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Message Board
Views: 152 | Replies: 8
of claim denials or paperwork. The better services usually pay for themselves (and then some) through improved collections rates and faster cash flow. Have you thought about what it would look like if your coordinator had uninterrupted time for patients while the behind-the-scenes insurance ran
January 09, 2026
Staff Management Issues
Message Board
Views: 178 | Replies: 5
a billing company, and we keep a stack of CIGNA denials for this and call them with prep/seat dates for those every week....it's ridiculous. Additionally, most payers will provide a clear reason for denying the claim. Cigna loves to use the denial code N4 - Claim is denied for lack of information
August 06, 2025
Claims Processing
Message Board
Views: 140 | Replies: 4
the difference? I have a lot of teachers and school administrators on this insurance so if I drop it I will lose many patients, but I really want to pick up the phone and cuss everyone over at UC out and demand payment UC is the absolute pits. The worst. Horrible. Followed closely by Humana. I don't
July 11, 2017
Claims Processing
Message Board
Views: 151 | Replies: 9
Dear Dental Townies, I have a question regarding SRP and downgrading and frequency from PPO insurance plans. For background, I am in-network with most insurance plans through umbrella networks such as Carington and Connection Dental. We almost always send pre-estimates before doing major treatment
January 22, 2026
Claims Processing
Message Board
Views: 653 | Replies: 23
I am really interested in outsourcing insurance and billing. I read some great things about eAssist. Do eAssist and Dental Support Specialities do the same thing? Have there been any positive or negative experiences with either? First, lets start with transparency here. I have known the founders
February 04, 2021
Front Office Discussion
Message Board
Views: 3400 | Replies: 160
dentists of over treatment. They are almost worse than the insurance companies telling what IS and IS NOT appropriate treatment. Like saying it over and over loudly makes it true.Guys. This is straight forward. The person is at uhc is practicing without a license or below the standard of care
June 21, 2014
Claims Processing
Message Board
Views: 398 | Replies: 15
Hey Townies! Wondering if anyone has input on a small situation I have. Even though I am full fee-for-service and out of network with all insurances, most of the time my front desk is quite good at estimating what the out of pocket for treatments for different patient would be. I just got an email
November 18, 2020
Patient Communication / Education
Message Board
Views: 827 | Replies: 13
? I've also been getting a ton of denials for Build-ups stating they are integral to the crown procedure code when billed together, and denied because they are to be done with a crown when its billed separately! These insurance companies make me crazy!!!! Now our Childrens medicaid isn't paying crowns done within 30 days of RCT!
June 15, 2016
Claims Processing
Message Board
Views: 166 | Replies: 7
Background info: 3 partner, private practice OMFS office. We are all 3 board certified OMFS and do our own sedations for bread and butter OMFS. We are in network with a couple of the major dental insurances and a few major medical insurances for our orthognathic surgery cases only. Everything
March 05, 2022
Coding Q&A
Message Board
Views: 303 | Replies: 18
for resubmission or denials. I think almost every insurance company I have worked with now has the ability to use digital attachments via NEA which is the industry leader for attachments. Whether it is perio charting, narratives, EOBs or dental x-rays, you do a screen capture of the data
November 21, 2021
Computer Hardware
Message Board
Views: 3400 | Replies: 160
. What do they expect me to do -- wait to place the crowns and risk having the teeth fracture to treat the adjacent teeth? Without a doubt they are attempting to dictate treatment. I can live the the denials for BS reasons, frequency limitations, and the downcoding because I signed up with the PPOs
June 25, 2014
Claims Processing
Message Board
Views: 443 | Replies: 20
I bought a dental office last month and it's kind of like a start up. I don't know the fees for cash patients. How do I find fees? I'm in the process of credentialing with few insurances and I accept medicaid. Thank you Cash fees are fees you feel are adequate for your time and skill. Ppo fees
August 23, 2020
Front Office Discussion
Message Board
Views: 295 | Replies: 7
