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Searching: insurance denials
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Page 1 of 757
Message Board (37849)
Message Board
Views: 130 | Replies: 5
is okay, but does not show the entire tooth/root. The second x-ray is not even centered. The tooth in question is a no brainer to get paid with good x-rays and photos. Estimate insurance will pay, get better x-rays and photos, and then do the work. Stop asking insurance for permission. The denial isn't
May 05, 2026
Claims Processing
Message Board
Views: 255 | Replies: 12
Add this one to the Why I hate Dental Insurance Companies list..... Recently, we preauthorized a patient for 4 quadrants of scaling and root planing with Delta of Minnesota. We completed treatment and submitted all necessary documents for payment. This claim was denied. Furthermore, the denial
June 26, 2025
Claims Processing
Message Board
Views: 786 | Replies: 28
the basics. Claims went out. Payments came back. Staff posted them manually and hoped nothing slipped through the cracks. That worked when volumes were lower and insurance plans were simpler. Today, it is a different world. More plans, more carve outs, more coordination of benefits, more denials
May 27, 2026
Artificial Intelligence
Message Board
Views: 100 | Replies: 3
Well we all know that a prophy requires no evidence so this article must be about a denial of 4 quadrant of scaling and root planning. If so, describing non surgical periodontal therapy as a preventive cleaning by this reporter is not honest reporting and does not help the cause of reining
February 15, 2025
Dentistry In The News
Message Board
Views: 36 | Replies: 1
Every few months, a new headline shows up that sounds like the opening scene of a sci-fi movie. The government wants AI doctors. Utah lets AI prescribe medicine. Autonomous cardiologists are coming. If you are a practicing dentist reading that between hygiene checks, crown seats, and an insurance
April 07, 2026
Artificial Intelligence
Message Board
Views: 1017 | Replies: 45
Principal Insurance Denied claim for crown on #9/10. Shocker!! We went through the appeal process and got the final denial today. The narrative said, restorations due to attrition, abrasion, and erosion are not a covered benefit. If you look at these photos and radiograph, ask yourself
May 24, 2019
Claims Processing
Message Board
Views: 98 | Replies: 1
insurance we had to submit it anyways to primary. Apparently, according to my FD, it took 3 months to get this formal denial from her primary insurance, and now we are still waiting on the payment from her secondary. 4 months later....!!!! Did my FD just screw up, or it this normal? I call BS
April 13, 2016
Claims Processing
Message Board
Views: 239 | Replies: 2
I'm probably not asking your typical DDS out there by posting this to you guys on DT, but we had a Mom call us because resin fillings are not covered on her (obamacare) insurance. She called around to some other offices to see how they handle this and she said they all told her they charge
May 18, 2015
Pediatric Dentistry
Message Board
Views: 53 | Replies: 0
I just heard an interesting webinar from henry schein. They had on an insurance adjuster forgot his name but here is the link:. He said that many policies cover business insurance loss and that loss that occur due to corona virus and gov shut time are not necessarily excluded. The insurance
April 22, 2020
Coronavirus (Covid-19, SARS-CoV-2)
Message Board
Views: 256 | Replies: 5
is cracked and you are feeling it. It needs a crown to fix it, it might even need a root canal in the future. Your insurance company is more concerned with not paying this claim as opposed to doing what is right by you. As I am sure you already know, insurance companies make a lot of money be denying
January 25, 2019
Claims Processing
Message Board
Views: 703 | Replies: 14
After over a decade with EDIC, and 20 years in practice, 1 claim that recently settled went beyond the risk threshold and received denial for renewal. Anyone experience this, have any pointers on signing up with a different carrier? Appreciate your help. I too was dropped after a payout. I am
October 08, 2020
Malpractice Insurance
Message Board
Views: 133 | Replies: 2
I am dealing with an insurance denial for crown pre authorization. I have included documentation of significant tooth structure loss. Despite this, they claim that the amount of damaged tooth structure does not support crown coverage. Any advice on how to strengthen my apparel would be greatly
September 09, 2024
Claims Processing
Message Board
Views: 1156 | Replies: 60
, when you attempted to extract it with forceps and needed to use a handpiece and bill as surgical extraction and you will be less pissed. Even in the OP's insurance Dental Doctor Review denial, there is a section that lays out what they deem is needed to constitute surgical extraction: If the tooth
May 14, 2026
