What is the correct way to set up a given insurance plan's bluebook when a procedure isn't covered by insurance?
For example, a plan (%PPO) does not cover implants. I tried changing the bluebook for those procedures to be 0%, but that also changed the allowed amount to 0. If I then use that plan to create a treatment plan that includes implants, the treatment plan shows that the insurance write-off is the entire cost with $0 paid by insurance and $0 paid by the patient. I need it to show that the entire cost is the patient's responsibility.
I've obviously set something up incorrectly. Thanks for your help straightening this out.
As often happens, I try to solve the issue myself for some time, finally cave and post here, and then figure it out within an hour or so.
I just had to click "upgraded procedure" when I change the percentage to 0 in the bluebook.
If this isn't the correct way (maybe it has other implications I don't know about), please let me know.
To answer your question. Simply mark the payment and percentage to zero and select the box to upgrade to your fee. NOTE: Blue books are group number specific. So all patients within that group number should have the same benefits.
If you have multiple patients on the same Group number that have different benefits, then I would suggest calling the patients plan to obtain Sub group/ sub policy/sub plan numbers. Metlife and United Healthcare will show this on a fax back, Cigna and Aetna you typically have to actually call for. Cigna calls these sub ids' as the Sub Policy and Sub Division numbers.
These sub IDs differentiate benefits between policy holders that work for the same company. For example:
Mr. smith is the VP of Disney-- Has group number 123456-001-45 or Sub plan 1 Branch 45 and has implant and full ortho coverage, and no downgrades , 5000. benefit
Mr. Jones is the Bus Drive at Disney, Group number 123456-01- 22 or Sub 01 Branch 22 --- has NO implant or Ortho, downgrades and 5000 benefit.