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bryandental
Canine III

Insurance downcoding

We cannot seem to get the estimates for our posterior composites correct due to down coding by the insurance companies.  So say we charge $100 for the procedure and the fee schedule is $90 so we write off $10 but then the insurance pays on $80 because of down coding.  Our patients are always confused as to why they are receiving an additional bill if they paid our estimate when they were here.    

2 Replies
bswh
Canine III

Re: Insurance downcoding

What we do to avoid that is to change the percentage in the blue book. So instead of 80% we will change to percentage that gets it to the closest reimbursement. So it will take a little math to find the correct percentage.

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mdunham
Premolar III

Re: Insurance downcoding

Ann, 

Please see my post regarding downgrade of benefits.   If you search the topic you will

see it.   This will help you immensely with these pesky downgrades. 

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