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Correct Secondary Insurance Estimation

Correct Secondary Insurance Estimation

0 Kudos

Currently, this is what SD online support declares is their estimation values. 

"Estimating Secondary Insurance Benefits

A new option—Coordinate benefits when used as a secondary plan—has been added to the Claim Filing tab of the Insurance Plan window (List > Insurance Plan > Double-click a plan > Claim Filing).

If you select this option, the software estimates the secondary insurance amount based on the total fee minus the deductible, minus the amount already estimated to be paid by the primary plan.

Example: A primary plan pays 78% of a transaction after the patient pays a $50.00 deductible. 
$125.00 fee - $50.00 deductible x 78% = $58.50

The secondary plan pays 55% of a transaction after the patient pays a $50.00 deductible and the primary plan amount has been subtracted.
$125.00 fee - $50.00 deductible - $58.50 primary plan amount  x 55% = 9.07

If you do not select this option, the software estimates the secondary amount as it always has, using the total fee and not taking into account the amount already estimated to be paid by the primary plan." 

 

This Type of COB is incorrect as it does not take into consideration the Contracted Allowance of the Secondary plan.  The COB Calculation method you display is known as  "Carve-OUt" and is not a popular Calculation Method of dental plans.   Standard Calculation is most widely used.