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Message Board
Views: 260 | Replies: 3
I was given these steps tonight for patients to do if a claim is denied. Anyone tried anything like this? 1 . Have the patient call the insurance company and tell them you (this is done by the patient, not by the office) want to speak with the HIPPA Compliance/Privacy Officer (by federal law
May 15, 2016
Claims Processing
Message Board
Views: 153 | Replies: 2
is much more efficient. Digital impressions sent to the lab work very well, especially if you have a dx wax up done. Insurance? Down coding is more of a problem than denials. Even if you only used it to make crowns you only need to do a few a week to make it worthwhile. I am on my third CEREC but am
October 09, 2017
CEREC Forum
Message Board
Views: 171 | Replies: 3
Does anyone know if we can bill 4341 one month after initial 4346? How do you bill to insurance co. if the patient came in with generalized moderate periodontitis. We did initial scaling full mouth. xkvt For the D4346 code and any associated periodontal treatment, I highly suggest you speak
February 09, 2019
Periodontics
Message Board
Views: 137 | Replies: 3
be surprised if this causes denial. I think their credentialling process is mostly a way to make sure you're really a dentist and to make you feel privileged for being accepted. Even if there was a complaint against you and you were found at fault, I think insurance companies want as many
December 29, 2017
Dental Insurance for Dentists
Message Board
Views: 2071 | Replies: 47
and then recommended for full coverage. Using words like pain, fracture and recurrent caries all help, but only if true. On the same page here; and there is never a denial. It just takes a little more time to assemble the claim and document. Insurance companies will pay for crowns on posterior teeth
September 28, 2018
Restorative Dentistry
Message Board
Views: 1619 | Replies: 54
little difference. Moral of the story? A more powerful statement will be a cancellation of the contract with the insurance than a letter to a congressman.I'd be curious if this bill could potentially end the BS of dentist profiling (utilization, denial and coding stats) because the data could
March 13, 2015
Legal Issues
Message Board
Views: 114 | Replies: 0
and been a provider for many insurance companies, but have never seen the level of denial, demand , and intimidation that is now occurring. Is it just intimidation and threats from the insurance companies to avoid treatment and paying on legitimate claims to raise their profits, or can
January 28, 2015
Claims Processing
Message Board
Views: 1160 | Replies: 22
Hi! My crown denial is just little weird than other case. INS company directly sent the letter to my PT and basically said that crowns are not necessary to be delivered based upon Utilization Review Agent(?). It sounds like I over treated PT with unnecessary cases. #3 and #14 that had 10 years
March 15, 2017
Claims Processing
Message Board
Views: 80 | Replies: 0
to rate all insurance companies ( with star ratings based on their performance regarding claim approval , fees, denial ,processing time etc ) It should be legal because the keyword is transparency How can one party be transparent in the contract and other not . 1. Coverage is NOT a guarantee
August 26, 2014
Claims Processing
Message Board
Views: 75 | Replies: 1
I have submitted a claim for a patient for an upper denture back on 12/14/2015. I submitted this claim after receiving a predetermination from the insurance company stating that their coverage and the patients portion. I have had to resubmit this claim 3 times with the predetermination and still
March 10, 2016
Claims Processing
Message Board
Views: 316 | Replies: 14
Greetings All, One of my front desk staff who collects the insurance faxes came to me with this problem. Pt with attached insurance came in, we tx planned and did a couple fillings. We collected her estimate at time of service. Couple of weeks later we get denial of claim stating that pt had
June 25, 2014
Claims Processing
Message Board
Views: 154 | Replies: 0
There are more claim denials for lack of medical necessity coming in as the language of certain plans demands this information. Here is a letter format to use to help file your appeals. Appeal Letter For Lack of Medical Necessity Your name and address Date Address of Claims review department
April 12, 2016
Claims Processing
Message Board
Views: 39 | Replies: 0
of denials from this once the Essential Health Benefit pays something, is there Coordination of Benefits with the dental insurance such that we then bill the balance to the families regular dental insurnance carriers which then could have a primary and a secondary? This sounds like an algebra equation
April 20, 2014
Dentrix
Message Board
Views: 283 | Replies: 5
for narratives if you don't ask them for permission first with preauth. Fmx and perio chart is usually sufficient for most insurances to pre auth. If you do treatment first then they will ask for much more in my experience. I preauth most crowns and srps. Just makes life easier than fighting with insurance
July 13, 2019
Periodontics
Message Board
Views: 841 | Replies: 13
annoyed when submitting cores because often we get funky denials. There are way too many plan specific insurance clauses which in the end DO NOT pay for the core build-up. Especially in provider practices bottom line...you may just have to charge the patient for the core.