, but why possibly pay interest when I can use their money for 12+ months? Maybe I buy a larger TV? Or in your office, maybe I accept the full treatment plan rather than only accepting what my insurance will cover? Just a thought.... I agree that it makes it easier for patients, and I agree that I
January 27, 2016
Patient Finance Plans
Message Board
Views: 412 | Replies: 11
paid. So, what do we do? My suggestion: Prepare a few pre-written narratives on the common reasons you take PAs and have them ready to use for these problem insurance companies that want to waste our time and theirs. Don't wait for the denial to appeal, that is a waste of time. Just send your
April 06, 2026
Claims Processing
Message Board
Views: 2694 | Replies: 84
written to include more generous benefits than newer policies so be sure to read yours carefully before deciding to cancel it . I'm no insurance expert so I'm not in any position to give advice on this. I just like to advocate for dentists to be informed when it comes to stuff like this. I almost
April 10, 2026
Disability Insurance
Message Board
Views: 507 | Replies: 29
If Im not mistaken, theres a service or services that will handle your insurance billing , posting, impatient collections? I may even have posted about this in the past. Does anybody recall the name or names of services that do this? Im not interested in everything but would be kind of cool if I
January 14, 2025
Claims Processing
Message Board
Views: 471 | Replies: 18
I'm in network with 3 insurance companies. 2 of them have a fairly decent fee for all ceramic crowns And I do mostly cerec and zirconia. Problem is they do not pay for all ceramic for posteriors and are downgrading all of them to base metal crowns. I have never done base metal crowns and my crown
February 24, 2017
PPOs and HMOs
Message Board
Views: 258 | Replies: 8
outsourcing company for you. Here are some solutions that offices have utilized: Core Billing Services: claim submission, payment posting, claim aging (denials/appeals) - typically billed at a % of insurance posted for offices that are in-network with PPOs or FFS offices that accept assignment of benefits
May 16, 2023
Claims Processing
Message Board
Views: 540 | Replies: 10
the interests of our patients when the insurance companies dump so many millions of dollars to lobby our lawmakers? Sorry for the rant, but it's getting harder to believe that I'm going to be able to continue to provide the level of care that I have enjoyed for my patients. I know that many on this board
February 03, 2015
Pediatric Dentistry
Message Board
Views: 176 | Replies: 7
to consult with another specialist in the area. The doctor will share the information with such specialist and obtain input. Example of use of your health information for payment purposes: We submit a request for payment to your health insurance company. The health insurance company requests
October 17, 2022
Practice Management & Administrative Forum
Message Board
Views: 4678 | Replies: 244
. My OM was surprised, because she's never seen a denial for a core B/U from this specific insurance company. This is our first. I always take intraoral pics preop, and then after the restoration is removed. I am relatively conservative, and do not crown a lot of teeth that I know other would crown
March 08, 2017
PPOs and HMOs
Message Board
Views: 17741 | Replies: 1414
, right now, like a gun, it's operated/guided by humans. If the very same AI/algorithm had told UHC to start approving more claims, ***the CEO and board would have gotten rid of it***. It may be a mistake to think there was a 90% error in how it instructed denials, it seems to be literally by design
December 16, 2024
Dental Insurance for Dentists
Blog
have no idea what you're talking about. ?? Others blamed their co-workers. Some made verbal threats against the dentist. A small number confessed their guilt and then lied about the amounts they stole. EVERY DENIAL WAS DECEPTIVE AND INDIGNANT When first confronted, the majority of dishonest employees
August 30, 2023
by Bill Hiltz
Message Board
Views: 798 | Replies: 25
the bridge was seated to complain again about not getting coverage, etc. What I don't understand is how can an insurance company tell a provider that a service cannot be charged to a patient at all due to a denial? The patient has the autonomy to elect to proceed with non-covered services at their own
April 11, 2024
PPOs and HMOs
Message Board
Views: 962 | Replies: 10
a long time To resolve such as extensive corrections or appeals on denials may also go by wayside. You can imagine a claim for $20 needs a two hour phone call and back-and-forth with the insurance the specialist may not choose to work on that. However your patient expects payment from insurance
June 23, 2021
Front Office Discussion
Message Board
