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Message Board
Views: 76 | Replies: 3
hi, Townies I have a unique condition, I would like to know which insurance I send a claim and how to do it? Patient has insurance A in last month and I did crown preparation forher inthe end of last month and sentimpressiontolab. then patient changed job and have another insurance B ( Insurance
November 14, 2017
Claims Processing
Blog
for FFS office and OON patient initial contact: NP: Do you take XYZ Insurance? FD: We are not part of the XYZ Insurance network but plenty of XYZ Insurance patients still prefer our practice. Let me explain why and how this might work for you. First of all XYZ Insurance patients love our state
September 30, 2013
by Kevin Tighe
Message Board
Views: 151 | Replies: 4
I was wondering what you bill to insurance if you take a pano and bwx with anterior PAs. Would you bill a pano and FMX or the pano/bwx/6 PAs? I didnt know if anyone had experience with how reimbursement works in this case. I was afraid of the insurance combining the pano and fmx into one code
November 12, 2020
Coding Q&A
Message Board
Views: 1896 | Replies: 33
it by canceling early....if there's a minimum funding requirement or you have the option to stop funding (the cash value earnings may be able to keep the insurance in place) those might be better options as opposed to killing it.Don't feel bad. I have a nice term policy. But, I also have a 90K (why
September 27, 2018
Personal Finance
Message Board
Views: 223 | Replies: 10
I have a question about in house membership plans. We are located in NC. If you offer an in house membership with cleanings and discounted services is this service available to all patients including those with insurance? For example if someone has a poor coveraged plan can they purchase membership
September 01, 2023
Alternatives to Dental Insurance
Message Board
Views: 190 | Replies: 4
to our records. From time tom time I was sending Valpack coupons with , let's say, $139 Exam, Xray and Cleaning. Well this person giving conference said it is fraud because we are not giving same deal to insurance patients. Or if the ad says free implant consult or so on, well the point is the ad
February 24, 2016
Claims Processing
Message Board
Views: 377 | Replies: 2
We are all familiar with the equation below. If you are out of network with any of your patient's insurance its important to provide accurate estimates and avoid surprise bills. We cant pre-auth everything in time for treatment. As we all know insurance companies do not disclose their contract
September 16, 2024
Open Dental
Message Board
Views: 212 | Replies: 13
The practice that I purchased has an accounting nightmare that I just realized. There are over $80,000 of insurance overpayments in the system, some real and some due to overwrite offs. When insurance companies have been refunded, the payments are not posted correctly to the procedures they just
November 10, 2024
Accounting / Bookkeeping
Message Board
Views: 997 | Replies: 24
We are basically a fee for service office as we are only in network with a single insurance company. We just had a patient cancel an upcoming surgery because we are out of network with his Delta insurance. He was very upsetsayingthat we did not tell him we are out of network and said if we cant
July 10, 2022
PPOs and HMOs
Message Board
Views: 855 | Replies: 32
Patient with a toothache saw me for an extraction, limited exam, and PA on Sept 28.She handed my FD her insurance card, and my FD didnt check if she was currently covered or what the coverage would be. My FD submitted the claim after the extraction, and we found out this patients benefits didnt
October 27, 2021
Practice Management & Administrative Forum
Message Board
Views: 575 | Replies: 19
they calculate copays with insurance as an out-of-network provider she said they bill the insurance first and then bill the patient for whatever is left over. If a predetermination was sent out for something like a crown or RPD they do collect the copay at time of service. Is this standard for a FFS
March 22, 2016
Front Office Discussion
Message Board
Views: 213 | Replies: 4
insurance before, so it may be different. But I would think that you would have to go after the patient for the money. The patient would then have to go after the insurance for their benefits. The patient has two contracts, both of which seem to be in default right now. First, between you
June 28, 2017
Front Office Discussion
Message Board
Views: 274 | Replies: 8
