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Message Board
Views: 201 | Replies: 6
but this one is a new insurance company to us. So all i need is a denial from the medical company. but i have no idea how to fill out a medical claim form or where i would get on. I would appreciate the help. thanks Ha. See if you can get the money from the patient, and have them reimbursed
February 10, 2017
Front Office Discussion
Message Board
Views: 466 | Replies: 10
and get a denial before we can accept any cash or we have them sign a waiver that they are bypassing their insurance and paying for treatment and do not expect to be reimbursed.Medicaid in AR does not cover S&RP and I have many patients who pay out of pocket for this service. Just make sure you
March 17, 2015
Medicaid and Welfare Issues
Message Board
Views: 878 | Replies: 12
All claims types: 30 days for payment or denial 18% annually North Carolina Department of Insurance PO Box 26387 Raleigh, NC 27611 919-733-2032
October 03, 2014
Claims Processing
Message Board
Views: 1022 | Replies: 48
a clinical exam to diagnose a patient, for a dentist at insurance to disagree with another dentist's treatment plan. This means disallowing treatment is purely illegal, unless they are claiming fraud. However, denials are NOT about treatment validity, they are more about whether your level
October 10, 2023
Claims Processing
Message Board
Views: 1065 | Replies: 67
long for the denial/request for info to arrive. I have never encountered an insurance company recouping anything from a providers bank account. If theyre going to take money, theyll do it from a future claim payment. Im not saying its impossible, Im just saying Ive never seen or heard it. I had one
February 02, 2024
Claims Processing
Message Board
Views: 361 | Replies: 12
Has anyone gotten this denial letter? A friend was denied payment for a root canal and crown because patient has not been in for 3 years. I know that in Kansas state employees get reduced benefits if they are not seen on at least once a year. This is an example of dental insurance valuing
June 19, 2014
Claims Processing
Message Board
Views: 217 | Replies: 10
deny any crown. Documentation is the most frequent denial reason. Composites andindirectrestorations (crowns, onlays, etc.) dont share the frequency. You should expect payment as usual. What may occur is a buildup not being covered, sometimes they share frequencies with composites. Buildups
March 28, 2023
Claims Processing
Message Board
Views: 415 | Replies: 16
the total of an FMX the insurance bundles it into the FMX. File your BW and PAs separately on a different claim, usually they will get paid. I tell patients that Delta is a crooked, corrupt den of snakes, and unfortunately they are denying payment for needed treatment so Delta's CEO can afford gas
November 11, 2020
Delta Dental
Message Board
Views: 297 | Replies: 9
I received a Economic Injury Not Substantiated denial letter from the SBA for my 2 offices.The application itself was the 4-page streamlined application that came with $1k advance per employee, which I did receive for both offices.All my colleagues with offices got approved for $150k EIDL each
July 22, 2020
Personal Finance
Message Board
Views: 6743 | Replies: 240
Can you share the denial EOB and the Delta recoupment request. They arent making a determination if the crowns are necessary. Delta, based on his contractual agreement, is stipulating that he must render the treatment on their fee schedule. If he had sent out a pre-determination and they accepted
February 26, 2021
Delta Dental
Message Board
Views: 131 | Replies: 4
it in the education area of our website (click the logo). It's not about limiting new patients, it's more about replacing the number of patients represented by the plan FIRST, then calling the insurance company and cancelling your contract with them. But there's a lot more to doing it right, so grab the guide
February 22, 2021
Ask a Dental Consultant
Dentaltown News
knowledge and understanding of the insurance and patient billing process and has worked in the revenue cycle field for the past nine years. At GEDC, Hartman’s role will cover all insurance and accounts receivable functions. He will focus on building systems and processes to reduce denials
January 03, 2018
Message Board
Views: 374 | Replies: 11
a breakdown on the front end on those common procedures so you don't get burnt on the back end. United Concordia is officially the worst insurance company I've dealt with yet Dropped those A-holes last week... Go back to your igloo.Have not seen this yet but they are one of the worst. Won't pay for PA X
June 17, 2015
Pediatric Dentistry
Message Board
Views: 12816 | Replies: 1922
