individual vs Family Deductible - Bug or Feature ???

[opensource]

Hello Team,

I am facing a situation where-in I have a Patient (who is the only one in the family) covered under an Insurance. The Benefits indicate the 'individual' deductible as $50 and 'Family' Deductible as '$150'. This Patient has had one Procedure done with us during 2009 calendar year and there was already a deductible charged for that Procedure. Two weeks ago, the Patient came in for a second Procedure and when a claim was created, It applied a deductible again. Does anyone know why that Happens in Open-Dental. Our office is on 6.4.12 version. Does the Family Deductible apply to the Patient once they their indiividual deductible is applied..that does not make sense . Appreciate your thoughts / clarifications on this...

Cheers,

OpenSource

[Debbie OD Support]

You should not have the 50 and the 150 in at the same time you are either putting it in as an individual or you are putting it in for a family. So you need to take the 150 out and make sure all of the boxes are empty under the Family. That should fix the problem.

[opensource]

Cool. Thanks for that clarification. I will assume that what this means is that if I have more than one member in the family and if they have a $150 as a family deductible, the System would know that it is $50 (per Individual)...How does the System know that it is $50 and not $25 or whatever.

[Debbie OD Support]

If you have 3 people in the family and you want them each to pay $50 of the $150 then you would put $50 in the individual.

If you set it up as a family deductable and you put in the $150 it will not evenly distribute the deductable because if only one family member comes in then they only get $50 for them instead they require $150 for family so that patient would have to pay the entire $150 before insurance would pay anything on a family plan

I think I explained that well if not please let me know.

[DavidWolf]

Yeah, most plans primarily use the individual deductibles. Some have an additional family maximum, which means the total amount would max at $150 but from my experience always leaving the family deductible blank and filling in the individual deductible for everyone in the family seems to work 99% of the time.

It is also important to remember to fill in 0.00 deductible for preventative if it applies. Otherwise OD calculates a $50 payment for the first cleaning of the year. Most plans do not require the deductible to be applied to preventative.