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Message Board
Views: 262 | Replies: 4
This has been probably asked and answered, so I apologize in advance. 1. For procedures insurance deems as 'cosmetic' (ie veneers) and they deny pre authorization stage, what can you charge the patient if they proceed? The contracted PPO fee? The UCR fee? 2. If a patient exhausts their annual max
April 11, 2022
Billing
Message Board
Views: 82 | Replies: 1
My office collects less than 1 million and have less than 1000 patients, how much insurance should my office get? I picked up 100k insurance option but not sure if that's enough Anything over 500 patients is considered a major breach and will get a person listed on the HIPAA Wall of Shame. Each
August 09, 2022
Practice Management & Administrative Forum
Message Board
Views: 4500 | Replies: 158
for a dental office team to read. I dont think more than a handful of people will even read a long letter and I really dont think it will sway many. If any one of us gets this same thing from MD would we do anything other then find the insurance website and start looking for another in network MD? Maybe Im
March 11, 2022
Going Out of Network
Message Board
Views: 604 | Replies: 4
Do office sponsored membership plans violate your participation with an insurance company? I mean a membership plan where the patient pays a set fee for exams, X-rays, prophys per year. Every state has different laws pertaining to this. Ask legal counsel from your state dental
February 28, 2022
Alternatives to Dental Insurance
Message Board
Views: 597 | Replies: 20
Hoping to get some advice on this. I had heard that in some states you are allowed to charge your full fee after pt. hits their annual maximum for in network insurances. For example, pt. goes to see OS for implant placement and uses up his annual max benefit of $1500, and then comes to me
March 15, 2022
Dental Insurance for Dentists
Podcast
Psychology Insurance Freedom Vickery
April 20, 2023
by Shelly VanEpps
Message Board
Views: 669 | Replies: 21
In the past, I've always been successful at calling the individual insurance companies and opting out of the credit card payment. Now Ameritas/Physicians' mutual are saying there is no way to opt out and that credit card payments are the only payments that are offered. This seems ludicrous to me
September 21, 2022
Claims Processing
Message Board
Views: 70 | Replies: 3
I have had this situation come up a few times and we aren't able to provide a good solution. I have had patients that have been patients for years with perio maintenance every 4 months getting covered by insurance. Then when the patient's coverage changes we don't have the dates of initial S/RP
June 22, 2023
Claims Processing
Message Board
Views: 110 | Replies: 5
Hi there we have a patient family who has delta insurance as their primary insurance and blue Cross blue shield as a secondary.Two of them came in for a hygiene appointment, and the insurance was billed to and paid by Delta.They had no CopaysA secondary claim got automatically sent through
June 21, 2023
Claims Processing
Message Board
Views: 95 | Replies: 2
I am a retired dentist and am looking to see if any one knows of a insurance co that offers coverage for a person such as I that is half way decent. Any feed back would be appreciated. Thanks in advance. The whole private insurance situation is so expensive. I feel has really changed the landscape of private practice dentistry. i think whenever i sell, i will add a clause that will be no cost cleanings for x years. haha
May 02, 2023
Alternatives to Dental Insurance
Message Board
Views: 179 | Replies: 5
Dear DT, I have a weird ask. My associate needs to setup his liability/malpractice insurance. He graduated quite a while ago, but put everything on hold to take care of his ailing father. He's having trouble getting liability insurance...and FWIW, I didn't know he didn't have it. Any tips? TDIC
May 03, 2023
Dental Liability Insurance
Message Board
Views: 277 | Replies: 7
Received a letter from Met Life asking for 80 dollars back from a claim from 2018 today. Is this common. It says Insurance Overpayment. The patient is no longer a patient here and I am Out of network, but wait for insurance for a lot of people. Is almost 5 years acceptable for them to ask
May 04, 2023
Claims Processing
Message Board
Views: 64 | Replies: 1
Wasn't there a recent law/stature that stops Insurance companies from adding you to networks without informing you? Is it state dependent? Can some tell me the name or post a link for review please. I also am interested in this. I need to credential with a few insurance companies for a new job and I dont want to get roped into some obscure network that a bigger network sold me off to.
