Treatment Plans would be so much easier to use, and beneficial for our patients if they would take into consideration the insurance calculation rules that exist for the practice and the plan.
Show the amount expected from insurance based on the insurance calculation rules and also the estimated patient due amount.
Create merge fields for these amounts so that I can create my own Treatment Plan letters with this data.
That's fine. We are using the dental labs space for all the feedback sessions with that customer group.
Another issue that needs to be addressed is having the system be able to correctly calculate the primary/secondary insurance payments. Maybe adding something in the software that could be checked for whether the secondary plan COB is standard, non duplicating, etc. as well as actually taking the estimated amount in the primary tx plan and plugging it in either manually or automatically to do the secondary calculation for the patient.
Great feedback! What is a "non-duplicating" plan?
what kinds of worksheets do you use today to calculate insurance benefits today?
Non-duplicating is the same as ‘carve out’ – The secondary carrier pays only the difference between their plan’s normal benefit (if they were primary) and any amount paid by the primary payor’s plan. They do not reimburse up to 100% of the total charges and the patient is responsible for any co-pays and deductibles.
Right now our tx coordinators print out the estimated primary plan payment and then print a new tx plan, minusing out manually the primary’s payment and manually calculating the estimated secondary payment by hand. Can be highly inaccurate. The only other option we have is to send in a pre-determination to primary, then to secondary along with the primary’s response which is lengthy.
Patient Account Specialist
Office (804) 897-7900
Fax (804) 897-7562
Got it. Thanks for the clarification, that makes sense.
Carestream Dental LLC
1765 The Exchange
Atlanta, GA 303339
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