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Searching: insurance denials
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Message Board (37851)
Dentaltown Magazine (455)
Podcasts (815)
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Message Board
Views: 234 | Replies: 5
20 y/o female patient came in with papule on #30. Extraoral examination: WNL Intraoral examination: Percussion positive on #30, papule on buccal of #30 Endodontic therapy completed on 11/17/20 Crown initiated on 11/23/20 Crown delivered on 01/11/21 Insurance denied the claim for the crown #30
April 26, 2021
Endodontics
Message Board
Views: 182 | Replies: 9
I recently purchased an existing office, and I figured that the insurance fee schedules in the Open Dental are really off. I have been going through each insurance and fixing the fee schedule by procedure codes manually... I was wondering if there is any faster and easier way to update the fee
May 16, 2021
Billing
Message Board
Views: 146 | Replies: 3
Is it offensive or crazy that the New York County Dental Society is promoting Dentegra Insurance company? They are doing promotional posts on social media, calling the company a friend of the dental society. See attached screenshot of from the dental society Instagram. I find it a gross conflict
May 12, 2021
PPOs and HMOs
Message Board
Views: 457 | Replies: 14
Just curious how all of you present tx plans to parents. Itemized breakdown of each coded procedure and the ins coverage for each item or Total cost, how much insurance is estimated to pay, and how much their out of pocket is. what I am getting at is, sometimes (rarely) we get parents who don't
February 04, 2021
Pediatric Dentistry
Message Board
Views: 412 | Replies: 4
Any recommendations for business property and general liability insurance in CA other than TDIC? Is it true that you should get your Bussiness property insurance from a company other than tdic because if youget a claim you can risk your malpractice policy. IE if you have multiple claims against you
February 05, 2021
Practice Acquisitions
Message Board
Views: 93 | Replies: 3
Hi, townier. One patient have a fractured crown for RCT treated tooth. We cannot do extraction for that tooth due to medical condition (fosamax taking). Then I trim down that tooth to gum level and sleep that tooth, place a RPD for patient. However, the insurance denied the claim and stated
March 07, 2021
Claims Processing
Message Board
Views: 190 | Replies: 6
I've had a few patients with more than one dental insurance ask if we accept both. We're FFS. How do you bill more than one dental insurance? Can you? I'm six months into practice ownership, so this is a first for me. Thank you in advance! Administrator. Reason: The post that you made has been
July 21, 2021
Billing
Message Board
Views: 663 | Replies: 7
Hello everyone! After our conversation with Howard this morning, he asked us to post this report: According to ADAs recent reportState of the Dental Market Outlook 2018, dentist earnings have not changed since 1997 (page 6) and insurance reimbursements dropped in 46 states between 2010 and 2015
June 12, 2019
Ideas To Make Your Practice Grow
Message Board
Views: 811 | Replies: 22
I am ready to start the grueling journey of learning everything front desk, insurance and collections.I use eaglesoft. I need to learn so i can teach staff. What is the best way to go about learning?Im thinking first Ill watch eaglesoft tutorial videos to collect payment and looking up the right
August 29, 2022
Ask a Dental Consultant
Message Board
Views: 1449 | Replies: 55
an implant. Again this is how a consultant looks at a D7210..right or wrong. You can take one quick look at that radiograph and see that that tooth needed to be sectioned. It is a no-brainer. Again, insurance companies that I want to punch in the face I read about some ADA code maintenance
October 16, 2022
Claims Processing
Message Board
Views: 306 | Replies: 6
Two weeks ago I did D7140 for $40 and thought that was low. Today I did D7140 for $14. Thank you, Delta. That is all. That's called a referral everyday. You pay the assistant more than that to be there Dont know how people look themselves in the mirror accepting those fees. Was that a PPO plan...
