Denied vs. Disallowed

Denied: Fee charged by dentist is not payable by insurance company, but can be charged to the patient.

Disallowed: Fee charged by dentist is not payable by insurance company, and cannot be charged to the patient.

This difference usually is applicable in situations involving a dentist who has a provider contract with an insurance company. The dentist has signed a contract with the insurance company, thereby agreeing to the terms of that contract. This is a legally binding and enforceable contract, and must be followed.

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Dr. O's Dental Consultant Coding Info