October 17, 2015
Claims Processing
Message Board
Views: 685 | Replies: 10
They are evaluating all my endo. They refuse crowns on old endo that is 30 yrs old and fine and not done by me. Deny all kinds of stuff. I am considering dropping them and maybe adding a PPO to take their place? BCBS? I was not told in dental school that insurance companies would
August 09, 2021
Coding Q&A
Message Board
Views: 381 | Replies: 18
(provider and patient) vs. THEM (insco) boundaries. It's the perfect way to start educating the patient on what they are actually paying for when they make their monthly insurance contribution.I read somewhere you may have less denials when you Pre-D but I'm not sold on that one way or the other but will see if I can find any statistical data to back it up.
November 27, 2017
Front Office Discussion
Message Board
Views: 279 | Replies: 6
In the last 2 months I have had 3 instances where I have gotten a denial on a claim that included a SC/RP 1-3 teeth (D4342). These instances have neen on either a patient on perio maintenance(D4910) who had a localized increase in pocket depth and needed treatment at their visit or a patient
April 30, 2015
Claims Processing
Message Board
Views: 266 | Replies: 5
We got 4 denials today on patients for exam/prophies from UCC. They are all patients that got insurance through the ACA for combined medical/dental policies. When you look on the UCC website it says they are active. It turns out that coverage is only through age 18, but none of the patients were
July 31, 2014
Claims Processing
Message Board
Views: 952 | Replies: 33
to open the pontic space for RPD, what happens to the abutment teeth that were retaining the FPD. According to the insurance co. we should just leave them bare!!! Christopher Bulfa DDS Hobart IN I would shrug my shoulders and say wow, your insurance really sucks. They don't want pay for your
May 19, 2016
Claims Processing
Message Board
Views: 802 | Replies: 22
was prepared for anything (approval or denial) as we discussed/watched this tooth since 2014 and how insurance probably wouldn't cover as they would call doing anything with cracks preventative. I am surprised they approved the crown without an appeal as there was no radiographic decay, however the IO
February 17, 2021
Alternatives to Dental Insurance
Message Board
Views: 95 | Replies: 5
in red ink (like the misleading paper seemed to say), Then I get another denial and realize they want to have the exact form (no copies). Buy those from amazon, no big deal. Complete the form the same way. Another Denial!!!! This time, the provider NPI (in the lower right corner was missing
November 26, 2018
Medical / Health Insurance
Message Board
Views: 611 | Replies: 19
from the patient. basically rehashes the situation and acts like its our fault for the denials (but we sent all the info in when requested) and that we work too slow at getting the insurance co. the needed info. We haven't charged the patient a finance fee or even asked the pt to pay what
January 01, 2018
Claims Processing
Message Board
Views: 335 | Replies: 5
). Resubmitted claim with narrative...still denied. Insurance also says it is a non-billable service to the patient since previous payment was made on the crown. Has anyone else experienced not only denial of payment by the insurance, but also not being allowed to bill the patient for this procedure
September 29, 2015
Dental Insurance for Dentists
Message Board
Views: 88 | Replies: 1
for anterior teeth. Don't see a lot of denials for simple operative. Will get the occasional case requesting PA's or photo for anterior composite, but rarely. Others on DT have posted cases where insco refusing to pay for obvious decay on photos (occlusals), so I would take into consideration your personal
February 23, 2017
Restorative Dentistry
Message Board
Views: 69 | Replies: 3
Hi, townies I am a little new to dental insurance. what is different about frequency:1 every 12 month vs. 1 per calendar year? Thank you very much! Once Every 12 months: Can only have one cleaning within a 12 month span. Cleaning Feb 1st 2018. Next one wouldn't be covered until Feb 2nd 2019
February 21, 2019
Claims Processing
Blog
other credit card) When you record the virtual card payment in your software; do you post it as an insurance payment or as a credit card payment? Maybe something else? Unless you make changes in your software or your record keeping, it will become difficult to reconcile insurance credit card
