Treatment Plan Estimating

[kpratt]

When creating a treatment plan for cosmetic work, is it possible to select estimating with insurance or without, when a patient has insurance? Something similar to the patient's ledger, when you can select whether to submit a procedure to primary insurance, secondary insurance or not to send at all.

[robertangus · Accepted solution]

There are options available to not show estimating information when both viewing and printing the treatment plan from within PracticeWorks.

While viewing the plan within PracticeWorks you have the option to update or clear estimating information at the bottom depending on your needs.

There are also options to update or clear estimating information when printing a treatment plan proposal as well.

[lisacourey]

Hi Robert!  I would like to be able to present treatment plans with our "out of network fee" as well as the patient's responsibility based on their insurance's fee schedule.  Currently I can only do either the "out of network fee" or the "in network fee".  This is troubling because there is no way to easily present to the patient that they are receiving a discounted rate AND to show them what their estimated Out of Pocket is as well.  Is there a way that I am missing this?

[jdowner]

@lisacourey 

Sorry for just seeing this comment. 

The Treatment plan proposals are designed to only show the fee that is connected to the producer that the code is assigned to. 

Employee profiles can be set to use their own fee schedule and then set to use fee scheduled 1, 2, or 3. 

if the code for 0120 is set so Fee 1 = 50 and Fee 2= 95
And
Dr1 uses Fee 1 and Dr2 uses Fee 2

Then on the Tx plan if you add the entry for 0120 using the producer Dr1 it will use the fee of 50.  If you add the entry for 0120 using producer Dr2 it will use the fee of 95.  

You can even add the 0120 twice to the Tx plan. Setting one entry to Dr1 and the other to Dr2 and it will put the fee for that copy of the entry to the correct fee for that producer. 

However, there is not a way to make it so that you use one entry of the 0120 code and have it show both Fee 1 (50) and fee 2 (95) on the same line when the Treatment proposal is printed out. 

When insurance estimating is set up correctly for the Employer/plan so that it can show the amount that Insurance will cover, the TX plan does have the office fees, write-off, Insurance amt covered, and expected Ptn amount after insurance is listed on it for each code. 

The different fee scheduled  (Fee 1, 2, or 3) on the Treatment code list are not meant to be used for insurance fees. 

[sonyap]

Unfortunately, there are too many things that don't communicate with each other in treatment plans, so you can't rely on your estimate being correct (if you choose to update estimating).  We had to stop entering pre-determination approval amounts, because the software would read that number only, and completely disregard how much the patient actually had remaining in benefits.  Now, we clear the pre-d so it doesn't show as "open".  The problem with this is that the estimating completely ignores the blue book.  For example - patient's plan pays $863 on a crown (according to our blue book), but we cleared his pre-d, so when we "update estimating and print", it shows insurance payment of just over $100 - and I'm pretty sure that number is coming from his secondary plan.....which is an entirely different hairball, depending on the surrounding factors.  This has been going on for years.  I think my most recent case # is 6342538.  

[robertangus]

I see the case with your Office working with tiffanym‌ on this issue and I see that it was submitted to Development. juriz‌