Claims Processing
Message Board
Views: 152 | Replies: 3
We are in our second UHC denial is a month. First they denied scaling and root planing with 5 mm pockets and bleeding in a juvenile diabetic. Now they denied a Build up on 15. We are writing an appeal but this is a huge time waster. Do you just inform the patient if insurance denies
November 15, 2016
Front Office Discussion
Message Board
Views: 170 | Replies: 9
to be covered. Obviously if I thought it was going to be denied then I would've told them so....anyways...does anyone have a form that they use for United Concordia for this particular scenarios. I've read elsewhere that our estimate that clearly states that insurance denials are their responsibility doesn't
April 16, 2019
Claims Processing
Message Board
Views: 782 | Replies: 12
I don't completely understand how accurate it is but will it help us diagnose or will it be a tool for insurance to deny claims? Does anyone have information about how this will work? I'm currently looking into overjet as well. Would love some feedback from anyone that has tried it. Software seems
February 19, 2026
Software Discussions
Message Board
Views: 149 | Replies: 11
it is required. Probing is not necessary, but I recommend you follow the AAPD guidelines because they will be your ammo against insurance denials for D4346 if probing is required for claim processing but not submitted. You'll be fine if you can thoroughly document the need without probing. I've attached the guidelines for you. Edited: I found the official published version
May 02, 2025
Coding Q&A
Message Board
Views: 159 | Replies: 4
, narrative, x-rays, photos, and EOB denial, I might be able to help. Most likely the department of insurance isn't going to be useful for you if the documentation is the problem. Documentation meaning you sent information that allows the insurance company off the hook (the first sentence above
September 17, 2020
Claims Processing
Message Board
Views: 95 | Replies: 4
for insurances, and general legality. Overtime my notes where getting more abbreviated and generic. Then I had a few insurance denials that I had to fight and just had crappy notes. You should try templates. Much less work in the long run .You can even have your DA start them for you and you can review, change/add then sign. If I do an exam I make a chart note of my findings. I agree templates are the way to go
November 30, 2023
Practice Management & Administrative Forum
Message Board
Views: 133 | Replies: 3
Recently I pulled a tooth on a patient with Premera Blue Cross insurance. I had a 2 year old xray of the tooth, and didn't feel the need medically to take a new one that day. Insurance denied coverage of the extraction because the xray was not current. This is a new one for me. Watch out
November 09, 2022
Billing
Message Board
Views: 65 | Replies: 1
denials for cleanings that were not covered by insurance. No, the lack or frequencies is a major hole in Dentrix.They should have the fields in the software and populate automatically from eligibility
October 17, 2019
Dentrix
Message Board
Views: 122 | Replies: 5
. In that regard, its not really a insurance plan at all therefore they dont have to play by insurance rules. Im guessing somewhere in the 100 page contract with delta it states they can do this. Ive appealed insurance denials to my state insurance commissioner a couple of times. In both instances
June 09, 2021
Delta Dental
Message Board
Views: 78 | Replies: 0
when it is appropriate to become aggressive in these cases and treatment plan endo/crowns on teeth that express craze lines and/or cracks running along the mesial/distal ridges. I can use intraoral photos to demonstrate to the patient where teeth might be cracked, but then an insurance denial comes
July 07, 2021
Restorative Dentistry
Message Board
Views: 194 | Replies: 3
Restored 8 and 9. Both were very sensitive to any air as she had literally no enamel on about 1/3 of the facial. The mesial facial had what I assumed to be abfractions. Principal insurance denial after a narrative was written No benefit payable: treatment is for attrition, abrasion, abfraction
January 04, 2018
Claims Processing
Message Board
Views: 139 | Replies: 5
We continue to run into this problem and I need help. Humana requires us to get medical denial prior to payment for extractions, nothing new. Get the denial and insurance pays. What's new is that no matter how many times we send a claim to Anthem (majority medical carrier here), they never respond
February 27, 2019
Front Office Discussion
Message Board
Views: 121 | Replies: 4
the patient pay it if insurance...problem is, with insurance denial i can't charge the patient because of the insurance contract. it isn't a non-covered service, it is disallowed and therefore the charge is 0 because i am in network. they say the tooth has been extracted so it can't have an occlusal...You
October 31, 2018
Coding Q&A
Message Board
Views: 65 | Replies: 2
