In another thread, there was mention of updating insurance estimation - it is my understanding with all the new plan designs out there there may be need for some different calculation methods going forward.
@suzanne, and others, what do you know about insurance estimates/the changes you are seeing, and what you need the software to do to make you the most successful?
I agree that this needs everyone's eyeballs. Insurance is changing all of the time, and our estimating needs to be flexible enough to handle those changes.
@Nina-Gilbert, @kevin_moloney, @matt_ackerman many of these things would apply to PW, CMP, and WinOMS too.
Another thing I've encountered with some Delta plans is a fixed co-pay by appointment....If a patient comes in for a preventive/diagnostic appointment, they pay $65 regardless of whether they just have an exam or have exam, x-rays, and cleaning. It would be nice to have that estimate correctly, if possible. I think insurance companies dream up ways to give us nightmares.
@callton Yes! We have a section of plans that have a $5 or $10 copay for every visit no matter what procedure is done. Then they pay their % of the fee schedule, after subtracting the copay to the first procedure on that DOS.
Since 2018, I've seen a lot of new plan designs that are impossible to track in Softdent currently. Here are some of the issues:
Yes, I agree, insurance plans are changing daily and we need to keep up with the changes. Thank for you requests.
Wendy
I applaud all of these.
1.) As of today, 42 states have adopted "Non-covered or Fee Capping legislation" A very easy way for SD to correct some insurance estimation is to AUTO CHECK the Box w/in BB screen to upgrade to practice fee. , ie NO ADJUSTMENT.
2.) Allow adjustments on Secondary Plans, Especially if there is no adjustment to be considered on patients' primary plan, ie, non-covered, Primary plan is non-contracted. etc.
There is MUCH more that can be done to improve Ins estimation, these two tasks would in the very least provide much relief to users.
The upgrade box would take the pt owes an amount to your fee whether there is an allowance entered or not. Unfortunately, if you are providing the plan adjustment to non-covered tx as a routine, the only way to do that is as you have stated.
I agree, there should be an easier way. Perhaps the wizards at SD could provide an option to mark a BB entry as Non-covered Apply Adjustment. This would take zero from plan and apply adjustment.
My suggestion to them was to auto check the upgrade box for all percentages set to 0% in the plan, as most states have protection now. If they did that and did not incorporate an option to allow adjustment per code, you still would be back to your current workaround option.
In the perfect world, they will get this working. Hang in there.
Awesome information - thank you for writing this up!
I will sit down and review tomorrow then forward on as user stories to our development team.
@Anon @Nina-Gilbert @Anon - this one needs everyone's eyeballs.
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