changes in US dental coverage?

sparkly · Post by **sparkly** » Wed Oct 24, 2007 8:49 pm

In the past few months, we've seen more dental plans that are designating Xrays (BWX, PA, FMX, Pano) as 100% coverage BUT 'Deductible applies.' The rest of Preventive is still 100% coverage but no deductible applies. Is there any way to rig this in OD's current setup (i happen to be on 5.1.18)? From what i see, deductible can only be applied to all or none of the Preventive category. Adding it to the 'other benefits' section doesn't make it function. Does everyone just write alerts all over the place and try to remember to collect this? (I know it's not that big of a deal now, but i suspect that more companies are going to do these dental ins cutbacks (if the employee will still HAVE the option of dental ins).

thanks all!

Post by **jordansparks** » Wed Oct 24, 2007 9:16 pm

Well, the good news is that, internally, we already do track D0xxx deductibles separately from D1xxx deductibles. But you're saying that even within the D0xxx category, they are being differentiated? Exams have no deductible, but radiographs do have a deductible?

sparkly · Post by **sparkly** » Wed Oct 24, 2007 9:38 pm

jordansparks wrote:Well, the good news is that, internally, we already do track D0xxx deductibles separately from D1xxx deductibles. But you're saying that even within the D0xxx category, they are being differentiated? Exams have no deductible, but radiographs do have a deductible?

i'm aware that OD does that tracking internally...thank goodness (that was something that was lacking in my last program). but lately, the ins co is separating out the D0xxx codes from all other preventive and pt is responsible for deductible $ on that (JUST xrays, not exams, cleanings, or others). so if you take a $99 FMX, pt pays $50 deductible, the ins then covers the $49 at 100%. (i'd think it would make more sense for ins to just say to hell with it and put all the preventive codes under Basic/at 80%...but that may be coming next

!! it sure would be easier for coding!!

Post by **jordansparks** » Wed Oct 24, 2007 10:38 pm

Once we can automatically grab benefit info from in the ins co, the plan details you described won't be hard. I think it would look like separate deductible overrides for each separate xray procedure code. Too much work for a human to type in, but easily done if automated. Actually, we'll also have to add a little more intelligence. We allow you to enter deductible overrides per procedure code, but they don't actually do anything yet.

sparkly · Post by **sparkly** » Thu Oct 25, 2007 7:23 am

sounds good. for now we'll put sticky notes everywhere for these plans and hope we see them on checkout! and who knows what weird combos ins co's will come up with next.
thanks!

cneelley · Post by **cneelley** » Thu Oct 25, 2007 4:08 pm

Sparkly, I have seen many plans that are now considering PA's to be basic, subject to deductible and 80% coverage. It's already here.

Dr. Neelley

sparkly · Post by **sparkly** » Thu Oct 25, 2007 4:38 pm

cneelley wrote:Sparkly, I have seen many plans that are now considering PA's to be basic, subject to deductible and 80% coverage. It's already here.
Dr. Neelley

right, i've seen a bunch of those too that just make 100/80/50 into 80/60/40 across the board.
the thing that throws us off with this new combo is that the PA's are subject to deductible but are still classified in the Preventtive/100% coverage category.
oh well, too bad patients can't actually take ownership of their own stuff and not expect us to know it all.