Disallowed and Denied…A Subtle Difference

Disallowed and Denied. They both start with Ds. They both are printed on EOBs. However, one you can collect from the patient and one you cannot.

Do you know the difference?

Does your team know the difference?

I learned only this past weekend the difference between the two. According to Charles Blair, when a claim is disallowed, you can collect the amount from the patient directly. When it’s denied, you cannot. In other words, claims denied you must write off (unless the denial is conditional, meaning you can re-submit). Claims disallowed, amounts due you can collect from your patient.

This is but one subtle difference between the two. And, I’m willing to bet MANY of the people working with insurance in practices all over the US have not idea there is a difference and oftentimes, just write off disallowed claim charges.

Do you know if it’s happening in your practice?

What else might be happening that you’re unaware is, that might be costing you tens of thousands every year?!

These are the kinds of things we pick up at events we attend. This past year, at the final day of the American Academy of Dental Practice national meeting in St. Pete, FL, where I presented two different times, in a session with Dr. Blair, a ClearPath Society® Silver Member indicated to me, that he’d learned more in 5 minutes of listening to Blair than he’d learned in years about insurance.

What your momma told you about hanging around with the right crowd vs. the wrong crowd truly can affect your income.

The edge you seek often is not in the clinic. Likely it’s very rare to be in the clinic. It’s elsewhere, outside of your practice, in meetings, among people who are smarter in specific areas than you, in hallways of conferences, etc. It’s rarely sitting at home or in your office “doing” dentistry. And, it’s about the questions you ask of those experts you surround yourself with.

I encourage you to get out and put yourself in situations where you can’t help but improve and reach your goals and vision far faster.