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Searching: insurance denials
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Page 5 of 757
Message Board (37849)
Message Board
Views: 995 | Replies: 26
(example Delta of Georgia) may have a slightly different fee schedule. There could be downgrades that were not anticipated (composite to amalgam, implant paid as a partial). And there is always denials, termed insurance, maxed out at another provider etc. I wish it was as clear the people
August 23, 2017
Practice Management & Administrative Forum
Message Board
Views: 2239 | Replies: 76
. Couldn't quite finish it Friday. I've done it once before and got paid immediately. But, it's been a while, so I didn't realize, without a contract with UC I could have filed the complaint after the first denial. With a contracted insurance company I have to go through all the internal procedures
August 22, 2017
PPOs and HMOs
Message Board
Views: 1033 | Replies: 10
to verify no odor, caries, etc) then the patient will likely have a flare up within a short time of new core placement. Not having a CBCT or an opinion from an endodontist on the retreat is leaving you open to denial of an insurance claim for the crown which could happen even with these.
January 09, 2017
Endodontics -- The ENDO Files
Message Board
Views: 631 | Replies: 19
as a provider. Out of network, Metlife and Anthem cause most our headaches. From what I read on DT, it sounds like Metlife, in or out of network is hands down the worst insurance company.United Concordia is by far the worst insurance.. I got a denial on an RCT today on #6 because it didnt go
September 09, 2016
Claims Processing
Message Board
Views: 120 | Replies: 2
, those with higher denial rate, because they are far easier to beat. Travis thanks for taking the time to provide that great information! From the above: Not to mention, even for OON offices, insurance can pull money you owe them from future claims, even from patients not involved with the original
February 17, 2026
Claims Processing
Message Board
Views: 3113 | Replies: 111
of the best parts about ownership is not having anyone above you shaking their head at you...) Thanks for the insight. I'm looking for the quickest path to ownership I can get. Any tips or helpful material for understanding dental insurance workflows/denials? I feel like that's the missing piece
March 20, 2023
Endodontics
Message Board
Views: 126 | Replies: 4
a Delta thing? I'm just curious if I have to delay seeing any patients prior to this being done. YES, IF THAT IS THEIR CRITERIA ALL CLAIMS WILL DENY, AND WITH SOME INSURANCES YOU CAN RETROACTIVELY REVERSE THE DENIAL AFTER YOU CREDENTIAL OON BUT WITH SOME YOU CANNOT Also when a patient has Delta from
August 13, 2021
Claims Processing
Message Board
Views: 303 | Replies: 14
. But one skeptical rationale for their use is simply to pay off the loan note and bill for it all you can to make up for the reductions/denials insurance companies use to drive down reimbursement for all the OTHER typical procedures. I am wondering what will happen to CBCT scan use philosophies when
April 15, 2025
Cone Beam CT Imaging
Message Board
Views: 17741 | Replies: 1414
aspects of those decisions. Im all for AI, but not when used for BS stuff. The three Ds of insurance are Delay, Denial, and Defend and has become something of a rallying cry for insurance critics referring to insurers delaying payment on claims, denying claims and defending their actions. Delay
December 09, 2024
Dental Insurance for Dentists
Message Board
Views: 990 | Replies: 34
I have notice 2 phenomena and want to know if anyone else has experienced the same. I am in Kentucky. 1) Increasing people having Anthem Dental Insurance 2) Increasing denials that are absolutely absurd (Telling US that the PA is post op and not pre-op, saying the whole tooth is not visible
April 05, 2021
Claims Processing
Message Board
Views: 5490 | Replies: 239
and the decay removal. U may need a narrative and need to fight a denial. Insurance blows. Yea that one you need pre-op, restoration removal showing decay, mid decay, and final removal showing enough missing tooth to warrant a crown . Silly because you can see where its going just by looking
February 26, 2023
Fixed Prosthodontics
Message Board
Views: 13399 | Replies: 423
with back peddling to explain differences from estimates vs what insurance pays. We also stress less about insurance denials because they are denials of pre-d's not actual payments. We work with the patient to send appeals to pre-d's and even help to file complaints with the state insurance commissioner
February 06, 2017
Patient Communication / Education
Message Board
Views: 4224 | Replies: 116