Delta attaching a copy of the medical insurance denial or payment. Of course, on EOB it says patient pays zero. We are not set up for medical insurance billing, and we don't even have the patient medical insurance card. Because everything was done in, and around the mouth, I feel like this is just
September 28, 2021
Delta Dental
Message Board
Views: 340 | Replies: 15
it is not covered but not for every single procedure you do. Thanks for the info. We're essentially applying this approach to about half a dozen proceduresthe ones we see the highest insurance denials for, such as crowns, buildups, scaling and root planing, and similar treatments. What is Delta going to do
August 08, 2025
Delta Dental
Message Board
Views: 17741 | Replies: 1414
Healthcare CEO killing reveals lack of trust and accountability in US insurance industry: I get it | Brian Thompson shooting | The Guardian Americans are sharing stories of heartbreaking insurance denials ones that led to worse illness and death in the aftermath of the killing of Brian Thompson
December 23, 2024
Dental Insurance for Dentists
Message Board
Views: 581 | Replies: 13
an insurance denial from MetLife today on a crown we just did. It replaced an old crown done 6years ago.Well......it's now 7 years before they pay for a new one. Lesson learned. i just hope he stays healthy enough to do my implants in 5 years, I'll fly out to see him...
January 28, 2020
Restorative Dentistry
Message Board
Views: 609 | Replies: 12
potential need for retreat but I think its hard to tell without having previous radiographs to reference. Any thoughts or insights on this? Probably will have insurance denial due to RL.I would get a cbct of it and opinion from endo dontist Seeing this after the fact, my plan was to cement perm. crown
May 07, 2024
Endodontics
Message Board
Views: 384 | Replies: 9
that teeth with crown never suffer from bacterial invasion that leads to decay may be an exclusion, but it doesnt mean you have to play by the insurance industries edicts. Good luck in following the insurance denial narrative writing image sending chain of command in the dental insurance game
October 20, 2022
Claims Processing
Message Board
Views: 268 | Replies: 4
days, with taking into consideration the attempts of collecting the balance. If any balance has to do with an insurance denial i personally think that waiting would be best. Ive went into an office and worked one month of collections and was able ti get them back 90k of collections by fighting the insurance company. You just have to.find someone/a company that will fight hard before resulting to a writeoff
June 30, 2015
Patient Finance Plans
Message Board
Views: 159 | Replies: 3
typically gets addressed last as it relates to any type of legislation, but isn't a missing tooth a pre-existing condition? We are doing away with insurance denials because of pre-existing conditions right? So if they have implant coverage and a missing tooth clause with their plan
May 02, 2014
Dental Insurance for Dentists
Message Board
Views: 158 | Replies: 1
. Companies like DentalXChange, Stedi, Zentist, Pearl AI, Overjet, Vyne Dental, DentalRobot, Curve Dental, and Stratus AI are all attacking the same giant problem from different angles: insurance verification, predeterminations, claims scrubbing, attachment management, denial prediction, payment posting
May 10, 2026
Claims Processing
Message Board
Views: 929 | Replies: 27
to say I didnt even notice it until I got the insurance denial of the claim earlier this week. They denied it due to excess dental material out the apex. They also denied the crown due to that. it worried me, so I called the patient in yesterday and she has no symptoms and no paresthesia. I do have
August 22, 2024
Endodontics
Message Board
Views: 491 | Replies: 12
insurance denials for GA and a lot more rough nitrous appointments and a lot more upset parents.. My life would be much harder without OCS. Hmm. This is a good thought. I have a lot of OR cases and I do have some insurance denials, which, makes things tough. I only use versed and hydroxyzine and find
January 02, 2014
Pediatric Dentistry
Message Board
Views: 239 | Replies: 3
before the bur touches the tooth. Saved my ass the other day. Pt. had a crack for a year, delayed crown due to insurance denials. After hygiene visit 2 weeks ago she finally decided to get a crown last week. Go through my speech (I do it at least twice, once hygiene/np exam, and again pre-op). She
March 07, 2018
Restorative Dentistry
Message Board
Views: 211 | Replies: 3
Collection - money actually collected. So if someone does not pay, you don't get paid Production. It can be difficult to obtain 100% collection from production(clerical mistakes, insurance downgrades, delay or denial of claims, secondary insurance, write-offs).A FFS office collecting 100% upfront, then it does not matter. you understand the first sentence makes the term collections turn into production.