. Not interested, insurance will just pass the costs on with higher premiums. Went to the US Attorney General with this problem, too small to be a concern. Took the problem to the US Postmaster General, because billing was being done by use of mail, not concerned. Went to the dental board and they were
February 18, 2008
Ethical Issues
Blog
, or can affect the whole mouth. Maybe you expected to hear you have a cavity or two, but gum disease?! Stage 2: DENIAL() “No way.” “Check again.” Denial is a powerful thing. The human brain can do amazing things to protect itself from things we may not want to have
March 30, 2017
by seodentals
Blog
, or can affect the whole mouth. Maybe you expected to hear you have a cavity or two, but gum disease?! Stage 2: DENIAL() “No way.” “Check again.” Denial is a powerful thing. The human brain can do amazing things to protect itself from things we may not want to have
March 30, 2017
by seodentals
Message Board
Views: 75 | Replies: 3
We had a patient who needs an occlusal guard, we scanned him and sent off to lab to fabricate the guard. My front desk tells me that we received a denial letter for the guard because of a frequency issue. We submitted the claim on scan date and that was 6 days before the frequency would allow a new
June 26, 2024
Claims Processing
Message Board
Views: 757 | Replies: 43
reimbursed for a composite in this situation. The bigger issue is the denial of treatment, not the treatment choice itself. If this keeps happening you are going to get doctors swiping off cusps with a bur and claiming cusp fracture to the insurance companies. My guess is this already happens
October 08, 2014
Restorative Dentistry
Message Board
Views: 1227 | Replies: 33
Got a denial letter on the post/core/crown I did on #31 for this patient that states it has been determined that the crown and post and core on Tooth Number 31 has a poor prognosis due to the proximity to the impacete Tooth Number 32, which is causing bone loss and root damage to the distal
October 25, 2021
Claims Processing
Message Board
Views: 1429 | Replies: 59
You know, Dew, this happens so rarely, it's barely worth talking about. If this were to happen even a few times per year, it might be worth investigating - but it doesn't even happen that much. If once every few year, I have to write off $1000 cause we messed up in figuring out the insurance - so
February 21, 2014
Licensing by Credentials
Message Board
Views: 75 | Replies: 1
setups (instruments/materials Phone scripts Hygiene protocols Scheduling policies Staff task checklists Process of how to do Insurance claims and billing For example, the other day we had a repeat offender who consistently denied X-rays, so I ended up creating an SOP for handling X-ray/exam denials
April 16, 2026
Practice Management & Administrative Forum
Message Board
Views: 1145 | Replies: 44
and it was a different insurance company. If anyone knows where we can find the rates of denial of claims, I would be interested in reading it as it would factor into my decision-making. As it stands now, I simply look at the #'s and it's not even close. To the original post, I paid $23/ month for each thousand
June 02, 2021
Personal Finance
Message Board
Views: 359 | Replies: 9
. We are seeing more and more insurances request medical necessity for taking xrays.If you take an x-ray at prep appointment, and you already took a recent x-ray at the recare visit for crown treatment planning, you may get a denial since you already took an x-ray for medical necessity of a crown
January 05, 2020
Coding Q&A
Message Board
Views: 4678 | Replies: 244
, if the insurance doesn't cover it, then I must not need it. So is the strategy to get a denial and have an upset patient? How not sending pre-d's makes it better? I am not following the logic. That and how is it different from telling the patient that the estimated insurance contributions are 0
December 02, 2022
PPOs and HMOs
Message Board
Views: 308 | Replies: 8
This is the first time I ever saw this. Guardian is denying a patient a full upper denture because he had no teeth. The preauth actually said that the extractions were done prior to his insurance being active. Patient had extraction several months ago and switch jobs. Has any one ever encounter
January 24, 2017
PPOs and HMOs
Message Board
Views: 209 | Replies: 12
not be made without a clinical exam last I checked, Im just saying Damn insurances! go out of network. Then they are screwing the patient, not you. Going OON won't change the denials and downgrades. Only improved documentation will. I would like to know more about documentation course I understand where
October 24, 2024
Claims Processing
Message Board
Views: 113 | Replies: 1
op PA or BW. To be honest I only take a post op BW when I bond the tooth to check for excess cement. I only get denials for the tooth having enough support for the crown, which means they are denying the build up.