up for it twice. she would also pull people forward in the schedule instead of calling people off the unsced list costing me money b/c of insurance denials due to dates of service.....she quit for another office... i had an assistant steal records and forge signatures...she was fired.... i had
June 16, 2014
Staff Management Issues
Message Board
Views: 178 | Replies: 3
, especially among hygienists and assistants. Recruitment and retention continue to strain practice operations and budgets. Looking ahead to 2026, dentists consistently identify insurance issues as a top concern, including low reimbursement rates, delayed payments, and claim denials. Staffing shortages
January 19, 2026
American Dental Association
Message Board
Views: 98232 | Replies: 4230
form of work. I bet you can do remote insurance denials if you wanted! If I retire, my wife might want to go back to work...heck, even with a teacher salary...50k w/ health benefits...that's super huge when add to the passive income. I have a friend who has looked for this kind of work and he
January 16, 2024
Retirement Planning
Message Board
Views: 17741 | Replies: 1414
their deductible and coinsurance. Or the coverage was denied for some reason. I'm not saying bullshit denials don't happen, but it's hard to take at face value when I have patients complain insurance didn't cover it when they did, they just expected it to be free, or it was written in the policy
January 03, 2025
Dental Insurance for Dentists
Message Board
Views: 1315 | Replies: 38
and incomplete fractures and are a medical necessity according to tot he standard of care for crown coverage. The insurance company receives the denial and then shreds the papers and sends back an EOB with the appeal denial. The information submitted was reviewed by our Dentist claim examiners
October 06, 2021
PPOs and HMOs
Message Board
Views: 1756 | Replies: 107
and celebrated by so many? He was a human with a family not an animal which can be slaughtered without a care in the world. I dont see much of this uproar for countless families devastated by insurance related claim denials that have resulted in premature death.Is it wrong to shoot someone in the back
December 11, 2024
Ethical Issues
Message Board
Views: 17741 | Replies: 1414
are suspects for insider trading. It was taken down likely due to the outrage he received. Most dentist understand that anger as we see the denials and delays with insurance companies daily. I Have they? Or is this like the classic I hate congress but love my congressman.? The stats.. Quality
December 17, 2024
Dental Insurance for Dentists
Message Board
Views: 2031 | Replies: 50
documentation of the denial will be sent to the insurance commission of your state if it is denied again. Include that the consulting dentist is incorrect in his/her assessment and their denial is not in accordance with the standard of care. This is abuse by the insurance company and cannot
May 09, 2018
Pediatric Dentistry
Message Board
Views: 705 | Replies: 17
From a practice management point of view: I've always been OON for United Concordia. But honestly they have to be the worst of a bad lot of insurance companies. Yesterday we got a denial for a PAN, with a note asking us to document dental necessity. No kidding. So I photocopied my hand
November 05, 2014
Practice Management & Administrative Forum
Message Board
Views: 463 | Replies: 6
There is a huge problem with letters sent to dentists and patients from insurance companies. Recently, we appealed a denial of scaling and root planing to Principal Life Insurance Company. The letter sans patient specific information is attached. I'm totally fed up with denials that appear
May 02, 2014
Dental Insurance for Dentists
Message Board
Views: 182 | Replies: 17
I just received a denial from Centene Heath Plans under Medicare. I appealed an inital ruling to cover prevident for a disabled patient who has a high caries rate. She can not use her arms and relys on staff to brush her teeth. I can scan and post the actual denial but here is the quote
September 25, 2025
Fluoride
Message Board
Views: 1125 | Replies: 26
while someone is in denial about their insurance and wants to waste this much time over 141.00. What could/should be done differently? Dismiss the hyg right away. 45 minutes seems short for even a simple rest, X-ray, exam, prophy (what about perio?). Debatable about how much you want to mess around
June 25, 2015
Practice Management & Administrative Forum
Message Board
Views: 17741 | Replies: 1414
, so there will be a bigger price to pay.Imagine calling your local PCP or hospital, and telling them you have UHC insurance. It will be an awkward conversation for the weeks and months ahead, knowing media keeps talking about how they abuse the system with denials. This is all speculation based upon
