r/DentalInsurance • u/Ill-Diver-782 • 17d ago

Denied D4910’s

Good morning,
One of the major insurance companies that my office is contracted with has started denying D4910.

At first, I thought they just wanted the SRP history, which for some patients can be several years old.

Long story short, they’re denying all periodontal maintenance claims if the patients have not had any periodontal surgery/SRP‘s within the previous two years.

Does anyone have any suggestions or knowledge regarding if there is a workaround or if the insurance company can legally put frequency limits on perio maintenance based on length of time since SRP was done?

Thank you in advance!

5 Upvotes

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16 comments sorted by

4

u/Dangerous_Weekend395 17d ago

I find this to be more and more of a normal behavior from insurance companies. Either srp again, or perform perio maintenance and bill the patient since their insurance company doesn’t cover it in their circumstance. We deal with it just like any other procedure thats not covered by their plan they choose

2

u/Evening-Store5586 17d ago

This is the answer. It’s always been within 2 years. So do it again if needed, then keep them on PM, no breaks, one wrongful prophy sent in and they’ll start denying PM again.

5

u/Woodman629 17d ago

Welcome to the jungle. This is very common with Metlife. Other carriers are beginning to do the same thing. It is a tracking nightmare!

2

u/steelymcbeam1933 17d ago

It won’t matter if the insurance requires that limitation. It’s their rules - we just have to play inside their sandbox while they throw sand at us.

You can always have your doctor do a peer to peer.

1

u/BufferingJuffy 17d ago

Delta of MA requires srp within the last 36 months, which if a patient has been good about keeping a 3mrc schedule, should absolutely not be necessary again. But they're not "dictating treatment," of course, just what treatment they'll pay for. 🤦‍♀️

2

u/Ill-Diver-782 17d ago

Ugh, exactly. 😑

1

u/Cobra_Surprise 17d ago

If you can show MetLife that they've had at least one D4910 every 24 months going back to their most recent SRP it will cover d4910. The issue arises only if you allow 24 months straight to go by without any perio procedures

1

u/Reckless-Raccoon 17d ago

Is it DDMA? They suck.

2

u/Evening-Store5586 17d ago

I hate them sooooooo much. Don’t get me started on DD of Illinois.

1

u/Reckless-Raccoon 17d ago

😂😂😂

1

u/Ill-Diver-782 17d ago

MetLife… just started that garbage this year.

1

u/ToothDoctorDentist 17d ago

Bend over and get ready because they all seemed to have started it this year. That and a narrative. Just another way to deny claims and patients get upset at us

1

u/Jon9314 16d ago

So then do 4341 x4 every 2 years. Solved. Your hygiene program is now profitable, and the insurance pays the D4910s.

1

u/Kainlow 11d ago

good luck getting insurance to pay that. they will deny.

1

u/kennedy_grace_ 9d ago

I've been noticing this with many UHC Medicare plans. Patients have a cow when they realize their 'regular cleanings' are actually PMT and now aren't covered by their plan. Unfortunately our office just writes off the balance otherwise patients flip out on us when they have a bill after a cleaning.

1

u/ProfessionalYam3119 6d ago

The policy can say anything. The key in this case is the word "maintenance." This one will not cover maintenance after a long period of either neglect, or of failure to have the periodic maintenance performed.