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Message Board
Views: 1479 | Replies: 78
is not many can afford it. It's so easily forgotten when you launder cash for insurance companies and dental vendors --- in a dental world the zeros tend to blend in and with time a five hundred bucks or thousand is something quite petty. But not for a lot of patients. That's where I think dentists
February 12, 2019
Practice Management & Administrative Forum
Message Board
Views: 538 | Replies: 5
Two legal teams led by, D. Brian Hufford, Esq., Zuckerman Spaeder, LLP, in New York, and R. Brent Irby, Esq, McCallum, Hoaglund and Irby, LLP, in Alabama, have joined OPT-In members to investigate dental benefits management by insurance companies. Each firm has experience in class action lawsuits
December 27, 2016
Dental Insurance for Dentists
Message Board
Views: 193 | Replies: 3
insurance, CPA, dental and office supplies, workers comp insurance, general liability insurance, life insurance, disability insurance, CE fees, licensing fees, and malpractice insurance. Am I missing anything?While we are at it, any advice? If you check out the resource section of DT I believe you'll find the financial info you're looking for Dumb question, where would I find that?
April 03, 2021
Accounting / Bookkeeping
Message Board
Views: 2808 | Replies: 67
of this? refer out a partial? I don't trust sweet old lady patients any more. They are all hugs and hellooooo Sunny until you tell them their insurance did not pay for a $30 exam! Then they go all 3 page letter on you, chiding you for your incomprehensible treatment of said sweet old lady on a fixed
July 15, 2019
Practice Management & Administrative Forum
Message Board
Views: 261 | Replies: 5
Attention insurance gurus, I have a question on how to bill insurance companies when specialist work in house. My office is heavy PPO and I am in network and contracted with all the major insurance companies in my region. I have a periodontist who comes in once a month, who takes NO insurance
September 24, 2014
Claims Processing
Message Board
Views: 194 | Replies: 5
actually paid for it. How often are you paid by insurance for the code? Sorry about going off topic.No experience other than taking the write off. Insurance does not pay. Insurance sets the fee in the PPO for what you charge the patient out of pocket. To the OP, buy autoclavable hoods. insurance doesn't
October 01, 2018
Practice Management & Administrative Forum
Message Board
Views: 655 | Replies: 14
of different insurance MarkStrange I'm the only one looking for this? Or is there no efficient way to check eligibility? With HRDSQ tools, one can do quick insurance verification in - 3 ways. 1) SmartCaller ID - phone ring from patient. 2) 1 Click - Pat Info Button on OpenDental Tool bar 3) Daily Service
March 08, 2017
Claims Processing
Message Board
Views: 307 | Replies: 11
Hello All, I am opening a dental office that won't be contracted with dental insurance companies. I plan to continue associating part-time in another office as the startup will take time to ramp up. The patients I treat at my associate job mostly have dental insurances. I was wondering whether
December 13, 2021
Practice Start-Up
Message Board
Views: 373 | Replies: 9
I did a search here at DT and found some others who asked similar questions in the past. But most patients involved had both medical and dental from Aetna. I came across a couple of students from a nearby art school that has international student medical insurance with Aetna( no dental). I am
February 18, 2019
Claims Processing
Message Board
Views: 208 | Replies: 6
. Do you call to collect balances? Send statements? Or both? What is your protocol? 3. Do you send billing statements at the same time every month (i.e. 1st and 15th) or do you send statements as soon as you receive insurance payment and you know whether the patient has a balance or not? 4. For those
September 22, 2016
Front Office Discussion
Message Board
Views: 482 | Replies: 16
will lag behind sending the claims in. The old owner may have practiced for many years so if the production was similar each month, collections would appear similar. Even with electronic claims it doesn't happen immediately. A lot of insurance companies will also withold payment until they get a tax
November 01, 2018
Accounting / Bookkeeping
Message Board
Views: 408 | Replies: 21
Hi Everyone Was wondering do insurances send a 1099 in January usually regarding the 1099, or we just mainly going off of our accounting in our PMS or accounts? Curious since that would be a lot of 1099s, but on some EOB it states keep this for tax purposes etc. Curious if 1099s or payment
January 27, 2019
PPOs and HMOs
Message Board