December 18, 2024
Dental Insurance for Dentists
Message Board
Views: 2004 | Replies: 86
start and end dates to procedures due to these common denials and requirements from insurance companies. Why does it happen? Two main reasons: 1) Too many dentists have fraudulently used the build up code 2) Some insurance companies interpret the crown code as seat date. This second point is why
September 25, 2022
Claims Processing
Message Board
Views: 4905 | Replies: 347
to believe someone with a doctorate cant comprehend that. Because a hygienist is on commission doesnt mean they will over treat or oversell. We have virtually no denials from insurance from SRPs. Thats how I usually gage how well thats working cause they usually catch everything. We dont do
February 12, 2025
Ideas To Make Your Practice Grow
Message Board
Views: 54639 | Replies: 1537
management duties, fees charged, insurance interference (denials, down coding), changes in monthly income, vacation time, days working per month, number of assistants, number of hygienists to check, length of hygiene appointments, just the facts as they compare to your private practice. Thanks
June 01, 2015
Practice Management & Administrative Forum
Message Board
Views: 1249 | Replies: 73
for a reconsideration. How bout that, AI ! I thought that was supposed to make things better. Maybe only better for the insurance company. Thanks for the input! Did you send a bitewing or did you also send a PA?MOD is right, the majority of claims are processed by AI.Write on the denial your diagnosis, cite
October 18, 2023
Practice Management & Administrative Forum
Message Board
Views: 209 | Replies: 5
Has anyone used it? Overjet is one of those companies that offer the AI xray reading. Im not really interested in that part, what im more interested is theyre saying now they will look at your insurance submissions before you send them in, first with AI, and then if it needs to, to one
January 10, 2026
Billing
Message Board
Views: 644 | Replies: 29
documentation, appeals, and x-rays to get the claims paid. Denials are a challenge to us and we love to win. Quite simply, we make you money. ClaimsNest will increase your collections and lower your accounts receivable. With time to jump through all of the insurance hoops, we can turn denials into money
May 04, 2021
Claims Processing
Message Board
Views: 4073 | Replies: 103
crown it? Midoc, do you get a lot of insurance denials for those crowns? What do you send to convince the ins company to pay for the crown? I could see them saying a filling is indicated.Thanks for the great info and photos I really appreciate the thought process and the great response. I agree
September 27, 2022
Restorative Dentistry
Message Board
Views: 510 | Replies: 27
George's comments it dawned on me that my neighbor might have the same content insurance I have and has already received a claim check from her insurance. She only showed me the bill, but not a denial from her insurance company. Is it possible she is trying to double dip by receiving an insurance
July 30, 2015
Legal Issues
Message Board
Views: 338 | Replies: 7
in dental and medical practices, including insurance eligibility verification, claim processing, payment posting, denial handling, and appeals. Foji provides specialized AI agents such as: VerifiAI for realtime insurance eligibility checks, ClaimSync for generating and submitting claims, DenialGuard
December 23, 2025
Artificial Intelligence
Message Board
Views: 1756 | Replies: 107
in support of global atrocities I could easily compare this look alike competition too but it'd be edited. I could likely name 50 instances off the top of my head. If you are at an insurance convention peddling claim denials, are you worse than a rat? How about peddling a new opiate medication
December 10, 2024
Ethical Issues
Message Board
Views: 2080 | Replies: 69
1996 levels 2. Insurance claim denials are even more creative than thought possible 3. Near elimination of indemnity 4. Cutting special deals with DSOs, not for private practice 5. DSOs are not responsible to the same level as private practice 6. DSOs skirt state laws 7. There is no such thing
May 05, 2015
American Dental Association
Message Board
Views: 1313 | Replies: 32
! HahaIn todays world of insurance with waiting periods, downcoding, and denials--, anyone that would prep PRIOR to extraction without confirming really solidly what the coverage is in some way or fashion is playing with fire and being foolhardy. Because this is the mess you get. I'm not going to do
February 28, 2017
Legal Issues
Message Board
Views: 2079 | Replies: 55
