Copay Fee Schedules

[rmb23]

1. Does anybody know why with 5.7 a fee left blank on copay fee schedules no longer gets filled in with default fee schedule values, like happens with PPO schedules?

The problem arises for things like "in office bleaching" which no insurance pays for. So the copay fee schedule is left blank and in previous versions the fee was filled in by the default fee schedule when added to a pts treatment plan. This does work properly with PPO fee schedules but not with Copay’s starting in version 5.7

If I understand correctly, if we contract with an insurance plan and they don't cover a certain procedure, we are allowed to charge our default fee schedule. I could manually go and put my default number in to every copay fee schedule but I feel that is incorrect because it is not part of their fee schedule and would require a lot more work to update the 30 fee schedules I already must maintain. If a fee is not in an insurance company's fee schedule we should charge our default fee schedual.

Thanks!
I love OD

[jordansparks]

Do you mean a plan type of "Medicaid or flat co-pay", or do you mean a plan type of "category percentage"? In either case, do you also have a fee schedule set for "Patient Co-pay amount"? The term "co-pay" is ambiguous.

[rmb23]

Fee schedule is set as "Medicaid or flat co-pay", the corresponding fee schedule is assigned, and the "Patient Co-pay" fee schedule is set. However, these two fee schedules, provided by the insurance company, have some items left blank which they don't pay for like bleaching, powered toothbrushes, etc. For codes which are left blank or null, I think they should pull the amount from the default fee schedule. For codes which have "$0" then they should not pull from the default fee schedule.

Thanks!

[rmb23]

Anybody else have this problem?

[Jorgebon]

The software doesn't have this feature yet, but I think it would be a great addition. Right now what we do is that whenever we see $0 in the treatment plan we edit the amount manually.
Jorge Bonilla, DMD

[atd]

This was one of the reasons I setup our Medicaid plans as PPO plans instead of using the Medicaid/Flat Copay type. Having everything set as 100% coverage without the ability specify when individual procedures were not covered (and charge the full fee) didn't work for us. Perhaps you could do the same and use PPO instead.