Views: 1690 | Replies: 91
Patient who has insurance came in for cleaning 1 month ago. We submit the claim and comes back denied bc hes maxed out. Earlier in the year he had rct done at endo and crown done with us. This is probably what maxed him out. We sent an email statement after we received this insurance claim he
December 05, 2024
Billing
Message Board
Views: 384 | Replies: 8
We had a patient who was involved in a car accident and had to have multiple implants and restorations placed. We had a pre-approval letter via her medical insurance to do the work. We started some of the work but come to find outthe medical insurance considered us out of network so patient had
March 07, 2015
Front Office Discussion
Message Board
Views: 529 | Replies: 8
the restorative office and us separately...We can only do this for patients with no insurance or if we are out of network. If we are in network, then the fees change since we cannot do a package deal.Toof, you bring up another issue regarding not being able to perform these procedures on patients whom
April 16, 2018
Legal Issues
Message Board
Views: 323 | Replies: 9
Question;I have dental insurance and would like to do my own COE, PLX and FMX (this would of coirse require the asst help). Can I bill the insurance if I'm the provider and patient???I'm so desperate for pts and $$ that I intend to PRR every tooth!. J/K. I already have fillings in just about every
November 17, 2019
Ethical Issues
Message Board
Views: 420 | Replies: 14
If a dental procedure is wanted/needed by the patient but not covered by insurance, it is my belief that these procedures are Beyond Insurance. Examples are TMD, Cosmetics, FRM, etc. Beyond Insurance means the patient pays upfront making it a cash procedure. What procedures do you do in order
October 03, 2018
Ideas To Make Your Practice Grow
Message Board
Views: 195 | Replies: 4
Insurance companies are still collecting premiums during the Coronavirus shutdown, but paying almost zero claims. It seems like a financial windfall for them. They could win some goodwill from dentists by voluntarily increasing their payments to dentists by 20% for the rest of the year. This would
April 21, 2020
Dental Insurance for Dentists
Message Board
Views: 54 | Replies: 2
Trying to understand my aging reports better and have a question: *As I understand it, the Aging Report will show all total balances-- patient and insurance balances combined. *When I compare the Aging Report to the Dental Insurance Claim Aging Report (DICAR), the DICAR shows a higher total than
November 09, 2020
Ask a Dental Consultant
Message Board
Views: 66 | Replies: 2
if the lowest allowed fee is for an insurance we are out of network with, then what?If collecting all primary copays and then filing secondary and assigning the benefits to the patient for the secondary, wouldnt that mean losing some money in case the secondary payment brings the total insurance
June 06, 2022
Claims Processing
Message Board
Views: 1689 | Replies: 50
outlawed. Wisconsin just recently limited this practice by insurance companies. I would use this as ammunition to kick start the process with your local dental society. The lobbying by the wda was the main driver to getting this legislation passed. Hope it turns out ok for you.They are telling you
January 21, 2015
Coding Q&A
Message Board
Views: 6743 | Replies: 240
Hi, I received a letter from Delta stating I have to refund $9500 to patient. Im looking for help on how to fight their demand. thank you in advance. ...During the initial consult, my treatment coordinator presented to the patient a treatment plan that showed no insurance will be used along
February 17, 2021
Delta Dental
Message Board
Views: 748 | Replies: 24
simply do not go together. It's a money loser, it will potentially put you into a bind with improper coding and insurance billing. My only advice is just don't. They just are not compatible.Incorrect, this depends on your stats and whether it is a self insured/funded plan (forget what exactly
January 08, 2019
Alternatives to Dental Insurance
Message Board
Views: 424 | Replies: 7
on and on, but long story short - they both need to go. A bit about my office- I have a very low overhead office. It costs me 40-45k per month in costs and we collect 70-90k per month. I am currently paying one of them around $45k per year (she does all of the insurance processing) and the other who basically
February 25, 2019
Staff Management Issues
Message Board
Views: 4443 | Replies: 66
manner as we can see the insurance companies are doing the same. When the next recession hits, and it will as we have completed yet another 9 year boom cycle, I think we will see a lot of employers drop fringe benefits like dental insurance altogether. It's kind of joke now when you see maxes at 500