August 02, 2023
PPOs and HMOs
Message Board
Views: 209 | Replies: 5
So we usually bill under D9940 but PPO reimbursement is pretty lousy. Im considering D7880 but I dont know what kind of narrative and tests I need for insurance to cover. Are there any other codes ? Check this out: (the DT software is being weird... click on this): Rose Nierman did an awesome job. -Jim Ty ! Those are the ones I use as well. The links on the website no longer work, is there an updated version? Try this
December 21, 2022
Appliance Therapy
Message Board
Views: 147 | Replies: 5
This year, January 2nd fell on a Monday, and my front office reports that it was very difficult to contact and confirm insurance benefits for patients being see on that day. The proposal was made to not work January 2nd, 2024, a Tuesday, to avoid that problem. (We normally work M-Th weeks). My
January 10, 2023
Front Office Discussion
Message Board
Views: 84 | Replies: 1
I have a pt in the chair with Florida BCBS insurance, we are in network. Her option is the higher option apparently. She has had a consult with the periodontist we referred her to and has decided on an upper fixed implant denture option, code D6114. Our set fee is 12,500 for this for a zirconia
January 10, 2023
PPOs and HMOs
Message Board
Views: 74 | Replies: 2
All,I am an owner seeking recommendations for insurance companies to insure the dental practice as well as the real estate (building).We currently useCNAfor the building andHanover Business/Contents and Workers Comp Insurancefor the practice. We were informed that CNA will drop hail damage
December 13, 2023
Practice Management & Administrative Forum
Message Board
Views: 174 | Replies: 5
Eaglesoft e-services down last 5 days. They have suggested we sign up with Vine. Considering just mailing claims for a while. Any thoughts or experience with them There are other threads about the parent claims company for patterson, HS etc has been hacked. My research on vyne is that it is very...
February 27, 2024
Claims Processing
Message Board
Views: 307 | Replies: 11
I am asking the author of the Understanding Dental Insurance book (great resource btw and so glad it was written) if the only time to use this form is when something is going to be disallowed? That seems to be the inference from what I read and re-read. Correct So as a follow up, it should
January 16, 2024
Coding Q&A
Message Board
Views: 1258 | Replies: 62
1) Depends on the company, it ranges from 20-50%. And can somewhat depend on the plan/policy as well. 2) Partially true. When insurance started around 1950 the average maximum was $1000. Today, it is shy of $1500. But inflation makes that $1000 worth somewhere around 12-15k. However, max
January 15, 2024
Claims Processing
Message Board
Views: 937 | Replies: 59
I am in the camp that the future of dentistry is screwed due to ever rising overhead (payroll, supplies and etc) while our fee which is controlled by dental insurance is stagnant or goes down. I am also in the camp that we as a whole need to drop PPO and go OON. However insurance is not raising
August 23, 2023
Pediatric Dentistry
Message Board
Views: 1257 | Replies: 31
Dental Insurance Industry Celebrates Negotiation Victory over American Dental Association By: Michael W. Davis, DDS 2-4-2024 This gets into many angles. Is the ADA truly working for you? How nasty is the dental insurance industry? Why are DLRs important, and how can
March 05, 2024
Legal Issues
Message Board
Views: 443 | Replies: 7
I have a question on how to bill for non covered services. For example treatments like veneers, implants etc are not covered by insurance. Do you still have to charge patient the insurance fee schedule or you can charge your private fees? Do we have to submit non covered services to insurance even
April 24, 2022
Claims Processing
Message Board
Views: 56 | Replies: 0
Hi everyone! I have a FFS practice and right now my receptionist is sending out all of the insurance claims for my patients. Asking patients to send the claims themselves is not an option, because thats part of the customer service we provide. However, I would love to lessen that load on her so I
May 21, 2022
Billing
Message Board
Views: 425 | Replies: 12
We did multiple upper extractions in preparation for a full denture. The insurance company is reducing them to simple. My question is, can we now file for alveoloplasty in those quadrants since they are not paying for the surgical components of the extractions? What's the cause of pt needing
November 11, 2023
Coding Q&A
Message Board
Views: 44 | Replies: 0
Admins, please let me know if I shared anything that doesn't follow the rules. Thank you! Everything you need to know about both Dental and Medical Billing. All new coding changes for 2024. Two full days of FANTASTIC information, LIVE! Hosted by Christine Taxin and MC by Lynne Leggett Website: ...
