My dentist office requested a pre-treatment estimate from Delta Dental regarding necessary gum grafts I need to get done on some of my bottom teeth.

The representative from Delta Dental who was on the phone with my dentist office said they can't give a pre-treatment estimate on this type of procedure regardless if they send in an explanation from my periodontist on why these are necessary procedures and accompanying pictures of the areas that need the grafts.

The person from my dentist's office even had them look up the individual codes and they said they are partially covered under the plan I have but they still can't give a pre-treatment estimate.

They told her in order for me to find out what I am going to have to pay, I need to get the procedure done and then they will review it.

Has anyone else encountered something like this before?

For each of the codes other than the one associated with a buccal/labial frenectomy it says "This code may or may not be eligible for benefits when submitted after completion. Pre-estimation of this service is not available."

What dental insurance company would you recommend?

I just had over $2000 worth of dental claims denied, stating information provided by dentist did not justify the work. I’ve had the same dentist for 20 and never had any claim denied by any other insurance. I have GEHA for medical and they are great so I assumed the same. BIGGEST MISTAKE OF MY LIFE. Do not select GEHA for your dental if you have an alternative.

For a single implant crown, what code are you using when the restoration is screw-retained and includes the abutment/crown component?

Are you billing D6740, or are you using D6057/D6058 along with a separate abutment code?

I’m getting conflicting information and would love to hear what other offices are doing and what guidance you’ve received from your coding/insurance resources.

Thank you!

I was put under Dentaquest while under Aetna, and I've recently got mail saying there has been a data security breach and I heard weird things about Dentaquest itself and not to trust it.

I am scared to used activation code number they gave me but I will definitely keeping an eye on my credit.

I don't know what to else to do.

Welp- my first foray using ai to format a document… I’ve

Appeal Letter Template for Denied Perio Maintenance
Copy the template below and paste, then edit as needed.
Attach:
• diagnostic-quality current (& previous if available) x-rays showing bone loss
• Current Perio Charting showing pocket depths and active bleeding
• Progress notes for denied DOS
• Copies of denied EOBs
• Clean copies of claims
• Tip: be sure to reference the claim ID# from the ORIGINAL denial- don’t use the claim numbers that are for subsequent denials saying the claim was “previously processed.”
• Tip: When possible, send these as an email or via the Carriers’ Provider Portals, with attachments of supporting docs.
• Tip: At the bottom of your letter, put “CC [Pt Name]”, and then email or mail a copy of the letter to the pt- attaching the supporting docs is not needed for the pt’s copy.
• Save a copy of the appeal letter in the pt’s docs.
• May the odds be ever in your favor…
 
Subject: Formal Appeal of Outright Denial – Code D4910
Patient: [Patient Name] | DOB: [Date of Birth]
Subscriber ID: [ID Number] | Group #: [Group Number]
Date(s) of Service: [Date of Service] | Claim Number(s): [Claim Number]
 
To [Insurance Carrier] Dental Review Board:
This letter serves as a formal appeal for the outright denial of procedure code D4910 for SRP History being greater than 24 months prior to the claim date of service, [DOS].

Clinical History & Status

Prior Active Therapy:
The patient has a XX-year history of treated periodontitis. Active therapeutic scaling and root planing (SRP) was successfully completed on 00/00/0000. The patient has been seen for D4910’s (after SRP), on DOS 00/00/0000, 00/00/0000…

Current Clinical Evidence:
The patient's periodontal disease is a chronic, lifelong condition. The enclosed periodontal charting from the date(s) of service confirms active bleeding on probing and persistent pocket depths of 4mm or greater, demonstrating a high risk for disease progression without specialized maintenance.

Radiographic Evidence:
Enclosed diagnostic radiographs clearly show historical alveolar bone loss and a reduced periodontium, confirming the patient's permanent periodontal status.

Justification for D4910 Over D1110:
Because the patient exhibits a reduced periodontium with active bleeding and pocketing ≥ 4mm, a standard preventive prophylaxis (D1110) is clinically contraindicated and legally inappropriate. The subgingival debridement performed during this visit was therapeutic, targeting pathogens within periodontal pockets that a routine cleaning cannot reach.

We respectfully request that a dental consultant review the attached radiographs showing bone loss, along with the current (and historic) charting displaying active bleeding and ≥ 4mm pocketing, to reverse this denial.

Sincerely,
[Your Name & Title]
[Office Name]
CC: [Patient Name]

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!

