing
Message Board
Views: 446 | Replies: 11
So we had an ins tell us we shouldn't do 4 quads in one session. Why is a full mouth rehab 24-28 crowns OK, or 4 FBI OK and not the SRP? Is it the time? The trauma? the post... anything excuse to get out of paying. the excuses are getting really really bad lately....I'm sure the insurance company
March 12, 2015
Periodontics
Message Board
Views: 245 | Replies: 3
for my state of South Carolina, but they can help me sign up for these three if needed. I will attach a doc of the fee schedules. There is a monthly fee of $750 to get you verified with all the insurances and to get the increased fee schedule. This monthly fee also includes an account manager
September 30, 2022
Practice Acquisitions
Message Board
Views: 228 | Replies: 7
My patient is convinced that his medical insurance pays for his implants. Apparently his medical plan required a formal denial from the dental ins. company before paying for the implants. He wants to know whether his med. insurance company would pay for the abutments and crowns. Is there a way
January 24, 2015
Coding Q&A
Message Board
Views: 593 | Replies: 7
Has anyone else had annual bitewings denied by UC? We had our first denial for payment and when my front desk contacted UC, she was told they only cover bw's every 18 months now. I never received any notification, did I miss... Cool, you should start to find more cavities to treat now that you only
June 15, 2017
PPOs and HMOs
Message Board
Views: 289 | Replies: 11
Need a good nerative to appeal uc claim denial. Pt no care over two yrs generalized 4,5,6 mm pockets. With all the clinical signs of perio including some radio graphic calculus.This is what they say some of you have seen this lame garbage Need evidence of loss due to perio. X rays do
September 17, 2014
Claims Processing
Message Board
Views: 121 | Replies: 2
the traditional methods of appeal. The DOL is the equivalent of the state insurance board for a self-funded plan. A 2nd plan is not obligated to pay just because it is a secondary. The clauses and provisions of the plan (no duplication, ect) can dictate a denial of payment for any number of reasons
August 03, 2014
Claims Processing
Message Board
Views: 208 | Replies: 4
Dentists love dentistry. They tolerate insurance. That is the relationship. Most practices do not wake up excited to 'optimize reimbursement,' yet insurance quietly decides whether your day feels profitable or like you are running a charity with better lighting. Townies keep circling back
December 15, 2025
Claims Processing
Message Board
Views: 1019 | Replies: 42
future treatment on patient. I would write a letter to delta throwing lots of dental words at it then threaten to send to the insurance commissioners. This worked for me on a double rejection from another insurance carrier. They also wanted me to charge nothing. After about a month they reversed
January 23, 2020
Delta Dental
Message Board
Views: 2295 | Replies: 48
Just got a claim denial back for crown #14. Yup, endodonticaly treated molar with MOD restoration has NO NEED for a crown. Yes, I know, it's probably a stall tactic and will be paid eventually, but come on! Idiots
June 12, 2018
Claims Processing
Dentaltown Magazine
Not all disability policies are created equal, and if you’ve got one from 2000 or after, chances are you may not have the coverage you think you do by Edward O. Comitz, Esq., and Derek R. Funk, Esq. As dentists, you probably have at least one disability insurance policy. But do you
March 2019
by Edward O. Comitz, Esq., and Derek R. Funk, Esq.