July 15, 2018
Practice Management & Administrative Forum
Message Board
Views: 557 | Replies: 30
. The dream, straight cash, fair rates, no insurance headachedes: I think this type of advertising will become more and more popular. I think people appreciate the up front information. Healthcare is changing and so should the approaches. Are there any GP out there with the same type of website
November 21, 2025
Going Out of Network
Message Board
Views: 131 | Replies: 4
we sent a claim as a courtesy for one of our patients, the out-of-network insurance company wants a w9 even though we are not collecting payment... what legal responsibilities do I have to send the out of network paying company (that reimburses the patient directly) a w9 if they aren't paying me
March 21, 2023
Going Out of Network
Message Board
Views: 224 | Replies: 13
you want an insurance company you have no contract with tell you what to do? Insurance is there for possible reimbursement. If there is no chance for reimbursement, there is really no point to sending. I thought so, but Ithink my FD was reading a paragraph for an "in-net" provider Travis
November 12, 2025
Claims Processing
Message Board
Views: 288 | Replies: 7
We had a patient not inform us that she had switched jobs, and thus lost her primary insurance/secondary for her kids. We billed them, and they paid us despite her not being active. We did approx $2000.00 of work, and it wasn't until the final claim of her treatment plan that they figured it out
July 03, 2014
Claims Processing
Message Board
Views: 331 | Replies: 10
with some treatment rendered by the office? Most likely patient went elsewhere. Wasn't happy that insurance won't pay for treatment to be re done on whatever situation it pertained to. They then file claim with insurance saying it was done poorly. Insurance will do investigation. If insurance deems
August 11, 2018
Legal Issues
Message Board
Views: 189 | Replies: 10
I am seeing more and more insurance limit that pano benefits to patients 12 years and older. It makes no sense at all. I used to just write it off and take them for free, but now this seems to happen every week . I going to tell parents at their visit that we will need a pano next time
March 02, 2021
Pediatric Dentistry
Message Board
Views: 249 | Replies: 9
? I thought the point of non covered services laws was to avoid this. Its crazy for an insurance company to dictate fees when they are not the ones paying. You'd think. Their answer is its covered, we're just not paying. ha!I I've seen delta say This is not a covered benefit. and still adjust
January 25, 2022
Dental Insurance for Dentists
Message Board
Views: 606 | Replies: 22
the insurance companies should be on board with this issue. yep, And yep. Disgusting use of power. Jann Awful! Crooks GR8 And what has Delta always done? It is an unfair trade practice. Patients should have the right to assign over payment if they want. PERIOD. What are BCBS and Delta Dental afraid
March 02, 2019
Dental Insurance for Dentists
Message Board
Views: 142 | Replies: 1
This topic has been rehashed multiple times on DT but is some ground worth revisiting in light of how some insurance companies are viewing PPO increases: WHERE TO SET CASH FEES For offices that are in-network with most PPOs, the debate often arises about whether it's necessary for cash fees
November 20, 2019
Practice Management & Administrative Forum
Message Board
Views: 495 | Replies: 9
with a detail or something, my FD makes sure to point it out to me and wants me to get out of the service. The next thing I wanted to try was using a service to do insurance verification. A lot of her time is spent verifying insurance, staying on hold etc. We talked briefly about it, she's very
December 10, 2015
Practice Management & Administrative Forum
Message Board
Views: 146 | Replies: 8
to each insurance entered so that's fine but this office pays their docs off of production - not collection and pays them off of the UCR fee. For example, say they pay 60% off of the UCR (which was recently raised) but then they are losing money on that medicaid crown because it doesn't even pay enough
May 01, 2023
Dentrix
Message Board
Views: 309 | Replies: 17
ringing when you are on the phone with someone on line 1? 2. We do accept assignment, but do not participate with any HMOs and PPOs. What are good verbal skills to answer the phone calls that begin with Do you take such and such insurance? Thanks!! 1, Depends what the conversation to the first
March 27, 2014
Ask a Dental Consultant
Message Board
Views: 2150 | Replies: 58
