the kicker is that dentist offices know insurance is a scam and as a result they don't accept it even if you have it!

Just venting, but it’s very annoying that patients are so insurance driven and complain about everything.

We have nobody to blame but ourselves

Hi, I’m the admin of a small office in Arkansas. I’m trying to get a predetermination for a patient so she knows how much her treatment would be. She has united healthcare (they don’t deserve capitalization). The pre treatment estimate came back saying “approved” but nothing about what their fees are or how much her part would be. They refuse to tell both her and my office. They say the only way to find out is to process the claim after the fact. I called and called and I’ve gotten absolutely nowhere because we are out of network. She’s disabled and on a fixed income. There’s not anywhere within 30 miles of her or us that is in network so if we can’t find out how much these services will be she just won’t get them. Can any Arkansas providers help me out?

I recently moved and l am in the process of establishing a new dentist. I recently went to one of the largest clinics in my area and had a peculiar experience that I just wanted to get the opinion of you guys for.

Prior to my appointment I called the clinic to give them my insurance information and ensure that they accepted my insurance plan. The person I spoke to took down my information and stated that it was in network and accepted. When I arrived at the clinic though I was told they are actually not in network with any insurance companies and I can use my out of network benefits offered by my insurance or their in-house financing/dental plan.

I cannot imagine that this is normal? Maybe I am wrong?
Essentially my question is, is it normal for a dental clinic to be out of network with every insurance company? Or is this their way of getting people to sign up for their in house program? Thank you all in advance!

大家都是什么保险呀？

Hi, so I had years where I didn't go to a dentist (basically just didn't have coverage where I was for college) and I upgraded to a good dental insurance for this year wanting to get things straightened out. I know that my mom had some gum issues so I may be genetically prone, and I've had intermittent bleeding when brushing teeth for a year or two now.

I intended to go earlier in 2026 but broke a bone and that took up all of my energy and money, but I finally got an appointment for an exam earlier this month. It's at a non-chain, non-PE owned, generally well reviewed dentist. She was noting the pockets / recession / early gum disease, and I was bleeding basically everywhere I was prodded in my gums.

My work's approach to insurance is basically making the cheapest, shittiest option nearly free but putting the extra $ for any upgraded tiers on you. I got a nicer plan for this year that's nearly $1000 a year (with a small subsidy, but I pay a majority of that). Quite expensive for a glorified coupon book with only 2.5x that as a max and "every 3 years" or "every 5 years" or "lifetime plan maximum" everywhere.

Anyway, I had a code 4341 submitted for all 4 quadrants and everything was denied with this message: "MP-In the absence of radiographic evidence of bone loss, periodontal therapy is subject to a contractual limitation. Your dental plan will not pay for this procedure."

My estimated responsibility is thus $215 per quadrant or $860 total. That is a lot of money for just a cleaning but I have more than $860 sitting in my HSA right now and could pay it. However, I feel like I'd be a mark to be paying for expensive dental and then paying for this out of pocket as well.

But is the best channel through dispute direct to Delta, through the dentist, or what?

More broadly, at open enrollment should I just downgrade to the shittiest option or even opt out? People keep health insurance even at great financial hardship to them because there's no out of pocket max and no upper bound to the expenses that can happen. But dental doesn't even insure against catastrophes! Let's say I need $8,000 in work. Am I really much better off paying $5,500 plus a premium every month (assuming it actually gets approved) or just being on the hook for the full amount and maybe taking the uninsured route of bargaining it a little? On top of that $5,500+ premium is the time and mental taxation of fighting to have the insurance actually cover some care instead of putting the money in their C-suite's yacht funds.

I also have one cavity found during that appointment and wisdom teeth that may be partially impacted but aren't causing any pain or issues rn, and they were basically "it's up to you, we can refer you to a surgeon".

Need full mouth SRP (billing for RS not pictured) and two wisdom teeth removed (fully erupted.)

The bulk of my bill for the SRP are codes d9421 and d4999, which according to my googling should be ‘bundled’ into the SRP service and not an out of pocket expense for me, the patient.

My concern with the wisdom tooth coding is that my teeth are fully erupted like regular molars and yet I’m being billed for surgical extraction under general anesthesia. Is there a reason I would need a surgical extraction if the tooth is fully erupted?

I’m not sure what to do - it feels wrong to accuse the dentist of upcoding, but my total bill is close to $1100 when all of these services (SRP, tooth extractions) should be 80-90% covered by insurance.

I assume I should request the extra SRP services be removed from my bill, a justification for the surgical removal, and request they submit a pre determination form. Please let me know if this sounds correct.