Message Board
Views: 147 | Replies: 7
. Instruct the insurance company to seek reimbursement from the insured (not that they will). Ask for correct EOB showing the reason for denials of each service mailed to you and the patient -- without the corrected EOB you will not consider their request for reimbursement. I would include
December 22, 2022
Claims Processing
Message Board
Views: 1273 | Replies: 40
Not to derail thread Laz, but i was just saying that similar insurance related issues are not specific to medicaid. Even PPOs have similar issues with bogus claim denials and jumping through hoops for obvious stuff. As far as insurance help goes, for most its like $700 of premiums every year to get
September 03, 2020
Pediatric Dentistry
Message Board
Views: 178 | Replies: 4
a D0140 for patients that call for second opinions or have been referred for txmt. They bring up the point that some insurances will not cover a D0150 if they just had one less than 6 months ago at a different office. How do others handle this? Never really thought about it. Where I was an associate
August 30, 2016
Pediatric Dentistry
Message Board
Views: 602 | Replies: 36
tooth syndrome, pain on opening, tooth has been symptomatic, visible fracture trapping debris" and I haven't run into any issues with denials yet knock on wood. Advanced course. gotta shout out Travis the dental insurance guy for sharing so much of his wisdom on here. He's a national treasure. Does
April 02, 2026
Claims Processing
Message Board
Views: 243 | Replies: 11
the United States. The top reason for claim denials is the incorrect or missing supporting documentation. 2.Implementing systems for insurance verification before their visit is essential for cash flow and minimizing headaches. You don't have to worry about this if you're collecting your fees
March 07, 2023
PPOs and HMOs
Message Board
Views: 148 | Replies: 2
Hi,New grad here. Accepted a position with a small DSO and was able to submit license, diploma, NPI, and DEA number to credentialing dept for PPO/DMO insurances. Any idea on how fast this process takes? Submitted paperwork a month ago and credentialing dept is telling me theyre not sure how long
August 11, 2021
PPOs and HMOs
Message Board
Views: 146 | Replies: 3
When a pt has extractions and needs something immediately. I use code5140 immediate denture. I will include a temporary denture for day of surgery, all the monthly tissue conditioners, and adjustments. This code also includes a final denture 6 mths later. I am now taking insurance- and trying
June 17, 2015
Coding Q&A
Message Board
Views: 249 | Replies: 6
I need to know if people are having the same issues. Stopped participating because too many denials for simple things like one surface fillings. NOW they are denying a root canal because NO SIGN OF INFECTION OR IRREVERSIBLE PULPITITS. Sent two appeals explaining patient had temporary filling
September 12, 2016
Claims Processing
Message Board
Views: 139 | Replies: 1
, after about 10 denials of D1110 and D0330, and about 5 phone calls to the VA, I think I finally talked to someone who knew what was going on. Guess what? I have the ADA to thank. Apperantly, they are reccomending including more area of the oral cavity and tooth number information, and the VA is going
May 11, 2021
Claims Processing
Message Board
Views: 141 | Replies: 2
reports. 2. I cross check daily reports. 3. She takes care of all denials, resubmits, etc and gives me all the entered claims and deposited checks to review. She's been doing a great job and our A/R is amazing so is there any reason for me to put eyes on the hundreds of claims per week if I've already
August 31, 2024
Billing
Message Board
Views: 92 | Replies: 7
We just got a denial from DD for SRP due to Patient exceeds age limit for this service. Is this a thing now? Or do you think this was a random automated/AI rejection? Is this an upper or lower age limit? How old is the patient? Exceeds? As in too old? Not sure there is such a thing. Too young
February 20, 2025
Delta Dental
Message Board
Views: 184 | Replies: 2
and allowed the site to heal then graft. WTF? Why would I do that? In the future collect for the grafting in full and explain to the patient that if the insurance pays they will be refunded but 95% of the time they will not pay. That lets the patient know you provide treatment that is needed
June 05, 2016
Claims Processing
Message Board
Views: 1372 | Replies: 33
the perf. I was trying to help the patient and the referring dentist so I only billed for the extraction which was covered by insurance. A month later I get a denial for the extraction because it had already been paid to the referring dentist. The bone grafting is what gets me the most. Had a few
July 20, 2017
Oral & Maxillofacial Surgery
Message Board
Views: 226 | Replies: 0
I am appealing a denial for a claim where I performed a flap for debridement and a bone replacement graft in the same quad. Does anyone have any clinical sounding jargon for the purpose of the bone replacement graft/GTR concept?