I was approached about the industry standard for billing ortho claims, and I realized I couldn't really answer the question. To you ortho billing geniuses out there: How are you billing insurance for comprehensive orthodontic plans? Are you sending D8090 when work begins and then a periodic D8670
February 22, 2017
Claims Processing
Message Board
Views: 216 | Replies: 7
Hello there,What do you do when you are applying insurance payments and insurance adjustments that result in the patient having a credit? I notice this happens sometimes if a patient is having some sort of preventative services or if the patient has a dual insurance. I mean I feel like the patient
January 10, 2023
Claims Processing
Message Board
Views: 177 | Replies: 19
I am a one-doc practice looking to outsource entering insurance payments and verifying insurance. A friend recommended Edge, but their employees only do full-time. I am looking for a part-time remote employee. Does anyone know of a tried-and-true agency that helps dentists find part-time remote
March 09, 2026
Accounting / Bookkeeping
Podcast
if you are a doctor of anything law, medicine you can rationalize anything can’t they? They have read too many books. They have always got an argument for denial. Jen Butler: Let’s go back to facts. Doctors were sent a survey and were asked would you ask – in the face
October 23, 2014
by howard
Message Board
Views: 120 | Replies: 4
We are OON with insurance A. But insurance A uses a fee schedule of insurance B that we areinnetwork with. Are we allowed to collect based on our UCR fee after they pay us based on insurance B fee schedule? Thanks. Depends on the relationship of A and B. Most often this use of a fee schedule
September 23, 2021
Claims Processing
Message Board
Views: 222 | Replies: 4
We are considering offering a 5% courtesy adjustment to patients who prepay for their dental treatment. This would be anything over $350. Can we do this with patients who have insurance that we participate with? We already take a write-off from the insurance company. Seems like it would
July 31, 2014
Front Office Discussion
Message Board
Views: 374 | Replies: 20
I have a new front office gal and she is now sending out statements to patients that is not a bill, but showing what their insurance has been billed for and any balance we are still waiting to get back from insurance. She places a sticker on the bill saying this is for your information only Does
April 01, 2015
Front Office Discussion
Message Board
Views: 100 | Replies: 3
One of the points of focus for my non-profit is addressing needs and collaborating with Dentists, Employers, Insurance Companies and patients to address the current dental benefit Insurance needs. Looking for some feedback. I am accepting articles submissions on this topic if anyone is interested
December 28, 2016
General Health
Message Board
Views: 2309 | Replies: 57
You are fine with the way you are doing that as long as you give the refund to the patient and continue to place the note in the remarks box. I also estimate the insurance coverage the same way for the same reasoning. I would prefer to send a check than a statement. Have a great day!!What do
June 08, 2014
Dental Insurance for Dentists
Blog
As everyone tries to grow their practice or start fresh with a new location, many docs have the same questions in regards to How and Where do they get started on insurance. I was looking at the Dentaltown message boards today during some free time and noticed a similar question. It was a doc
November 14, 2019
by Davy Clay
Message Board
Views: 163 | Replies: 8
Hi All, Need helping understanding the correct adjustment amount. I have two team members, both from different backgrounds and don't seem to agree on a number. Following scenario. We enter $100 for a service on pt's ledger. Insurance tells us we can actually charge $150 (Allowed/contracted
April 21, 2017
PPOs and HMOs
Message Board
Views: 119 | Replies: 8
I have a 43 y/o male patient who would like to restore tooth #K that has heavy occlusal wear. I recommended a cast gold crown and then started thinking I've never restored a primary tooth with a permanent crown. Will dental insurance provide benefits to restore a primary tooth with a gold crown
January 10, 2024
Coding Q&A
Message Board
Views: 143 | Replies: 6
Americas Dental Health Is in Trouble A recent TIME article highlights a worsening dental health crisis in the U.S., driven by policy changes and systemic issues. Approximately 27% of adultsabout 72 million peoplelack dental insurance, compared to 9.5% without health insurance. While Medicaid
June 06, 2025
Cariology
Message Board
Views: 151 | Replies: 9