21 yr old female come in today for Invisalign. Has a chipped #8. I tell her we can fix it today, ask her to wait while my front desk gets an estimate on what the insurance will pay and what her portion will be. She responds I have insurance. I never have to pay when I come to the dentist. My
April 12, 2014
Delta Dental
Message Board
Views: 420 | Replies: 11
. But as of last week, she has not gotten paid for the collections that needed to be filed with insurance and has only gotten two paychecks from the 8 weeks that she has worked there. The owner dentist told her that it usually takes a couple months for insurance to reimburse but he has taken
December 16, 2019
Staff Management Issues
Message Board
Views: 348 | Replies: 11
Purchased a practice this year, and I just found out my FD will be entering the seat date for crowns on the prep date in order to maximize the patient's insurance benefits. I asked her about this, and she said not to worry about it, it will be fine, it is fine either way. This way, patients can
December 15, 2017
Practice Management & Administrative Forum
Message Board
Views: 1121 | Replies: 27
Dental Office Manager Sentenced to Prison for Defrauding Insurance Companies .... billed 37 private dental insurance companies for services allegedly performed by an identity theft victim for patients of Advanced Dentistry, when the victim did not in fact perform those services. The identity
September 28, 2017
Dentistry In The News
Message Board
Views: 519 | Replies: 19
I've been placing Surgifoam absorbable sponge into my extraction sockets, sometimes I use collagen plug and I think I should be charging for that using the code D7922- Intra-socket dressing for heostatis/clot, correct? Especiallyif it's an in network extraction that insurance pays anywhere between
May 16, 2025
Oral & Maxillofacial Surgery
Message Board
Views: 2044 | Replies: 30
We did sealants and some fillings on a new patient. Unbeknownst to us the patient previously had sealants done on the same teeth at another office two years ago and they had completely popped off, no traces. The insurance denied the new sealants because the benefit was already used. The patient
November 07, 2016
Pediatric Dentistry
Message Board
Views: 527 | Replies: 28
into with PPO's out there and the daisy chain world of additional contract obligations which may entail assorted Tom, Dick, and Harry insurance company alliances to which they become obligated to accept also. I get kinda impatient with accepting injustice with a shrug of the shoulders.......that has gotten
November 01, 2019
Delta Dental
Message Board
Views: 335 | Replies: 13
Probably an easy answer, I just can''t find it--- How can I have Dentrix print my UCR fees on insurance forms submitted to insurance companies, and at the same time have the PPO or Delta fee posted to the patient ledger? I am sick and tired of submitting lower than UCR fees to the insurance
May 27, 2014
Selecting / Installing Software
Message Board
Views: 1084 | Replies: 21
The (3/22, Garvin) reports that on Wednesday the House of Representatives voted 416-7 in favor of repealing the McCarran-Ferguson antitrust exemption for health insurance companies by passing H.R. 372, the Competitive Health Insurance Reform Act of 2017. The article notes that the ADA strongly
May 14, 2021
PPOs and HMOs
Blog
Do you know how to answer the dreaded question, Do you take my insurance? I have several offices that have asked me how to answer the question,Do you accept my insurance?when a new patient calls. This can causeanxiety for a practice, especially if they'reout-of-network with that particular
June 11, 2018
by KPConsulting
Message Board
Views: 165 | Replies: 10
If a dentist is in network with an insurance carrier and the treatment plan exceeds the yearly maximum, is the dentist bound by the fees in the agreement with the insurance company if the patient chooses to proceed with treatment regardless of the insurance. YesThanks...What about procedures
February 25, 2016
Claims Processing
Blog
Beginning in August, inform your patients that their yearly insurance benefit is about to end. You can do this several ways. You can send an End of the Year Insurance letter, have staff communicate it verbally to patients or print it on statements going out. A message should print on every
August 13, 2013
by Sandy Pardue
Message Board
Views: 108 | Replies: 3
I know that when buyers purchase a/r there is a format for of percentages to pay depending on the age of receivables. does this include outstanding insurance payments? i know some of my ppo's will take even longer than 90 to pay, or delay asking for different radiographs, etc. does that just get
February 02, 2026
Practice Sales
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