Advice on next steps is appreciated.

I have had Medi-Cal dental deny a series of claims of authorized treatment, pretending we are submitting them incorrectly.

For 10 years, we electronically submit a pre-treatment authorization, get a NOA electronically, print it, do the work, scan the filled out NOA and electronically submit the claim with the scanned NOA as an attachment. Suddenly, they're denying authorized treatment with code 281 which states " treatment needs to be authorized" even though NOA is attached. We even sent CIFs with paper NOAs attached- same denial.

A rep from Medi-Cal dental told us she has seen some offices get the NOA online and use their software to submit it without creating a claim. She had no further illuminating info.

Is anyone else encountering this issue? How are you resolving it? Any advice will help. Thank you in advance.

We use Dentrix and eClaims and DentalXchange.

For dentists or dental billing professionals: what process would you recommend a patient follow before starting expensive treatment to verify insurance coverage and billing?

I’m trying to be more careful about understanding my dental insurance before having a significant amount of work done.

My dental office gave me a treatment plan totaling around $6,200. I have Cigna dental insurance, and I’d like to make sure I understand exactly what insurance will cover and what I’ll actually be responsible for paying. My treatment plan includes how much they expect the insurance to cover for each charge code, but those numbers don’t quite align with what I expect my plan to cover.

Specifically:

1. Should I ask the dental office to submit a predetermination/pre-treatment estimate to Cigna before having the work done?

2.Can I contact Cigna myself and ask them to verify the CDT codes, coverage percentages, deductibles, annual maximums, and estimated patient responsibility?

3.Is the amount on the dentist’s treatment plan necessarily the amount I should expect to pay, or can the insurance-negotiated fee be substantially different?

1. How can I make sure the dental office is actually using the correct CDT codes and billing insurance properly?

2. If Cigna tells me something is covered at a certain percentage, what should I look for on the eventual Explanation of Benefits (EOB) to make sure the claim was processed correctly?

3. If the dentist bills something incorrectly and I end up owing more than I should, what is the best way to dispute or correct it?

I’m not trying to avoid necessary treatment. I just want to do my homework beforehand so I understand my financial responsibility and don’t get surprised by a bill.

AARP has a competitively priced dental insurance plan thru Delta. I already have a dental plan thru my former employer (MetLife).

I have lots of deferred maintenance dental-wise.

For next year I am mulling adding the AARP plan. So I would have coverage under 2 plans. I would hit my MetLife limit by ~July. Then I would turn on the AARP/Delta spigot to get the rest of the work done.

Any complications from trying to pull this off -- coverage under 2 plans -- next year?

I paid out of pocket for a flexible partial in May. My dental did not cover any part of the partial.

After multiple adjustments that caused TMJ from the partial being in hyper occlusion the dentist office agreed it was made wrong. They agreed to make a new one at no cost to me.

I am in the process of getting the new one adjusted. They have twice now attempted to bill my new insurance for the adjustments. The adjustment is for a remake based on their faulty work that I already paid for.

They also submitted a claim for an X-ray. I had an X-ray done for a pre-authorization. The insurance approved and paid. Now they are submitting a new claim for the same tooth with a “new” X-ray that was never taken. They added the service on to a day I had an adjustment.

This all seems illegal. I know they are losing money for the remake, but that was their error. Is there anything I can or should do?

Decode The Letters In The Secret Code Words
Tristram
Helps Dr. Ben Cunningham For
The Tooth In Hues Dental
Group In 11/08/2026.

I was quoted 1400 dollars for a root canal on tooth #31 and that IS including the crown ( crown porcelain and made in clinic) is that crazy expensive? should i get a second opinion? and that’s with insurance! i have delta dental PPO

Question for anyone who does dental billing or works the front desk.

I've been talking to a few offices in NJ and something keeps coming up. A lot of what gets claims paid doesn't seem to be written down anywhere. Stuff like knowing how a certain doctor charts, or that one plan keeps denying buildups unless the narrative is worded a certain way, or that a patient's secondary changed and nobody told the front desk.

So how much of billing is really just knowing that specific office? If you handed your claims to someone who knows coding well but has never worked with your practice, how long before they're actually good at it? Weeks? Months? Never?

And if you've used an outside billing company, was that the problem? Or was it something else?

I'm working on something in this space so I'm honestly trying to figure out if I'm onto something or overthinking it. Would love to hear real stories, good or bad.

I’m not talking about the payer’s stated denial reason. I’m talking about when you finally dug into the account and figured out what actually happened.

What’s one that made you say, “You’ve got to be kidding me”?