Hello, So I am in the current position of selling my practice to another dentist who wants to see our united concordia patients. So his office manager reached out to me as they continue to sign up for united concordia insurance and wanted me to forward our current fee schedule that we are receiving
March 30, 2026
Practice Management & Administrative Forum
Message Board
Views: 1091 | Replies: 29
Soo when I worked for corp, they always figured out how much insurances paybefore presenting treatments. So when a treatment coordinators talksto patients, both treatment coordinator and Ptknowexactly how much thepatientneeds to pay. Today I saw my front desk girl sending statements
July 09, 2018
Front Office Discussion
Podcast
Things You Need to Know Before Choosing an Insurance Policy Guest Speakers: Gregory Dell and Stephen Jessup Gregory Dell is the managing partner of Dell Disability Lawyers and for more than 30 years his law firm has helped hundreds of dentists nationwide to collect long term disability insurance
April 26, 2021
by howard
Message Board
Views: 48 | Replies: 1
Hi Everyone! I have always had the policy of treating staff and their immediate family( kids) for free plus lab fee unless they have insurance then I would charge insurance only. I only have one employee with dental insurance and her family requires lots of work. Her 17 yo son gets his teeth
February 01, 2023
Staff Management Issues
Message Board
Views: 1726 | Replies: 37
We have recently gone out of network with a few insurances. We try to explain the best we can to patients what that means, but some are still confused. Telling them you are going out of network sounds like you will not be taking their insurance. So what is YOUR best way of explaining out of network
June 25, 2024
Going Out of Network
Message Board
Views: 395 | Replies: 31
was just curious from a legal perspective if its malpractice if you are contracted with a insurance carrier and you dont submit a claim that will be denied You do submit the claim but you collect full 100% of the contracted fees from patient upfront. If you are sure about frequency limit dont wait until
May 08, 2023
Claims Processing
Message Board
Views: 2451 | Replies: 57
Corp, then that corporation could be out of network. But I'm not 100% about this. Because my NPI is still the same. Anybody know about this. Also, long term I worry about insurance companies no longer paying to out of network providers in the future. This has been discussed on dentaltown before
May 04, 2016
Practice Acquisitions
Message Board
Views: 258 | Replies: 5
Just bought an office and currently OON with all insurances until I get credentialed. However many of the patients have insurance. What's the best way to check and verify insurance while being out of network? Don't fall into the trap. Why do you care if they have insurance? ALL patients will tell
June 21, 2017
Claims Processing
Message Board
Views: 641 | Replies: 17
Patient called at around 6pm friday night because of a broken crown, wanted to get it fixed for a meeting next day (saturday). Told patient we can't verify insurance and that we will do work as a cash patient. Work was completed and patient resides in arizona, he got work done at our office
January 24, 2018
Patient Communication / Education
Message Board
Views: 1265 | Replies: 14
I am in the process of fabricating an All-on-Four fixed complete upper denture. I have coded it as follows: D6114 - Implant/Abutment Supported Fixed Upper Denture D6055 - Connecting Bar (Upper Arch) Insurance (MetLife) has paid for the D6055 Code which was in the amount of $260.50
March 27, 2017
Implantology
Message Board
Views: 3009 | Replies: 51
and put them b/w my teeth and cheeks all day. yeah......... I've seen that also. Then their insurance company wants you to do everything at no charge if it has been done less than 5 years ago. Had this happen to a patient with cough drops................ Pat Cough drops is the usual culprit around here
September 30, 2016
Restorative Dentistry
Message Board
Views: 1372 | Replies: 14
the rewards bring an exceptional improvement to your life. Then disappear in Paraguay. A few thousand dollars is not worth it.Laz Sounds like something Bernie Madoff would have said prior to 2008. That family must have had some really good insurance. Most plans would have maxed out far before $61K
October 22, 2020
Legal Issues
Blog
The Affordable Care Act mandate that requires businesses with 50 or more full-time equivalent employees to provide employee health insurance benefits has been waived for one year. Beginning in 2015, employers who fall into this category will face penalties for not offering employee coverage
