3 dental billing myths that cause unnecessary write offs

3 Dental billing myths—debunked

Navigating dental billing can feel overwhelming—even for experienced professionals. With misinformation spreading rapidly on social media and within dental communities, many practices unknowingly follow outdated or incorrect billing practices that lead to lost revenue, unnecessary write-offs, and compliance risks.

Let’s break down three of the most common dental billing myths and clarify how your practice can maximize collections while staying compliant.

Table of Contents

• Myth 1: Cigna Never Pays for Core Buildups—They Must Be Written Off
• Myth 2: You Cannot Appeal Timely Filing Denials
• Myth 3: You Cannot Accept Insurance Payments That Exceed PPO Allowed Amounts
• Final Thoughts

Myth 1: Cigna never pays for core buildups—they must be written off.

Reality: Cigna does pay for core buildups—when properly documented and submitted.

Many dental offices assume that core buildups (CBUs) are automatically denied by Cigna and must be written off. However, these denials are often due to missing documentation, not a refusal to pay.

Cigna requires specific criteria to be met before processing payment for a core buildup (D2950):

• The buildup must be necessary to retain the crown due to insufficient remaining tooth structure.
• The provider must report the seat date of the crown before the claim will be processed.

How to Ensure Cigna Pays for Core Buildups:

Call in the seat date of the crown once it is delivered. Without this step, the claim will remain denied, even if the buildup was medically necessary.

For same-day CAD/CAM crowns, document this in clinical notes and attach those notes to the claim submission. The remarks section should include a clear note stating: "Same-day crown. Seat date matches prep date."

By following these steps, practices can avoid unnecessary denials and collect payment on CBUs that are frequently written off.

Myth 2: You cannot appeal timely filing denials.

Reality: Timely filing denials can often be overturned—with the right documentation.

Timely filing limits vary by insurance company, typically ranging from 90 days to 12 months from the date of service. Many practices assume that once a claim is denied for timely filing, it is non-negotiable. However, many of these denials occur due to missing or mishandled claims, and they can often be successfully appealed.

The most common reason for timely filing denials is that the insurance company never received the claim. This is a frequent issue with electronic submissions and can sometimes be resolved with proof of submission from the clearinghouse or PMS. Another common scenario occurs when a claim was initially submitted on time but was denied for another reason. If it was corrected and resubmitted after the filing window closed, the insurer may issue a timely filing denial, even though the original submission was timely.

How to appeal a timely filing denial:

• Retrieve submission reports from your clearinghouse that show the claim was originally sent within the timeframe. These reports should clearly display the submission date and the payer ID.
• Include a timely filing letter from your software or clearinghouse that confirms when the claim was submitted.
• If the insurance company mishandled the claim or lost it, request an exception by providing supporting documentation. Many payers will reconsider the denial when presented with valid proof.

While timely filing denials can be frustrating, they are not always final. With persistence and the right documentation, many of these claims can be successfully appealed and paid.

Myth 3: You can never accept insurance payments that exceed PPO allowed amounts.

Reality: In some cases, your office can collect more than the PPO fee schedule allows.

One of the most common misunderstandings in dental billing is the belief that a provider must refund any amount paid beyond the PPO fee schedule. However, this is not always the case—it depends on how coordination of benefits (COB) is handled between primary and secondary insurance plans.

Example of when you can keep the full payment:

A patient comes in for a prophylaxis, and the office charges $120 (usual, customary, and reasonable fee).

• Primary insurance is a PPO, and the office is in-network. The allowed amount for a prophylaxis is $70, which is paid in full by the primary insurer.
• Secondary insurance is also a PPO, and their allowed amount for the same procedure is $85. They pay $50—the remaining difference between the office’s usual fee and what the primary paid.

Because the total payment does not exceed the UCR, the office is allowed to retain the full $120 payment.

Understanding coordination of benefits rules:

Each insurance carrier handles secondary payments differently, so it’s important to review each payer’s COB rules. Some secondary payers coordinate up to the provider’s fee, while others limit their payment based on the primary’s allowance.

Knowing when additional payments are permissible prevents unnecessary refunds and ensures that your practice collects what it is owed.

Final thoughts:

Dental billing is complex, and misinformation can lead to costly write-offs and lost revenue. By understanding these common myths and applying the correct billing practices, your office can maximize reimbursements, reduce denials, and stay compliant with insurance regulations.

If your practice is struggling with claim denials or unclear billing policies, partnering with an expert billing team can help streamline the process and improve cash flows. ‍