April 22, 2015
Claims Processing
Message Board
Views: 362 | Replies: 14
. as far back as i remember. circa 2000's. you answered your own question bill out the bu on the prep day and then bill out the crown on the seat date. Some insurances only pay on seat date so watch out for that. i dont know what same day crown ppl do if they did bu and crown and complete
July 28, 2022
Claims Processing
Message Board
Views: 323 | Replies: 11
of respondents said they either could not find a provider in their area or could not find one that would accept their insurance. From Kellog, 2017: Bethel, Alaska Children had lower rates of tooth extractions and more preventive care in Alaska Native communities served frequently by Dental Health Aide
September 26, 2017
Dentistry In The News
Message Board
Views: 329 | Replies: 8
An insurance company denied a claim for a surgical extraction claiming that the patient does not have coverage for surgical extractions, only for simple extractions. Can we refile for simple extraction instead and write off the difference? Your insurance policy doesn't cover the procedure
December 30, 2021
Oral & Maxillofacial Surgery
Message Board
Views: 78 | Replies: 1
So pt had a #9 extracted due to perio. We did a bridge #8-11. My favorite insurance beginning with United denied the abutment on #11 saying it was not necessary. I appealed citing antes law, etc. Final decision denied- obviously.. So my question is what will happen if I a) resubmitt 11 as a single
October 24, 2019
Claims Processing
Message Board
Views: 843 | Replies: 26
definitely full perio chart with CAL for another insurance carrier. You won't win this without it. Learn from it. If you can't probe its a FMD period. I do this for all my SRP patients. So far one denial with United Concordia in November when they seem to deny everything. Dentist reviewed the claim took all
August 27, 2021
Periodontics
Message Board
Views: 1087 | Replies: 34
United Health Care is a relatively new dental insurance we have been having to deal with. Lots of claims denials, for the most trivial of reasons. They are an ornery company, taking up a good bit of time by my office manager. The way they operate, I figured they were just some small-time
July 17, 2024
Claims Processing
Message Board
Views: 997 | Replies: 38
on this. LEAT/APB is just insurance paying less of the service, not the dentist agreeing to that lower fee. Patient pays more. No again, denials are not synonymous with non-billable. Denials are legal and normal. Disallows are non-billable services and are illegal, doesn't mean insurance doesn't try though
August 29, 2024
Coding Q&A
Message Board
Views: 887 | Replies: 19
and cracked teeth etc that could use crowns, that we monitor. And when I do a crown on a patient that needs it and is symptomatic, and then get denied and told to resubmit to an advisory board, it's borderline criminal what these insurances are doing to their clients. So we can't collect or bill
October 15, 2017
PPOs and HMOs
Message Board
Views: 111 | Replies: 3
Dear Townies, I am in need of some help. I'll start by saying I don't do medical claims and we verify benefits prior. However, one slipped through the cracks and in order to get paid i need a denial from medical. We filled out the 1500 form but the medical carrier states that we need for complete
March 31, 2018
Claims Processing
Message Board
Views: 256 | Replies: 3
Scenario and Question: I am a preferred provider for MetLife. A MetLife subscribing patient receives a prophy at my office. 1 week later we receive a denial of payment for the prophy from MetLife due to the fact the patient had received a prophy 5 months earlier. So MetLife denied it due
March 09, 2016
Claims Processing
Message Board
Views: 481 | Replies: 7
a wall or doing GBR. Hope that helps. Do insurances generally cover bone augmentation in conjunction with dental implants? code i use is 7953. bone graft and membrane is all inclusive. If the plan has implant coverage, it does! The code for this isD6104 - Bone graft at the time of implant
September 04, 2022
Oral & Maxillofacial Surgery
Message Board
Views: 163 | Replies: 11
OK Docs, I am trying to get reimbursement for this patient. She paid cash for the lip repair. She has no dental coverage. I want to know how to submit this to her medical insurance. Lip repair was done I think I need a diagnosis code and a treatment code. Any help would be most appreciated. Thanks