October 31, 2013
by Bill Hockett
Message Board
Views: 220 | Replies: 1
You and your dentist may have a bone to pick with Delta Dental by Dr. Craig E. Neal DDS, MD Consent order of the WA State Insurance Commissioner seems to support claims of a pattern, by DD of WA and president and CEO James Dwyer of corporate malfeasance. Michael W Davis, DDS Santa Fe, NM June 8
November 08, 2017
Delta Dental
Message Board
Views: 402 | Replies: 16
I know you can't write off patient's balances that aren't paid by the insurance (in-network). Is this the same if you are out-of-network? My understanding is that the answer is no, because you could just say the services cost some ridiculous amount and now you don't have to pay any taxes at all
January 16, 2024
Claims Processing
Message Board
Views: 514 | Replies: 16
??? Impossible to get any decision maker on phone. Each phone call keeps you locked down for two hours..between waiting... asking for supervisor..threatening to call insurance commissioner and .. wanting to Please help with comments..suggestions!!! You have to get embarrassingly ugly and demand
September 23, 2024
Claims Processing
Message Board
Views: 2566 | Replies: 67
I know a dentist that waives copay for many of the procedures he does. He is out of network with most insurance companies. I have confirmed that his staff even tell the insurance company ( and they know ) that he is waiving fees. They say that they can do that because they are out of network
January 29, 2018
Claims Processing
Blog
The cost of healthcare in the US has continued to rise in recent years. Health insurance premiums are at unprecedented high levels and out-of-pocket medical expenses are just too much. With this situation, it's becoming harder for most US households to meet their healthcare budget
November 25, 2020
by Luke Worlie
Message Board
Views: 292 | Replies: 10
Not sure how to deal with this type of billing, so thought I'd ask fellow townies for advice! Our patient has 4 dental insurance plans, 2 Delta 1 Principal Financial Group and Guardian, he is the subscriber for all 4 plans. In 2017 he only had 2 plans Delta as primary and Principal was secondary
March 30, 2018
Claims Processing
Message Board
Views: 313 | Replies: 13
If a patient is maxed out for the year, do you still file new claims? If so, do you still have to take the Delta Dental write offs for services? And/or can you just not bill additional services to insurance? What do you do? What is your obligation to delta dental write offs? Are they mandatory
November 12, 2023
Delta Dental
Message Board
Views: 278 | Replies: 10
Can I bill insurance on the day I impress, or do I have to wait until the appliance is cemented? If it were a cash paying patient, I would charge on the day of impression. Unfortunately, the PPO is paying towards the delivery of the appliance and not the impression or lab... This is not always
June 11, 2014
Pediatric Dentistry
Message Board
Views: 419 | Replies: 9
So, I'm in the process of securing a 1 million loan. Little did I know that this requires a few things for SBA. I thought it was just apply, no house/car debt/student loans, 8-10% and sign on the dotted line and done..... One being Life Insurance, some require disability insurance, and some
January 03, 2017
Equipment, Acquisition & Practice Expansion Financing
Message Board
Views: 118 | Replies: 5
Hi, Townies I just felt crazy about this case: one patient has both medical and dental insurance from Aetna. I did routine exam, x-ray, prophy and send claim to Aetna. finally I got EOB from Aetna and stated no payment: because patient has both medical and dental insurance, the claim first go
November 14, 2020
Claims Processing
Message Board
Views: 1079 | Replies: 24
I am covering for a general dentist tomorrow. It's a small single dr practice. She accepts medicaid and insurance. I am a medicaid provider, but I am not contracted with ANY insurance companies. Can I see patients with insurance? Will the front desk be able to submit the claim? Not sure
August 25, 2015
Practice Management & Administrative Forum
Message Board
Views: 1369 | Replies: 42
all know, only the Congressmen who were formerly healthcare providers even have a clue what is involved minute to minute, day to day, year to year, NOT THE INSURANCE COMPANIES NOR PUBLIC CORPORATIONS. I sent the following letter to my Senator and Trumps good friend, Jeff Sessions, yesterday. I sent
July 17, 2017
Dentistry In The News
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