October 18, 2022
Dental "Pearls"
Message Board
Views: 808 | Replies: 26
to schedule a couple of peer to peer reviews when the reviewing doc still questioned necessity but the 2 peer to peers were paid in the end with a 5 minute call with the reviewing doc. Unfortunately, insurances know that a lot of offices won't even respond to the denial appropriately or send an appeal
September 21, 2023
Claims Processing
Message Board
Views: 591 | Replies: 14
overhead to pay. Then give a list of free clinics nearby. Send her a certified letter includes a dismissal letter and a copy of insurance denial letter. You only did 1 exam and have not done any treatment. You are not actually her dentist. I'm pretty sure she gave hell to the other dentist
December 01, 2014
Ask a Dental Consultant
Message Board
Views: 25 | Replies: 1
I received some emails from a group called NPCC. They give webinars on insurance claims, narratives, denials, etc. Soundsinteresting. Anyone purchase their courses? What's your opinion? Thanks a lot Any reviews?
January 28, 2022
CE Comments / Suggestions / Events
Message Board
Views: 592 | Replies: 10
Any suggestions for a letter template to fight an insurance denial for SRP? We have a patient who had 2 quads of SRP done with probings in the 4-5+ range and the insurance (MetLife) has denied SRP claims twice now. I don't think we've had an issue with them before. Her radiographs don't exhibit
March 03, 2017
Claims Processing
Message Board
Views: 281 | Replies: 13
with him/her, option chosen, and what youre going to do about insurance denial. I think it will look more professional and like you care more. Delete the letter. Have your FD call the insurance company and ask what is it they do not like about the x rays, and solve the problem with a 49 minutes phone
March 30, 2017
Restorative Dentistry
Message Board
Views: 583 | Replies: 20
. Paid cash that day lol. sounds similar to the insurance denials I get regarding recommended treatment - chewing isn't a medical necessity but please keep paying your insurance premiums to have all your benefits denied.I could see attorneys defending dentist using this argument. your client didn't need
September 26, 2018
In the News
Message Board
Views: 1330 | Replies: 55
Alright, let it out. What's one thing in your practice that's been driving you nuts lately maybe it's a system that won't work. Patient situation or team dynamic vent it out here we're all ears. Fickle patients, insurance denials, training staff, clinical decisions, Adult male patients with wives
July 09, 2025
Just Plain Bitching and Moaning
Message Board
Views: 2314 | Replies: 56
seeing the dental insurances want a denial from medical insurance before paying. And then I see it covered under medical but the patient has one of those 5k deductibles. Go figure. Funny thing is: I'm reading this thread and read this comment at lunch. The patient immediately after has #1 and 16
February 26, 2015
Oral & Maxillofacial Surgery
Message Board
Views: 554 | Replies: 13
point)United Concordia is notorious for denying claims despite sufficient evidence for needed treatment. Collect in full or risk of working for free. Patients nowadays hop from one office to another when they have a balance due to insurance denial or incomplete payment, and they bad mouth
September 08, 2014
Claims Processing
Message Board
Views: 570 | Replies: 7
Recently, I've been getting more denials for SRP's from insurance companies. I send x-rays and pictures, but sometimes the bone and attachment loss isn't obvious on them. Go through the appeal process and they still deny. Has anyone been successful in getting paid for SRP when it's not obvious
October 02, 2014
Claims Processing
Message Board
Views: 394 | Replies: 16
), but pays you... right away. You've now been docked for an insurance denial. You'll WILL ge paid IF the patient pays for the insurance shortfall. Better tell FD to get on the phone and collect. Sound like a hassle? You betcha...
January 14, 2021
Associates Corner
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