November 16, 2020
by Bill Hiltz
Message Board
Views: 2650 | Replies: 60
The ironic thing is is that most of these procedures were pre-authorized by delta wondering if we should just pay the 10k or try to fight these denials. concerned that if we try to fight that they will audit more charts and cost us more money or should we just pay it to hopefully just get a 10k slap
September 19, 2020
Delta Dental
Message Board
Views: 296 | Replies: 6
Hi townies, How can I learn the ins and outs of dental insurances like claims processing, etc before opening my start up practice? Thanks Learning the ins and outs of claims processing is no easy task. There are many different policies, restrictions, and requests and no insurance is the same
July 10, 2018
Claims Processing
Message Board
Views: 1552 | Replies: 35
with that insurance I've decided I'm not taking assignment of benefits. Just don't want anyone else with UCCI. Submit build ups with BWs, they want PAs. Submit PA's, they want BW. Send 4 BW, they want FMX. Exactly. I mean I can see denials of scaling, crowns, as you need some radiographic proof
October 15, 2015
Practice Management & Administrative Forum
Message Board
Views: 777 | Replies: 22
:-)Back in 1986, my first year in practice I got a denial letter from Delta for some extractions and a partial. They claimed that the work was not performed and my insurance form was fraudulent. I saved all my teeth back then so I put a half dozen of the nastiest teeth I could find in a ziplock bag
June 28, 2016
Claims Processing
Message Board
Views: 1379 | Replies: 40
) comes my way, but shortly afterwards, find out online that a bunch of other providers got the same bull**it denial/letter at same time. Just re-confirms the shady crap the insurance industry will pull off to earn a buck. For a second, I wish universal healthcare would come just to wipe out those guys
October 31, 2018
Claims Processing
Message Board
Views: 906 | Replies: 25
). Haven't had a problem yet - knock on wood. Every single denial I have had has come from United. They are without a doubt the worst. They are using third party companies paid on the number of denials they obtain. What was the explanation given for denial? Cheryl The request is denied. The x-rays
January 21, 2014
Just Plain Bitching and Moaning
Message Board
Views: 150 | Replies: 3
We are getting denials for pre-authorizations for scale and root planing because we don't have the proper quadrant code, supposedly. Anyone know about this? I am not aware of any changes to the code. Did you call the insurance company and ask why in their opinion the codes do not match? Check you
March 26, 2014
Coding Q&A
Message Board
Views: 299 | Replies: 7
So I've about had my fill of poor fee schedules and denials of claims. What's the process of dropping UC? I feel bad as we have a large number of teachers, cops, etc who are great patients but I'm sick of UC's games. We called and they said it takes 60 days from the time they receive notification
April 21, 2017
Dental Insurance for Dentists
Message Board
Views: 315 | Replies: 7
if the patient has multiple missing teeth in the arch they may downgrade it to an RPD.We always preauth as implants involve a lot of $ and patients always seem to be under the idea that my insurance covers everything. We have seen approval for implant, abutment and crown, denial of the abutment
July 13, 2015
Implantology
Message Board
Views: 2451 | Replies: 57
While we are talking about ethicalness of forgiving the patient portion how about this: You do a crown for $1000. Collect the patient portion. You go though all the steps in submitting the claims to prevent the denial of the build ups etc. You finally get paid $500. Two month later you get
October 19, 2019
Practice Acquisitions
Message Board
Views: 273 | Replies: 3
At about the same time that the state of Alaska Medicaid started having budget trouble, we started to get denials for code D7310 (alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant). The accompanying notes attached to the dial letter are not very
May 08, 2016
Claims Processing
Message Board
Views: 1257 | Replies: 29