November 02, 2022
PPOs and HMOs
Message Board
Views: 63 | Replies: 3
with an office that is 1 mile away in the same zip code. We had to do some paperwork work for my PPO plans to recognize the new site as in network. All but a couple insurance company contracts are location specific. And each of them has a slightly different process. You need to call each company and ask what
August 25, 2023
Billing
Message Board
Views: 471 | Replies: 15
Has anyone had success getting insurance to pay for a crown on an asymptomatic old endo tooth. The tooth had an old chipped pfm and a new crown was made. This is the preop radiograph. I am trying to get the patient to come in for a new radiograph. If I told the patient to get an endo retreat
May 29, 2022
Claims Processing
Message Board
Views: 507 | Replies: 31
I want to drop our employee insurance benefit so I can pay a higher hourly wage to attract employees more easily. My insurance broker says that if we offer health insurance, it has to be offered to every full time employee and we have to pay at least 50% of the premiums. So it looks like the only
July 26, 2022
Staff Management Issues
Message Board
Views: 154 | Replies: 4
I am curious if anyone has had any success with submitting pulp caps (D3120) and gingivectomy (D4212) and having the insurance cover it? If anyone has any experience with this, please let me know your thoughts. Thanks! No. Never. I never charge out pulp caps. But I do use the gingivectomy code
July 28, 2022
Restorative Dentistry
Blog
There's plenty of insurance pain everywhere across the country. In the last two years, more dentists have said, I've had it and transitioned their insurance participation.But can a transition from PPO insurance to fee-for-service be successful? Yes!In this episode,Bill Rossishares how. Bill
March 11, 2022
by Bob Brooks
Message Board
Views: 1525 | Replies: 59
contacted me first to get my side before deciding on a resolution. At no point was the solution immediately disqualify Dr. Roy as a provider while we sort things out. I wonder if Delta and other insurance companies secretly lobby state governments to keep medicaid reimbursements low. If you think about
July 21, 2022
Pediatric Dentistry
Message Board
Views: 324 | Replies: 6
I have two patients that have left then came back after going to a dentist that is IN NETWORK with the patients PPO. I asked my front desk and FFS front desk down the street what they tell patients about Insurance that is NOT in NETWORK. FD We work with that insurance we are not an in network
April 18, 2023
Going Out of Network
Message Board
Views: 1665 | Replies: 57
Thank you, I appreciate it. The insurance companies don't measure it as much on the percentage of dentists going out on claim so much as looking at the size of the claim and how long the claim will pay. A 40-year old dentist getting $17,000/month with a 3% Cost of Living Adjustment every year
June 01, 2022
Disability Insurance
Podcast
What I do is become a consultant for the patient: I tell them what they need, listen to what they want, then deliver. ~Dr. Bruce B. Baird This question is often the first thing out of a patient's mouth What will my insurance cover? I won't sugarcoat it, this is one of the hardest questions you
June 26, 2023
by Productive Dentist Podcast
Message Board
Views: 145 | Replies: 8
Apparently, my front desk did not realize that in our electronic claims software there is a separate folder for all claims that were rejected by the clearinghouse (anything from no x-rays attached, to missing subscriber information, or insurance terminated etc.) and never got to the insurance
July 24, 2023
Claims Processing
Message Board
Views: 1116 | Replies: 20
This was on MedPro newsletter. Seems to me that a NEW pt that asks you to waive his copayment is wayyyy too comfortable with participating in insurance fraud. I bet you he very well knew what he was doing. In CA this was just so common years ago, don't know if it still is Malpractice Minute
July 27, 2023
Legal Issues
Message Board
Views: 734 | Replies: 14
So I've been an owner for all of 3 months now. Currently the office does not give any health insurance benefits to employees, and I just buy insurance for my family privately.My Cpa just told me as a S-corp I can't deduct those premiums if I don't offer health insurance to the office
January 04, 2023
Taxes
Blog
Dental insurance companies spend a lot of ad revenue promoting their coverage to millions of Americans each year. For the consumer, though, picking the valuable information from the barrage of ad speak is not easy. But pick a plan you must. If you don't choose correctly, you might end up having
April 19, 2022
by nikkigordon12
Message Board
Views: 298 | Replies: 4
. BACKGROUND: Insurance claim forms contain a provision that allows a patient to instruct the insurer to direct payment to the health care provider directly, particularly when a patient is seeing a provider who is out of network. Health care providers contested that despite
April 23, 2022
Going Out of Network
Podcast
on over to their website! Discover the Dental Up Podcast and subscribe on your favorite listening platforms like Spotify, Apple Podcasts, iHeart Radio, YouTube, and more! Spotify: Apple Podcasts: iHeartRadio: YouTube: Dental Insurance Disconnect This episode is brought to you by Keating Dental Lab, a full service award winning dental lab that is here to add value to your dental practice. Visitfor details.