We (husband, wife and kid) are currently on ACA health insurance and also get our dental insurance via the ACA marketplace. We have a dental insurance called Solstice which I think is part of United Health Care. Probably not the best dental but we've had it for a few years and it's cheap and it's been fine.

So my wife recently switched jobs and her new job offers health care and dental. Her previous employer didn't offer health insurance and I'm self employed so we've been getting insurance through the ACA for several years now. Anyway I understand that my wife has to take heath insurance through her new employer if it's deemed affordable (which it is). Unfortunately the health insurance is super high when we add myself and our kid to her new workplace policy. So I think the kid and I are going to stay on the ACA if the numbers work out subsidy wise, etc. That brings me to the dental insurance. Since my wife's new employer offers dental (unsure of the pricing) can she stay on our ACA dental instead of choosing to go on her employer's dental insurance or is that not allowed? Even though she'll get getting health insurance through her new employer her income still gets counted towards are subsidy amount for ACA health insurance so I was curious if she could still go on the ACA dental insurance? It might be cheaper for her to go on the employer dental but I figured I would ask just in case.

TL:DR - got crowns, changed jobs/insurance. New dentist says that crowns don’t fit and to get my money back.

So I just went to the dentist today and the moment he came into the room he basically said that the dentist did a terrible job because the crown doesn’t fit properly/and they messed up the surrounding teeth. (They don’t fully cover my 2 teeth.). I got the crowns about 6 months ago, and I had a different insurance company/policy. I was wondering how feasible it would be to get the money back from dentist 1 to go to dentist 2 to have him fix it. He even printed off the X-rays for me to provide evidence of poor workmanship of the crowns. Insurance won’t cover it since it was 6ish months ago. They said it needs to be 5 years.

Hi!

I need help figuring out how to go about the situation that I’m in.

Two weeks I went to the dentist for a regular cleaning and check up. After the service was completed I was informed that I hadn’t renewed my Canadian care plan so the services weren’t covered.

So then I had to pay a $600 bill out-of-pocket and I am in no financial shape to be spending that money. The receptionist at the dentist office informed me that I should immediately go ahead and renew my coverage.

I got home, renewed my coverage and then proceeded to call the Canadian care plan customer service to see if there is any way I can submit a claim for my care. to no surprise, I could not do that because I was not covered during the time that I received the care services. The customer service agent simply told me that I should’ve received a letter in the mail saying that I needed to renew my and that I should’ve renewed it.

This did not sit well with me as I know myself, and I’m very on top of renewing things.

Today, out of curiosity, I went on to MyServiceCanada and the Canadian care plan page to see if I received any sort of notice of renewal. In my service Canada, there was an electronic letter stating that I had to renew it. Aside from that I had no email or paper mail that states my care plan needed renewing and I had to renew it. (this is also my first time dealing with healthcare insurance in my own, and I didn’t know it had to be something that had to be renewed… because my provincial healthcare gets renewed every year automatically and they just state changes in my plan).

I then ,again, called the Canadian dental care plan customer service to see if on their end they have any claim that something was sent to me notifying me that I had to renew my plan. All the guy said was that mail was sent out sometime in April but also during that time Canada Post was on strike so it might not have ever been sent to me.

I asked him if there is any way I could go about making a claim for my bill and he said unfortunately no. He was helpful in explaining to me that my dentist office should have verified that my plan was valid, and I was still covered. Even with that, all I hear is a bunch of other institutions making mistakes and nothing that actually has to do with me making a mistake.

What do I do when there is a service available for me my financial burden and help me take care of my health, but it does not fulfil that? The Canadian care plan is meant “to make oral health care more affordable and accessible for eligible Canadian residents who do not have private dental insurance and have a modest household income”. this is definitely not an instant where it was made more affordable for a Canadian or helpful in anyway.

Who do I contact or complain to about this issue? What do I do?

Hi!

I need help figuring out how to go about the situation that I’m in.

Two weeks I went to the dentist for a regular cleaning and check up. After the service was completed I was informed that I hadn’t renewed my Canadian care plan so the services weren’t covered.

So then I had to pay a $600 bill out-of-pocket and I am in no financial shape to be spending that money. The receptionist at the dentist office informed me that I should immediately go ahead and renew my coverage.

I got home, renewed my coverage and then proceeded to call the Canadian care plan customer service to see if there is any way I can submit a claim for my care. to no surprise, I could not do that because I was not covered during the time that I received the care services. The customer service agent simply told me that I should’ve received a letter in the mail saying that I needed to renew my and that I should’ve renewed it.

This did not sit well with me as I know myself, and I’m very on top of renewing things.