I am surprised how the above insurance company stays in business. I am out of network and still hard to get paid . I recently took one patient from their Tricare product Did 4 quad SRP in one claim .They paid for 2 quads and denied the other two. Requesting FMX and charting. Send twice comes back
October 26, 2017
Claims Processing
Message Board
Views: 104 | Replies: 2
We have a new dentist in our practice who is not yet credentialed for some of the insurance companies we are in network with. Here's my question: We received a denial for a claim stating that there was no coverage because the dentist was out of network. Our insurance coordinator wants to re-file
May 03, 2016
Claims Processing
Message Board
Views: 243 | Replies: 7
-win for the insco.What insurance company was...Delta... If it is a simple extraction most dental insurances are paying for them(unless there are multiple). If you file the surgical code almost all of them are going to require you to send to medical fist get the denial, then send to the dental
October 08, 2015
Claims Processing
Message Board
Views: 4452 | Replies: 220
the insurance. Insurance denied and along with the denial they sent a form saying we had to sign the form for any appeal to proceed. The form stated that I would give up my right to bill the patient if the claim was denied again. When we called and told them we had never seen this form before, we were
January 14, 2015
Medicaid and Welfare Issues
Message Board
Views: 480 | Replies: 10
I'm seeing special needs patients in a hospital OR. Outside of the Medicaid realm (so let's say typical 3rd party medical insurance), do you expect medical insurance to pay for hospital facility fees and MD anesthesia for dental procedures? Any input from experience is appreciated
June 12, 2017
Pediatric Dentistry
Message Board
Views: 948 | Replies: 10
Does anybody have any information for narratives that can help get insurance claims paid easier. In recent months I have been getting a lot more denials on crowns and inlays. I was wondering what most billers are documenting that may help get a claim paid easier. Even if there is obvious need
February 03, 2014
Claims Processing
Message Board
Views: 89 | Replies: 0
are sending claims on the newest ADA 2012 insurance form because this form has an area on it to include the diagnosis codes from ICD-10. Some states are requiring this one county at a time so may not be state wide as of yet. The date that this has gone into effect is July, 31, 2016. The list does not include
November 14, 2016
Claims Processing
Message Board
Views: 130 | Replies: 2
in the future. Send out claim, gets denied due to missing teeth clause. And guess which insurance company it was? Drumroll......................United Healthcare....no surprise there. I can understand some of the denials on cracked teeth without narratives, fillings vs crowns.... but where can you draw
September 29, 2016
PPOs and HMOs
Message Board
Views: 402 | Replies: 10
have substantial amounts of disability insurance in place? I hate to think that my future in dentistry is determined by whether I can get disability coverage or not. Thanks for the help. Most banks will work with you. I know of a bank that requires three denial letters
August 25, 2015
Practice Acquisitions
Message Board
Views: 325 | Replies: 8
Placed an implant on this patient - insurance denied - stated that an RPD was indicated but that they might pay for the crown. Any thoughts or wording I could use in a narrative? Wasting my time?!? Thanks It's not that an RPD is indicated it's that's is all they are willing to pay for. In my
August 16, 2016
Implantology
Message Board
Views: 68801 | Replies: 15670
in premiums should be paid out in claims or something. Problem is this doesn't happen. They deny claims on all kinds of reasons, just had a denial on SCRP, and they write, BS language....and make it a problem for providers and patients. If you think insurance companies serve a good purpose you
October 27, 2016
Politics - DO NOT Enter if easily offended
Message Board
Views: 846 | Replies: 14
a denial, i give the patient the information on how to file a complaint with the insurance commission. I tell the patient that their dental benefit is a part of their paycheck from their employer and this insurance company is trying to keep part of their families pay. That usually outrages them. However
December 14, 2015
Periodontics
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