May 24, 2022
by Keating Dental Lab
Message Board
Views: 168 | Replies: 2
I did a RCT for a patient and it didn't heal. So endo did a retreatment. How do I work with insurance on this? Do I credit the patient their co-pay and write a check back to the insurance? I believe that is the best way. Refund each party what they paid in what is the time between the rct and retx
February 03, 2022
Dental Insurance for Dentists
Message Board
Views: 341 | Replies: 9
I have disability insurance through Lockton which is a TDIC insurance program.My benefit amount is $15,000/month.I get billed $2800/quarter.Im turning 55 in 6 months and in very good health.Paying $11,200 per year!What other options are available to me?Is it even worth having a disability plan
January 02, 2024
Disability Insurance
Message Board
Views: 205 | Replies: 8
Hi. We share these responsibilities among three people at my office. We used to have one person do it. So much better now that people are cross trained. I was wondering how other offices divide up these responsibilities. ... Wow - sounds good. Seems like we are always calling insurance companies
January 04, 2024
Billing
Continuing Education
Most patient issues in the practice are related to billing, which can cause low retention and are not good for the reputation of the practice. Because more Americans have access to insurance benefits than ever before, dental insurance is here to stay. Dealing with this service for your patients
March 2021
Practice Management, HR and Accounting
Continuing Education
money, the future value is many, many millions of dollars. In this CE article, learn about a real life situation first and then about the basics of what to look for in a personal disability insurance policy.
December 2012
Financial Planning and Investments
Message Board
Views: 253 | Replies: 4
Good Morning: We are out of network with all insurance plans. We still get insurance infro, check coverages, and downgrade when enetering in the coverage tables. We collect whatever we anticipate insurance won't cover. My question is this: *My front staff insists that we need to call to get
June 23, 2024
PPOs and HMOs
Message Board
Views: 1883 | Replies: 51
This report offers a good overview of the corruption behind this insurance industry scheme, and how the government was apparently coopted. BTW- not all the insurance industry finds such actions ethical w/in their industry. We examine a wide variety of states, and what actions are taking place
January 16, 2025
Legal Issues
Message Board
Views: 741 | Replies: 37
In the 2023 legislative session, Illinois passed a law prohibiting insurance companies from requiring dentists to accept virtual credit cards. The law took effect on January 1, 2024. Since then, I have been trying to stop dental insurance companies from sending me virtual credit payments. The fee
January 29, 2025
Claims Processing
Message Board
Views: 600 | Replies: 13
I am selling my practice privately. The buyer needs to get credentialed by several insurance companies as we take PPO's.How is this normally done? If the buyer submits paperwork and waits for credentialing before closing it could take 4-6 mos or more...and we risk staff finding out about the deal
November 15, 2024
Practice Sales
Message Board
Views: 1794 | Replies: 116
think of cheating. Im very grateful. How would you set your fees? Are you familiar with the ADA fee survey? If so, what percentage/bracket would you recommend? What patients that have insurance don't understand is that no treatment plan is ever covered 100% by insurance(except hygiene which
September 19, 2024
Going Out of Network
Message Board
Views: 226 | Replies: 11
So long story, but we have a patient that has two insurances. We are in network with both. The first insurance (anthem) said they paid $2 for the childrens fluoride, patient owes $49. So then we submit the claim to delta, delta sends patient an EOB saying primary insurance paid claim, delta pays
February 12, 2025
Claims Processing
Message Board
Views: 77 | Replies: 1
I heard there is a book out there that goes over what you need in a treatment narrative. You are probably talking about this book:
December 10, 2024
Dental Insurance for Dentists
Message Board
Views: 208 | Replies: 3
of everything. I have another solid front desk person who is very strong in many areas, but lacks insurance experience. I am wondering if anyone has experience (good or bad) with companies that can help with insurance verification, pre-auths, etc... I am currently researching DCS and eAssist. Does