January 08, 2024
CE Comments / Suggestions / Events
Message Board
Views: 1248 | Replies: 28
with third parties (insurance companies) continual manipulation of that relationship, an interference which aims to compromise the integrity of the healthcare you deserve. I am a strong advocate for freedom of choice, especially as it pertains to your well-being. It is my belief that your decisions
February 10, 2024
Dental Insurance for Dentists
Message Board
Views: 92 | Replies: 4
Are you obligated to honor discount plans from major networks if you are in network with them ( for eg - Aetna , Cigna. )These plans have no reimbursement but offer in network fees to patients who sign up for it . I know for Cigna it was an add on that your office had to sign up for in addition to...
June 21, 2024
PPOs and HMOs
Message Board
Views: 640 | Replies: 16
Hi, townier.I just got a letter from Delta Dental NJ which request auditing around 10 patient notes. I just felt very strange and our office has only no more than 20 patients with dental dental NJ insurance (probably around 15 patients). what is the reason that triggers dental insurance do a audit
June 25, 2024
Claims Processing
Message Board
Views: 533 | Replies: 24
A few months ago I had to let my insurance coordinator go do some issues and I went without one for about a month in total and it almost destroyed me (because I had no free time). I hired an employee that claimed to have experience although not a ton, so I invested in her, paid for 2 months
January 31, 2025
Front Office Discussion
Message Board
Views: 292 | Replies: 4
- it's not a reflection of a great PPO fee schedule, it's a reflection that your cash fees haven't kept pace. Some insurance companies don't care about your cash fees at all with negotiations but there are some companies that do not even create their initial offer until they review your cash fees so
January 16, 2025
Front Office Discussion
Message Board
Views: 29 | Replies: 0
The allowable fees are suddenly incorrect in the treat plan module making it pita to give estimates. Not sure what changed or if the FD was tinkering with OD. While I'm searching for a fix, any one else have this issue? quick solution?
January 08, 2025
Open Dental
Message Board
Views: 104 | Replies: 5
Hi DT Community, We are trying to assist a patient that had a major fall from an urban scooter provide medical billing codes to her major medical insurance provider to assist with the large dental treatment cost. She originally submitted her statement from our office, but they are requesting
January 08, 2025
Coding Q&A
Message Board
Views: 1008 | Replies: 42
Who is successfully providing insurance benefits verification for their patients before their visits as a service to those patients? HOW are you doing it? I dont mean formal pre-determinations, but verifying that patients actually have coverage that they claim to have, and whether
February 09, 2025
Claims Processing
Message Board
Views: 230 | Replies: 11
Hello all, I just had a consult with a lady from the Washington State Unclaimed Property Dept and she requested to have us refund insurance overpayment in patients accounts. A lot of these are from secondary insurance overpayments. A lot of times the insurances don't read the primary EOBs and pay
February 11, 2025
PPOs and HMOs
Message Board
Views: 428 | Replies: 13
Hey guys. I had a great office manager for 10 years. Im not educated enough on insurance reimbursements. Here is the scenario Pt had service done 13 months ago for a crown. 100% coverage insurance covered 100% payment was sent to us. 1 month ago I received a notice saying that patient had termed
October 09, 2024
Claims Processing
Message Board
Views: 81 | Replies: 3
Any one else noticing that insurances that previously had implant benefits are now dropping coverage? We have patients on plans that went from 100% coverage to 0%. It's obviously starting to affect case acceptance. We have not had that issue yet. Which insurance companies are you referencing? I
December 05, 2024
PPOs and HMOs
Message Board
Views: 106 | Replies: 1
hOW IS THIS TYPICALLY HANDLED? credentialing AND PAYMENT THESE DAYS? Based upon your posts you are either trying to do this on your own (definitely not recommended) or using advisors that don't know these issues (definitely not recommended). Every situation and practice is different, the...
