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doctom4300
Premolar III

Calculations when there is a secondary insurance

If a patient has two insurances, the calculations for treatment plans are incorrect. The calculations for the patient payment when posting a transaction are also incorrect.

Is there a way to get the calculations to ignore the existence of the secondary insurance?

For example, if both insurances cover 50% of crowns (I'm ignoring the deductible for this example), the calculations are saying the patient owes 25% of the total crown cost. But if the insurance has a non-duplication clause, which many of them do, the patient is still going to owe 50%.

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mdunham
Premolar III

Re: Calculations when there is a secondary insurance

Brenda, if your Allowance Table and BlueBooks are properly entered, your treatment plans should be correct FOR THE MOST PART.  

Situations that throw off Tx plan calculations are if you are participating with both policies and the lesser allowable plan is the secondary.   (softdent automatically applies adjustment to primary plan)  

In the event of NON-Duplication.  You could simply open the line item in tx plan and enter $0.00 inside the Secondary Payment window field.  

Picture on page "6/15/2017 1058 AM - Screen Clipping"  (Web view)

Caution:  it will revert BACK , so if you may want to print your tx plan after you have completed or screen shot and save in documents.   add a note, whichever.   

If you need help with COB Non-duplication types let me know, I would be glad to help.     Non-duplication types such as Maintenance of Benefits, and Carve-out etc can be difficult.  I have a few work arounds, if you need.

Melissa

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doctom4300
Premolar III

Re: Calculations when there is a secondary insurance

Both plans are Delta and they use the same allowance table. The percentages and blue book are set up correctly for each plan. It still tells me that the patient's share for a crown is 25% of the total cost. This is not accurate. The patient owes 50% of the total cost.

So, the solution is... don't use SoftDent's patient payment estimates if the patient has two insurances.

edited to add: When I say the plans are set up correctly, I mean they produce accurate estimates when used alone as a primary insurance. Whether or not "Coordinate benefits when used as a secondary plan" is clicked, the results are inaccurate when the plans are used as a secondary insurance.

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mdunham
Premolar III

Re: Calculations when there is a secondary insurance

That is peculiar.   My treatment plans produce the correct tx plan amounts in general when tx planning for patients with duplicate primary and secondary plans.      I will play with this when I am in office tomorrow and get back to you.

  Your Delta adjustments should be correct as they both share the same allowance table. (I am assuming your allowance table is configured correctly and attached to both plans because you state that they configure correctly independently.)  

In my experience Delta generally has the Standard COB rules, so the secondary payment should be equal the difference between what the primary paid and the allowable charge.  I have not seen many Delta plans have a non-duplication clauses.  

Standard COB:   Secondary pays up to their allowed amount minus what Primary paid. 

 example:     $1000.00 charge   Allowable 800     Primary payment $400.00 Secondary payment $400.00 with an adjustment of $200.00 the patient would owe zero.  

Maintenance of Benefits: (imagine different companies to show MOB math)  Maintenance of benefits (MOB) reduces covered charges by the amount the primary plan has paid, and then applies the plan deductible and co-insurance criteria. Consequently, the plan pays less than it would under a traditional COB arrangement, and the beneficiary is typically left with some cost sharing.   HInt:   these types of plan generally never remit a payment until primary is maxed or is a non-covered service, or a benefit limitation, such as age or frequency.  

      1000.00 Charge     Allowable Primary : 800    Allowable Secondary: 900   Primary paid:  $400.00  Secondary scheduled payment: $450.00   Secondary ACTUAL PAYMENT after MOB applied:  $0.00   Patient Secondary co-insurance estimated: $400.00    Patient Payment:   $400.00

Carve out:    Subtracts Primary Payment from Secondary estimated payment to create actual payment: 

   1000.00 Charge   Allowable Primary: 800   Allowable Secondary:900   Primary paid $400.00    Secondary Scheduled payment $450.00  Secondary ACTUAL PAYMENT:   $50.00    Patient Payment:   $350.00

**** If you would like to eliminate the Secondary estimation, simply zero out the Secondary payment within your treatment plan.   This works out for you in your Delta Scenario as both Allowable are the same.   In the event your secondary is the lower allowable you have to manually configure the extra adjustment.   

If your patient has a non-duplication clause, what type do they have?    Obviously Softdent does not configure those, but I can help you if the above examples do not make sense.      If you like feel free to message me through here and I will try to help you.   Most of my tx plans come out correctly., I am sure there is some fine detail that is being missed.  

Have a great day!  

  The COB as Secondary Button does not work at all and does not change the treatment plan in any case.  I have had many conversations with Softdent regarding the COB button.  

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doctom4300
Premolar III

Re: Calculations when there is a secondary insurance

Melissa, the calculation that we'd like to see is the Carve Out calculation. How do I have to set things up to get that calculation? That's the way I've seen things work when a patient has two Delta plans.

Thanks,

Brenda

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mdunham
Premolar III

Re: Calculations when there is a secondary insurance

I will work on this today.  If you feel comfortable screen shot your tx plan and allowance table, bluebook for each procedure code.   I would black out the dr .name and pt Name.   You can send it to me via a message to my name (not in this thread) and I will try to

help.     Self-proclaimed insurance And Softdent geek.   

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