December 18, 2024
Pediatric Dentistry
Message Board
Views: 1804 | Replies: 142
relationships just to have to be on defense against some of the people I treated for experience. The last thing my office needs is some bad reviews. Reviews and positive word of mouth are the only things bringing people in aside from people finding me on their insurance portals. I want to do more. I just
August 28, 2025
Ideas To Make Your Practice Grow
Message Board
Views: 68 | Replies: 1
I always had my personal Liability/ Malpractice Insurance while working as an associate for different private practices. However, recently I joined a DSO and the DSO purchased liability insurance for me. However I am skeptical of the insurance, because it is a claims made policy from a non popular
July 18, 2025
Dental Liability Insurance
Message Board
Views: 118 | Replies: 6
Our office is experiencing a serious address error with Guardian Dental insurance claims. We submit claims through DentalXchange, and all of our office information in DentalXchange is correct. However, for an unknown reason, Guardian processed our claims under a different dental office
January 02, 2026
Claims Processing
Message Board
Views: 48 | Replies: 1
I've read understanding dental insurance by Travis Campbell. It seems like a great primer on dental insurance. I have a new front desk employee that has a working knowledge on dental insurance, but I'd like her to become more knowledgeable. I'd like her to read this book. Question is, what's
November 07, 2025
Practice Management & Administrative Forum
Message Board
Views: 57 | Replies: 1
Dentists and dental students rallied at the Alabama State House this week urging the state Legislature to pass dental insurance reform laws. They're backing bills that would require dental insurers to spend a higher percentage of premiums on actual patient care rather than administrative costs
January 29, 2026
Going Out of Network
Message Board
Views: 134 | Replies: 7
I have been receiving paper checks from my in network insurance companies. I have a couple of carriers that I allow Electronic Funds Transfers (EFT) for payment. What system do you use to verify that the EOB payment is received by EFT. I dont love the idea of having my account receivable staff
November 21, 2025
Claims Processing
Message Board
Views: 82 | Replies: 0
There have been so many new agreements added between insurance companies and third parties that it's become difficult to know what fee schedule applies when. Hopefully this helps sift through some of the confusion: Does a direct contract always take priority over a shared network agreement
March 03, 2026
PPOs and HMOs
Message Board
Views: 83 | Replies: 3
Insurance company not letting us drop them. They have been holding us hostage for months. We are trying to drop BCBS since last Sept, and UCCI since Jan. Every time we follow up the say they will get back to us in 5 day. What should I do? My hygiene is booked for months now so I can't see new
March 16, 2026
Alternatives to Dental Insurance
Message Board
Views: 275 | Replies: 11
Insurance company not letting us drop them. They have been holding us hostage for months. We are trying to drop BCBS since last Sept, and UCCI since Jan. Every time we follow up the say they will get back to us in 5 day. What should I do? My hygiene is booked for months now so I can't see new
March 17, 2026
Alternatives to Dental Insurance
Message Board
Views: 600 | Replies: 28
Dear ADA: Reimbursement rates Association uses advocacy, education to address decreased reimbursement Dr. Hughes Dental insurance issues are often rated as one of dentists' biggest challenges. In response to an in late 2025, more than half of dentists reported that one of their top concerns looking
March 26, 2026
PPOs and HMOs
Message Board
Views: 372 | Replies: 23
that they give zero $hits what your states laws might be, esp. if their BS gets no pushback. It's one of the D's, Delay ask chatgpt to give you a template for notes that an insurance proof. it will give you a template that covers everything. Yes, and the "wordier" the better! I'd bet one could make a 5000
April 29, 2026
Dental "Pearls"
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May 2026
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