Views: 486 | Replies: 15
Question 2 passed easily in Massachusetts yesterday. It appears dental insurance will need to follow the same rules as medical insurance...spend 83 % of the premium money on patient care. How will the insurance companies do this? Increase patient annual maximums, decrease premiums, increase fee
September 24, 2025
PPOs and HMOs
Message Board
Views: 4993 | Replies: 97
to get overseen. My OM told me that UC has partnered up with Assurant insurance. This means that if you are in network with UC you will be forced to accept lower Assurant fees even if you are OON with Assurant. For this reason we have dropped UC.Never thought I will drop military insurance, but I
March 01, 2017
PPOs and HMOs
Message Board
Views: 1753 | Replies: 62
insurance coverage for this particular procedure so there is no way I can do this for you. Something along those lines. Just my thoughts.Thanks. I agree I worry too much about this type of shit all the time. Damn UC, wish I could drop it yesterday. I hear you man. We're all in this together
November 09, 2015
Dental Insurance for Dentists
Message Board
Views: 645 | Replies: 15
always gets pre op and post op Intraoral pics and a higher estimate.Would of stood my ground. By giving up and doing at no charge they think they were right all along and you were trying to cover...Fear Denial Arguing Negotiating Concession Replacement Regret DT Bitterness Anger Acceptance Peace I
January 18, 2017
Restorative Dentistry
Message Board
Views: 427 | Replies: 18
are screwed. If you are out-of-network, then I simply send a note to the insurance carrier advising them that their contract is with their policy holder and not with you. YOUR bill has been paid in full, if they want a refund they must collect it from their ploicy holder and NOT from you. This has NEVER
October 07, 2015
Front Office Discussion
Message Board
Views: 516 | Replies: 12
with UC because we don't want the collateral damage from a rejected procedure. . We are OON and have had almost no denials since leaving them in Jan 2019. I am finding that when you involve the patient in the process (some of the checks go directly to them), UC doesnt put up a fight about approving tx
December 11, 2020
PPOs and HMOs
Message Board
Views: 309 | Replies: 11
who know too little about how insurance works and/or working off not enough information about the policy breakdown of benefits. Insurance estimates work the exact opposite of the judicial system: guilty until proven innocent. There are many ways insurance policies cover less than the standard amount
October 17, 2024
Billing
Message Board
Views: 48 | Replies: 1
, and is not inclined to may me stating that we should have preauthorized. That sucks....hopefully since your patient is a lawyer she is smart enough to understand HER insurance policy and the ridiculous fine print and exclusions they throw in on her...pre-existing conditions should be illegal, but nobody
February 14, 2020
Delta Dental
Message Board
Views: 240 | Replies: 10
a flow in mind. Start of day, end of day, bur blocks, insurance breakdowns, cassettes, sterilization process .... Assign clinical staff an op. Start a Google doc and keep it open in each op. Ordering is a system, restocking is a system and should only be done once a week. yes, I, too would like to hear
June 27, 2021
Staff Management Issues
Message Board
Views: 791 | Replies: 23
to claim employment insurance. We will get over this and in 9 months there should be a lot more little dental patients!! Regards Terry You will never know if you have been in contact with someone who is infected because most people don't know they are infected!!! I just read the comments below in our
March 21, 2020
Coronavirus (Covid-19)
Message Board
Views: 134 | Replies: 8
that they paid incorrectly they would just kick it back saying they paid correctly.I would love to hear what some of the insurance experts on this forum have to say. I'm happy to help. Any chance you can share the EOBs with sensitive information blocked out? It would help to see those with any denial
June 13, 2023
Claims Processing
Message Board
Views: 398 | Replies: 16
...they will not guarantee payment and their denials are much more arbitrary than dental insurance. If you do the case then you risk not getting paid at all for the anesthesia and because you are in-network, you cannot bill the patient. I have had this happen to me when I was in-network with medical
January 11, 2017
Pediatric Dentistry
Message Board
Views: 4993 | Replies: 97
a good guy. If you try and explain copays and deductables and all the insurance nonsense all the patients will hear is blah blah blah expensive. I don't want to price myself out of this market. Most of whom I see are lower ranks, they make about $2500/mo in the military and study. Treatment