January 05, 2025
Practice Acquisitions
Message Board
Views: 630 | Replies: 18
by an insurer when no misrepresentation was made on our part to induceoverpayment. We obtained a copy of the patient's insurance card at the time of service and have a valid written assignment of benefits. We provided dental services and received your payment in good faith. We did not bill the patient
December 19, 2024
Coding Q&A
Message Board
Views: 104 | Replies: 3
happened to my pt. She doesn't have Connection Dental though. TPA? What are their crown fees Ceramic vs metal? downgraded $100. Absolute garage This can be a provision for certain plans within that insurance. The employer picks the plan that can be cheaper with certain provisions. Are you positve
May 08, 2025
PPOs and HMOs
Message Board
Views: 337 | Replies: 10
Patient has 100% insurance but Insurance didn't pay fully for few procedures. Is it legal to not charge the patient and write off the remaining balance? In case of 80% insurance, patient was supposed to pay 20% but in this case, I am wondering can we write off or waive the remaining balance
May 12, 2025
Billing
Message Board
Views: 241 | Replies: 9
I've been getting more insurance payments that are coming in as those Quickremit payments that are in the form of a credit card. Would it be possible for an employee to embezzle these payments by using them/depositing into their personal purchases or accounts? I read on here that yes they can
April 21, 2025
Practice Management & Administrative Forum
Message Board
Views: 87 | Replies: 4
the same TIN for insurance purposes but I'm guessing that you may want to consider different TINs for tax purposes. Maybe Tim Lott can chime in about the relevancy for that part.
August 20, 2025
Delta Dental
Message Board
Views: 223 | Replies: 7
economically free. Imo..only get minimal term type ins one needs and drop it as soon as possible. Don't use ins for any other reason. Full Disclosure: As a Financial Adviser, I help people with life and disability insurance. I believe that your agent is talking about an Accelerated Terminal Illness Rider
September 24, 2025
Personal Finance
Message Board
Views: 134 | Replies: 7
I learned some patients of mine have a contracted rate for an after hours service call for a dental 'emergency.' In one specific insurance example the reimbursement rate is $100. Well, guess what, I won't go in for that rate. We all know even to get a plumber after hours we're probably paying
October 06, 2025
Billing
Message Board
Views: 5 | Replies: 0
Good Morning ALL, Tired of waiting on Long insurance hold time, inaccurate information on portals? If your Dental or Medical practice is facing hard time in dealing with insurances to verify patients eligibility or to recover pending accounts receivable, Revu Billing will assist you by take off
August 18, 2025
Billing
Message Board
Views: 102 | Replies: 3
What is the correct response to insurance when a CBCT screen view is not an accepted x-ray from insurance. (CBCT taken for another reason). Taking x-rays for Insurance is not ALARA. It's such a game and yes - I'm ready to drop our last insurance. That point besides, is there a response we can send
October 21, 2025
Claims Processing
Message Board
Views: 116 | Replies: 3
Hi All - I am a newbie dentist who just started a practice with a front desk that has never don't dental claims or billing before - not to mention - I am a in giant cesspool of crap and need people here to help pull me out. I am taking all insurances including NJ Family Care - use open dental
June 29, 2025
Ask a Dental Consultant
Message Board
Views: 4500 | Replies: 158
. (For instance the school district patients)Has anyone gotten feta to allow coverage for patients with out being in network due to geographic restrictions ?Thanks Are you talking delta sends the check to patient or literally has no OON benefits? If insurance isnt paying at all then patient pays, I
June 30, 2025
Going Out of Network
Message Board
Views: 23 | Replies: 1
I think one of the biggest issues with the Dental Software programs I've used (Dentrix and EagleSoft) is their inability to flag specific frequency or coverage issues per insurance plan. I'm unsure if any of the Cloud-based softwares do this, but if so please let me know! We have to rely too much
December 18, 2025
Software Discussions
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