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First Molar I

Re: How to fix wrong expected insurance and patient out of pocket from Bluebook?

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I stumbled upon this again and I embarrassingly did not make this additional point.    The scenario you propose will only work for Plans that universally downgrade between Molar and Premolar.     

Many plans downgrade ONLY on Molars.    Therefore your alternate allowance table would only be correct a portion of the time.        Modifier codes entered into allowance table at the same allowance as a general code is the only way I have found to be near precise.  

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