June 20, 2017
PPOs and HMOs
Message Board
Views: 940 | Replies: 43
Can we file any dental procedure to medical insurance? It is true that many services performed by licensed dentists may qualify for medical insurance. Some of the newer policies that have arrived with the ACA have embedded dental coverage in the medical policy. This often means
September 06, 2016
Claims Processing
Message Board
Views: 575 | Replies: 21
the need for full coverage and most insurances pay the abutments. I will not bill them as crowns. I am surprised they paid a build up, almost all insurances only pay a build up when done on the same day as the crown, even that's becoming a hit or miss. This is the most horrific advice i have seen
March 24, 2017
Claims Processing
Message Board
Views: 377 | Replies: 15
Is any one having problems with dental insurance denying claims requesting dental radiographs when services have been pre approved? Prior to rendering services we send an estimate of benefits to the insurance companies along with radiographs and the services are approved. After the service
August 12, 2014
Ask a Dental Consultant
Message Board
Views: 2489 | Replies: 55
of write offs due to insurance errors 3) 50k in insurance aging over 90 days The good news: 1) we resubmitted everything and expect to be paid. Most of the denials were due the previous front being inept lazy and not attaching pa/perio etc. 2) patients are paying off their balances when we first
December 16, 2017
Practice Management & Administrative Forum
Message Board
Views: 2818 | Replies: 189
of denial of claims? Several witty comebacks have popped into my head but I always try to keep the discussion on an elevated plane. Because our field is failing! Dental insurance is a full time job if your office is doing it right. It is a leap of faith for you but I have seen it done over and over
November 08, 2013
Medical / Health Insurance
Message Board
Views: 1147 | Replies: 24
(okay, no surprise there...) * Contracting providers agree to charge the patient only the amount indicated as 'patient pays'. Hmm, patient pays amount = $0. We've agreed to this? Since when? The alternative is to just allow the tooth to rot out? Sorry man, but that's standard insurance practice since
November 08, 2024
Delta Dental
Message Board
Views: 1196 | Replies: 57
and standard operating procedures for how to conduct the billing of dental insurance for each practice. 5. The dental billing company should vet the dental billers on their platform. 6. The dental claims specialists should promptly follow-up with denials. 7. The dental billing company should aim to get
June 12, 2023
Dental Insurance for Dentists
Message Board
Views: 641 | Replies: 13
? Not to be a prick but what's the old saying?Snitches get ditches?Let it go. Nothing good can come out of this for you. Karma will come his...Not condoning fraud, but wait until you are an owner. Things will look different to you then.Move on.....UCC is the worst insurance company out there by far
September 07, 2016
Ethical Issues
Message Board
Views: 396 | Replies: 10
a provider . It takes effort from the patient to change providers. FFS PPO go wherever and whenever they want. Thanks for all the replies. It's all what I've read before but I guess I needed to be reminded. A lot of brokers/sellers seem to be in denial about the value of Medicaid patient based and I
May 05, 2018
Practice Acquisitions
Message Board
Views: 1066 | Replies: 25
for a single surface. are you contracted ppo level?I got something like this for a posterior tooth. Wouldn't pay for a DB on #20 downgraded to a 1 surface. I just had my insurance person resend it as a 1 surface D and a 1 surface B on #20. I want to see how they handle it. Pretty sure
April 05, 2017
Delta Dental
Message Board
Views: 207 | Replies: 8
I saw adults with special needs. Dentaquest has been good for us for Illinois Medicaid. Only complaint was a denial on a indirect crown on a 12 year old after endo. Reported them to the state insurance commissioner and it was paid. We will accept Delta Dental which will administer one of the two
January 13, 2021
Pediatric Dentistry
Message Board
Views: 129 | Replies: 0
Hello to all those who accept Dentical in California, If Dentical denies a procedure, let's say Scaling/Root Planning, and we as clinicians see the need for it, can we perform the procedure given that the patient is willing to pay for it out of pocket? Am I violating any Insurance Agreement by doing so? Please advise. Thank you.
February 15, 2022
Medicaid and Welfare Issues
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