My first office was a Medicaid practice. We had a 16 year old pt who needed full mouth extraction and dentures. It was sad. Medicaid denied all his extractions due to “frequency”. I came to find out that his last dentist billed out the full...
Here's a short fun one to share. Office had a patient whose birthday was February 29th. And, decided to do sealants as the next year they would no longer be covered due to the age limits on the plan. Well needless to say the system...
My worst claim story is for a worker's compensation claim for a patient that had an accident in 1970. The patient had to have major facial reconstruction. He lost all of his teeth on the lower arch. He has a subperiosteal implant that retains a...
Our office was once undergoing some re-credentialing issues with United Healthcare. One provider with the insurance had over $16,000 in aged claims. When we would send claims for approval the representative at United Healthcare continually denied them stating he was out of network. Having reached...
When I started with a new office last year they had about 6 claims with Premera that were not being paid due to credentialing. The OM had not completed the credentialing correctly and it was extremely delayed so, as a courtesy, I assisted her. Almost...
A Claim was sent to Cigna on Jun 26, 2019. -Jul 26 Insurance showed the claim was set to pay up to $558, but pending info from Subscriber. Mess to office (only they contact patient in this office). -July 29, Reply that the office manager left a...
Feb 2018, I had a patient that was seen for a recare appointment. The day of, Metlife confirmed their coverage. The claim was paid quickly, without any hiccups. However, 2 weeks later Metlife sent an EOB with $0.00 pay. I called and spoke with a...
We had a patient that had a crown done on a molar, I believe #14. The office is VERY good about documentation, taking x-rays, taking intra oral photos, impeccable chart notes, etc. This tooth had a very large amalgam on it, if I remember correctly,...
I had a claim that Aetna kept denying, perio maint, due to lack of perio history. Aetna paid on perio maint prior in 2018 - just under a different group. The rep kept stating since no perio history on the new group they couldn’t pay...
Calling CIGNA on an unpaid claim can be frustrating! I called on a build up for #30 to give the Cerec information to have it reprocessed(same day crown) and the rep told me that per Cigna guidelines they will not approve the build-up and it...