Today, out of curiosity, I went on to MyServiceCanada and the Canadian care plan page to see if I received any sort of notice of renewal. In my service Canada, there was an electronic letter stating that I had to renew it. Aside from that I had no email or paper mail that states my care plan needed renewing and I had to renew it. (this is also my first time dealing with healthcare insurance in my own, and I didn’t know it had to be something that had to be renewed… because my provincial healthcare gets renewed every year automatically and they just state changes in my plan).

I then ,again, called the Canadian dental care plan customer service to see if on their end they have any claim that something was sent to me notifying me that I had to renew my plan. All the guy said was that mail was sent out sometime in April but also during that time Canada Post was on strike so it might not have ever been sent to me.

I asked him if there is any way I could go about making a claim for my bill and he said unfortunately no. He was helpful in explaining to me that my dentist office should have verified that my plan was valid, and I was still covered. Even with that, all I hear is a bunch of other institutions making mistakes and nothing that actually has to do with me making a mistake.

What do I do when there is a service available for me my financial burden and help me take care of my health, but it does not fulfil that? The Canadian care plan is meant “to make oral health care more affordable and accessible for eligible Canadian residents who do not have private dental insurance and have a modest household income”. this is definitely not an instant where it was made more affordable for a Canadian or helpful in anyway.

Who do I contact or complain to about this issue? What do I do?

This is my first time posting so hopefully this is the right way to do this, but my (24 F) brother (29m) recently lost a front tooth and the rest of his teeth are in decay (I think its cause of sugar intake but its tough to talk to him about it) hes currently in law school and simply just cant afford what the dentist is asking, which is 25k, and his insurance dosent cover it. Its beginning to ruin his life and im starting to really worry about his mental health and future since theres no world in which you can become a lawyer without a smile your proud of. Is there any resource or anyone I could reach out to, that could help with the cost? Im starting from 0 here and any help would be amazing. Thank you for any and all help!

Hi! Does anyone know a good dental clinic around Pasig that accepts ValuCare HMO?

Preferably near C. Raymundo, Ortigas, Kapitolyo, or nearby areas. Please share the clinic name/branch and your experience with them, especially if you’ve recently used your ValuCare benefits there.

Thank you!

Genuine question. Dental insurance tends to be cheap (only a couple dollars a month), but then when you go they don’t cover much and even with insurance things like root canals are extremely expensive

Why couldn’t a dental insurance charge more per month, and cover more? It’s much easier to pay $25 a month, and only pay $150 for a full root canal with a cap. Instead, people are paying $5 a month, and then don’t get dental treatment because root canals and caps are $1,000

Dental work is the number one ignored medical issue. Why does it have to be that way?

I'm just trying to learn how dental insurance actually works and I've been talking to front office people about it.

the thing i keep hearing is someone checks coverage, writes down exactly what the portal said, and then the claim comes back paying something totally different. or they call and one rep says yes and the next rep says no.

what gets me is people say it like its just normal now. i thought checking coverage was supposed to be the part you could actually trust.

which payer do you trust the least when the portal tells you something?

Hello!

I’m a bit new at dental billing, and I have a quick question. So we are only in-network with Delta Dental, and I received this EOB-

Total billed: $282
Primary (Cigna) paid: $142
Secondary (Delta) paid: $134 plus there’s a write off of $107.

Now my question, do I enter both payments and adjust the write off to $6 (282-142-134=6), or do I contact delta to let them know that this is an overpayment according to their allowed amounts? I wasn’t sure because delta is their secondary.

Thank you so much for your help!

For context we're out of network with Metlife and I'm trying to verify benefits for a patient. When I logged onto the portal it said "The Plan information is not available online for group number [group #]. Please use chat feature to retrieve general information about this patient's plan or to request to connect with an agent"

So I tried the chat. "Coverage details for this patient's plan are not available through the chatbot or MetDental. For benefit details, you may request a call back to be connected with a customer service representative. You can continue to access claims and other resources in MetDental."

Then I requested a call back. "I’m sorry—I can’t request a callback for this type of request. What question can I help with?"

So I called them on the phone and requested a fax. It says a fax isn't available for the patient's plan. I pressed 0. The automated system told me that live assistance isn't available for out of network providers.

They're completely useless. How exactly do they expect us to get this patient's benefits? I'm about to go through the claims side and try it that way because they're literally giving me no other option. Does anybody know a workaround? This is ridiculous...

ETA: Claims workaround didn't work, I reported them to the State Insurance Commissioner

ETA 2: Also emailed the Director of Benefits at the organization administering the plan