March 25, 2024
Claims Processing
Message Board
Views: 119 | Replies: 7
developed an abscess under a bridge abutment) and again for a broken bridge (other side - completely broke off at the gumline). MetLife is denying both of the limited exams due to frequency. Normally when I do an appeal, I go to the insurance company's website and use their verbiage. For example
March 18, 2022
Claims Processing
Message Board
Views: 614 | Replies: 14
Hello Townies, I am considering outsourcing billing insurances. I've heard bad things about eAssist. I talked to Dental Claim Support (DCS) and I liked them. Of course I spoke with a salesman so naturally he'll make it sound amazing. I want to ask yall about any personal experience yall may have
March 05, 2026
Billing
Message Board
Views: 934944 | Replies: 348121
legislation. A better, stronger, more respected USA under Trump? Only if you will stop the denial that nothing good can come of a slightly warmer and greener Earth vs a browner, colder Earth.... When he spoke at the Libertarian convention he also promised that he would pardon Ross Ulbricht. I
December 09, 2024
Politics - DO NOT Enter if easily offended
Message Board
Views: 422 | Replies: 7
I have finally had enough of the 100% arbitrary claim denials from MetLife. We send charting and X-rays with EVERYTHING, some get bounced back..... Random claims are never received, we submit everything electronically..... Claims are just sitting there, we call and NOW they will be sent
October 17, 2015
Claims Processing
Message Board
Views: 327 | Replies: 14
, NO rejections, NO estimates, NO disallowals or denials. I would rather ALL my patients switch to the discount plan. They just become a discounted FFS patient. I am missing why this is a problem.....It is a blessing! Because I would like to convert these insurance disc plan pts to my in house program I have
September 15, 2021
Claims Processing
Message Board
Views: 393 | Replies: 8
I submited for an extraction of #1 for D7220 to Ameritas insurance. The x-ray showed the occlusal surface was partially covered by tissue and requiring mucoperiostial flap. They downgraded it to D7140 saying that D7220 required the ENTIRE occlusal surface to be covered by tissue. I looked
July 27, 2023
Claims Processing
Message Board
Views: 419 | Replies: 12
for permission they make your life hell. Clinically you did what you think is best for patient. Insurance doesn't have same concerns. Delaying payment helps them make interest on premium payments. Even if you preauthorize, they will deny at that time These denials along with rificulously low
September 17, 2020
PPOs and HMOs
Message Board
Views: 101 | Replies: 5
Lately(or maybe not so lately) we've noticed certain insurance companies(Guardian in particular) deny everything. So, large cavities or significantly fractured teeth that are typically slam dunk crowns, Guardian will initially decline. We typically send xrays, photos, and a diagnosis. We
December 19, 2025
Claims Processing
Message Board
Views: 129 | Replies: 5
Has anyone else come across this??????So in the last three weeks we have had two different insurance companies deny pre-estimate for scaling and root planings on the assumption that all four quadrants are going to be done on the same day ..... assumption appears to be because they are submitted
May 04, 2021
Claims Processing
Message Board
Views: 315 | Replies: 5
.. and then after reading Peter Wacko's posts I went ahead and removed 2 mm of osseous again knowing now that the lesion developed from the osseous tissue / attachment apparatus at the level of the lesion likely. Anyhow... I was not expecting insurance to pay.... I even reduced the charge knowing
March 14, 2014
Claims Processing
Message Board
Views: 328 | Replies: 10
I live in Virginia where insurances can't cap fees for non-covered services. I've noticed though that when we use a code that is on their fee schedule for cosmetic treatments, veneers for example, they reduce the fee to the contracted fee but don't pay anything on it. Legally, can they do... if its
November 07, 2016
PPOs and HMOs
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