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Premolar I

Turning off Insurance Estimation for specific codes on Treatment Plans

Is there a way to turn off insurance estimation or edit insurance estimation on specific codes entered on a treatment plan?

We may have treatment that is cosmetic and does not have necessity that  we know will be refused by an insurance company. 

For example:

If a patient has necessity for a crown on tooth #8 and would also like a veneer on tooth #9 for cosmetic reasons, I would like to put both procedures on one treatment plan and have the insurance estimation for one procedure and not the other.

Is it possible to do this?

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Hello @kpratt

There is not a direct way in the TX plan to specifically mark one code as not being covered/estimated.

Under the assumption that the veneer would also fall outside of cosmetic and be covered making it so you have estimating set up for it for those scenarios, you're options will be limited.  The best way would be to enter in a pre-authorization amount for the veneer/uncovered code of $0. This will make the software use the pre-auth'd amount for it's estimating numbers. 

If this code never get's sent in for any patient to be covered, you can edit the code under List > Transaction codes > Select code > click OK/Edit > check the box on the lower left "Do not submit to insurance" 

If you have any additional questions about it, let me know!


Johnathan Downer | Technical Support Analyst
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