. As to UC... yeah, I would never credential with them directly unless you like working at medicaid prices or below. if you have the energy FIGHT it - Then send complain letter with denial to the Insurance commissioner . if you fail at that DROP it . Then Call the CONSULTANT and advice him
October 20, 2014
Claims Processing
Message Board
Views: 1471 | Replies: 49
an abutment used in the manufacturing process, but you cannot code for the abutment separately. Same thing for the insurance denial scenario that Dr. Blair shows in his post (page 204 coding companion). I may not like or agree with the stance they are taking, but Im gonna follow it. At the end
August 26, 2022
Coding Q&A
Message Board
Views: 87 | Replies: 4
% annually, and incorporates monthly data from 70+ payers covering 225,000 dentists, 189,000 locations, and 110 million insured patients. I think we all saw this type of thing coming. The insurance companies will start weaponizing AI programs as an excuse to deny claims. Once you get the denial, you
September 20, 2025
Artificial Intelligence
Message Board
Views: 1393 | Replies: 45
at it. I guess they haven't gotten to you yet. More and more insurance companies are sending flat denials on things because they dont have an attached radiograph. Class V on #9? no PA no pay. This is what I thought she would be talking about. AI will be in the hands of insurance companies to decide
May 19, 2025
Computer Hardware
Message Board
Views: 115 | Replies: 3
How long does delta typically take to pay for a conventional fixed bridge. It always goes to review..... Does anyone have the answer on this? Thanks! Within 30 days, if they have everything they need to process it. Every insurance company has to follow the same state rules: Respond to a claim
December 09, 2025
Billing
Message Board
Views: 417 | Replies: 15
. Getting denials is the worst one, because it does nothing to solve the denial problem. Instead, focus on how to avoid denials. Then if you want to drop, go for it and have happier patients who's insurance still pays out benefits. As a former claim review consultant - send me everything and I can
September 18, 2025
Claims Processing
Message Board
Views: 4198 | Replies: 233
. But to many times employees complain about this and that...and then when they realize how much a new cavitron is with new tips and calling a repair guy in and then getting denials from insurance- they understand that business is not that easy. NO FD and no CDA? Even better. When patients cancel
September 01, 2025
Staff Management Issues
Message Board
to pay for treatment or not. We've all had patients suffer from indecision, or denials for insurance companies and not following through with payment because it's not covered. Patients who buy into, the insurance is the primary way to pay for dental needs. Nonetheless, it would be helpful to see
May 09, 2017
CE Comments / Suggestions / Events
Message Board
Views: 166 | Replies: 4
with some discount and no response.Appealed to insurance since their reps gave conflicting answers.Appeal denied again with patient responsibility listed as zero.Does FL law allows to bill patient Full or ppo fee for denial due to frequency?How can an insurance company dictate to collect zero from
May 22, 2025
Claims Processing
Message Board
Views: 1295 | Replies: 34
medical billing since so many insurances require a medical denial prior to considering processing claims. 10. Ladies and Gentleman we are definitely heading towards a major industry change, it is anticipated that by 2021 Medicare will be the main clearing house for all claim submissions and work
September 28, 2017
Claims Processing
Message Board
Views: 2874 | Replies: 54
from over ordering and theft, she quit when she didn't like the new checks and balances put in place....the book keeper was not re-filing insurance claim denials, just writing them off or depositing the money into the previous owners account. SIGN everything yourself, no signature stamp, deposit
September 07, 2014
Future Planning General Discussions
Message Board
Views: 353 | Replies: 11
to proceed or not. The pictures and narrative looks like an instant denial, especially since you said erosion and attrition. Never utter those words to an insurance company. Yea, no way insurance is going to pay. Bad for patients . We all have many cases where crowns can treat these . Fillings
March 19, 2025
Claims Processing
Message Board
Views: 889 | Replies: 46
. Are they denials or requests for more information? As for the chipped tooth, if you can consider it more cosmetic than decay, you should be billing the patient 100% and leaving insurance out of it. Post the x-rays. So for the chipped tooth he had severe attrition so replaced a part that chipped.So am I stuck
March 27, 2025
Delta Dental
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