Correct Insurance Plan setup

[drtmz]

We are having trouble with discount insurance plan setup such as Careington. We take this plan and agree to accept their fees as payment in full.
Here is what we have:

Insurance Plan Type......... PPO Percentage
(It is not a Capitated Plan since we don't get any monthly payment.)

Fee Schedule..................Standard
Pt Co-pay amounts...........Careington 500
Carrier Allowed Amounts....none

We would like to show our fees in the first column and then the patient fees in the last column so they can see how much we are reducing our fees. Can't seem to get it to work properly.
It the error in the Carrier Allowed Amounts?

[Debbie OD Support]

So the Careington 500 has the PPO fees on it right not what the patient is responsible for? If it is the PPO fees then this is how you would put it in.

Plan Type: PPO Percentage
Fee Schedule: Careington 500

you do not put anything in the Copay or the Allowed.

[drtech]

We have this issue also...
I haven't tried this, but i don't think the above is right. The Carington plan is just a discount plan, the fee schedule is what the patient owes, there is no insurance payment. (Like Unicare and is either based on a 15% discount for most procedures and fee schedule for preventative) I haven't figured out a way to put it into OD except to calculate it manually every time and put and adjustment.)

Any help?

[drtmz]

The best solution we found is as follows:
Discount Plans such as.... Fidelio, Teamsters Health and Welfare, Carpenters, Careington 500
Plans where they have a set fee schedule and that is the patient's total fee for the procedures.

Plan Type......................Medicaid/Flat Co-Pay
Fee Schedule .................Standard

Patient Co-Pay Amount......Set this to the fee schedule for the plan as in Teamsters H + W
Carrier Allowed Amounts....none

Then Edit Benefits Anyway on the left side
Set percentages to 100% for all the procedures (100% of the fee schedule)
Set the yearly max to the plan max

This seems to work for us.

[jordansparks]

See:
http://www.open-dent.com/manual/insplantypes.html
I think you should very carefully only follow patterns listed on that page. For Medicaid type, that page specifically says not to use co-pay fee schedules.

Based on that page, the best option seems to be PPO Percentage (because you have agreed to reduce your fees), and coverage of 100% for everything.

I think you might instead be able to get away with using Medicaid/Flat Co-Pay, but then you can't see your regular fees on the TP.