February 09, 2015
Periodontics
Message Board
Views: 154 | Replies: 2
Am I missing something? In the last couple weeks, we have had 3 separate families who's insurance has denied fluoride for the second cleaning of the year. Since I was a kid old enough to remember, fluoride was standard at every apt! Two families had Metlife Insurance and one was Cigna
December 22, 2014
Claims Processing
Message Board
Views: 200 | Replies: 3
to collect more than the insurance estimate to stay in business rather than wait months to see the denial and request for more docs. usually i am against insurance companies, categorically as I find them to be an impedance between ourselves and the patient. that being said I am ok with this stipulation
June 21, 2021
Claims Processing
Message Board
Views: 311 | Replies: 10
) Not sure where the idea of a pre-D being necessary for SRPs came from, but that is untrue. Almost every case of SRP denial is due to lack of GOOD documentation. (And of course every dentist thinks they have good documentation until they see what good really means) 2) Yes, with some insurances you
April 13, 2022
Claims Processing
Message Board
Views: 395 | Replies: 8
seeing dual insurance coverage. But, now it is more paper trail, phone calls, denial of coverage leading to frustrations. TIA for any advices. Anyone have any input on this? Thanks! Our office policy states that we will file secondary as a courtesy but will only calculate copays based on primary
March 22, 2025
PPOs and HMOs
Message Board
Views: 662 | Replies: 24
correct. Somehow the office always enters the data correctly under the owner's name and the denials magically disappear. Our office has both a Premier doc and PPO doc. So I can also assure you being in network can cost the insurance company more on some claims than being OON or a provider being premier
May 01, 2024
Claims Processing
Message Board
Views: 56 | Replies: 5
the arbitration - however, if a contracted fee is 5000 and a company does some hocus pocus magic and says, no you can't charge more than 4000 for this code because the treatment is not 24 mo, but only 16 sounds wrong. Except that the insurance company doesn't think so. Not only they don't take the D80xx
July 18, 2019
Claims Processing
Message Board
Views: 98 | Replies: 1
New Year and thank you for being a participating provider in Humanas Federal Employees Dental and Vision Insurance Program (FEDVIP) PPO network
January 10, 2023
PPOs and HMOs
Message Board
Views: 145 | Replies: 5
them examine it under a microscope and then have it fedexed back for reimplantation....Guys there is no insurance anymore, just blatant scam artists. Do insurance companies make you submit evidence of caries on simple fillings? A human never saw this claim. Theyre just hoping that your
March 05, 2025
Going Out of Network
Message Board
Views: 963 | Replies: 29
. If anyone else wants it, I will PM it to you. Thanks, Sue Insurance and patient accounts recovery. This is the one that I use on my claims: Build-up necessary because insufficient tooth structure remains to support the crown after all removal of caries. This come right out of the ADA code
March 26, 2018
Claims Processing
Message Board
Views: 410 | Replies: 8
Hi, Im a new grad. This has concerned me since I started working in this dental office. Basically the office accepts all insurances including Medicaid. When doing crown cases for Medicaid, the office only pre-D full cast metal crown, then once it has approved, the office tells pt that the insurance
October 15, 2022
Legal Issues
Message Board
Views: 202 | Replies: 8
will be there. Curious- do you refer to the uploaded EOB often? These can be accessed on the insurance portals. Just wondering what benefit there is to uploading them if you have access elsewhere. We only upload EOBs that are unusual (denial, partial pay for large case, etc) or that we would have difficulty getting
November 15, 2022
Practice Management & Administrative Forum
Message Board
Views: 198 | Replies: 3
Insurance(PPO) companies are now downgrading 2 surface fillings that dont involve interproximal surfaces to one. I have seen D4341 being downgraded to D4342- 3 teeth or less even though there are more than 3 teeth in that quadrant. Most dental offices dont have the time or resources to balance bill
September 26, 2024
Claims Processing
Message Board
Views: 73 | Replies: 2
in network with both. If you're OON with one or the other, Depending on which one is primary sometimes you have to bill the HMO or the PPO justto get a denial beforea secondary will consider the claim. Crazy!
February 08, 2018
PPOs and HMOs
Displaying 551-600 of 40839
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Page 12 of 817
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