Worst Claim Story— November 2018

Worst Claim Story— November 2018

A Patient came in with tooth #8 fractured at the MIL cusp after he got into a drunken fist fight.  The doctor proceeded with restoring the tooth with a full porcelain crown. He had no other existing restorations. The insurance denied the claim for no x-ray. I contacted the office and asked about the x-ray, thinking I had overlooked it or maybe it was located somewhere else. The doctor responded and said he didn’t take an x-ray or photo because it was very evident that he needed a crown.  We sent in a detailed narrative and the insurance still denied the crown. At this point I am racking my brain on how to get this paid. Then I thought of an idea. I called the office and asked them to contact the patient and see if he had taken a selfie with his broken tooth. Yes, he had! We sent the selfie in and the claim was paid.

Cicely Mitchell

Account Executive, eAssist Dental Solutions


Dental Billing Tips and News for Pros; Edition #129

  • Yvonne Reid
    Posted at 19:36h, 07 November Reply

    A selfie! of course!! What a great idea, good job!

Post A Comment