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doctom4300
Premolar III

How to set up this insurance

A patient has an insurance plan that is quite different from anything I've seen before.

For the procedures that the plan covers, for each claim it pays 100% of the first $150, and then 50% of the amount of the claim that is between $150-$2700. There is no deductible, and there is a yearly maximum of $1500.  We are out of network with this insurance. It is a PPO plan. Just to mix things up a bit, I'm not certain if they use UCR fees or not.

Is there a way to set this up in SoftDent so that the the amounts SoftDent says to collect from the patient are accurate?

So far this is just one patient, so we can just do the calculations manually, but I was curious if there's even a way to make SoftDent do these calculations.

7 Replies
Community Manager
Community Manager

Re: How to set up this insurance

softdentgirld.canalesbert‌ any ideas?

chriscornett
Premolar II

Re: How to set up this insurance

I'm working with one of our managers that is very knowledgeable about SoftDent insurance claims and setups. If this scenario is possible within the software then they will be one of our best sources of information. I hope to have further information for you soon doctom4300‌.
tpelham

pksaari79
Premolar III

Re: How to set up this insurance

By any chance, is the insurance company Simple, because they are not simple to deal with? Florida Southern College in our area has a very similar insurance situation. We usually just try to guess what their out-of-pocket is, based on the 50% for the first visit. We really don't bother with the blue book because it's never correct. Luckily, it doesn't involve too many patients and for you it is only one, so that's a relief.

doctom4300
Premolar III

Re: How to set up this insurance

No, it's not Simple (in more ways than one! lol).

chriscornett‌ Don't put a lot of effort into this, at least not on my behalf. It's one patient, so we can do the estimations by hand.

chriscornett
Premolar II

Re: How to set up this insurance

doctom4300‌ I spoke with tpelham and she had the following to say:

Sorry I couldn't provide further assistance with your question.

CS Dental Employee
CS Dental Employee

Re: How to set up this insurance

To my knowledge there is not a way to set up a plan like this in SoftDent.  

I personally have never heard of a plan that works this way... I wonder if this will up trend?  If so, we may have to focus future efforts on making the software capable of handling it.  Like you said, for now I would just calculate this one patient manually for accurate numbers, but please let us know if you start seeing it more.  

Thanks for being a SoftDent user and an active member of the Exchange Community, we appreciate you!  

cgdfrontdesk
Canine II

Re: How to set up this insurance

Sounds like the same plan I have for several pt.s from 1 company.  When I do a treatment plan for a patient with this plan I subtract by hand $150 from the 1st visit so the patient can see the adjustment is being made for them and they know their amount due for the treatment.