How do I set up a plan like that?

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ForrestGumpDDS
Posts: 177
Joined: Fri Oct 14, 2011 3:31 pm

How do I set up a plan like that?

Post by ForrestGumpDDS » Tue Apr 09, 2013 3:52 pm

My wife is having an issue setting up two ins plans. Let me start with the first one.
It's a discount plan, but with some modifications.
For the procedures marked as FC$30 the pt. pays a one time co-pay $30 per visit AND the insurance pays $15, making $45 total. For one FC$30 procedure, or for all of them done the same day. It doesn't matter how many of those FC$30 procedures done during the visit.

For the procedures marked with actual $ value the pt. pays by fee schedule.
For the procedures marked as N/B - the pt. pays my office UCR fees.
If NO FC$30 procedures performed - the pt. pays $11 co-pay per visit in addition to the procedure performed.

The "fee schedule part" I can set-up as PPO with 0% coverage.
The N/B procedures - same PPO w. 0% coverage, but I'll just copy my office UCR fees into the plan fee schedule.
If there were no "FC$30 part" I would set the plan up as Medicaid w. fixed co-pay. However I can't come up with any solution how to charge a flat fee for FC$30 for several procedures, yet being able to send a claim to the insurance to get the remaining $15, and keeping account module clean and w/o routinely writing adjustments by hand. I was thinking to create a special code like N0030 and substitute all FC$30 codes with this one. But then 2 codes will increase pt.'s balance 2 times.
Maybe I should set the whole plan as HMO? HMO with no capitation checks... I am confused.

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Jorgebon
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Location: Mayaguez, PR
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Re: How do I set up a plan like that?

Post by Jorgebon » Tue Apr 09, 2013 5:28 pm

This is a per visit copay plan with several complications. Do a search in the Open Dental website for "per-visit copay". It explains how you may define at least part of it. The problem is that OD doesn't handle this type of situation yet and we need to start voting on request #2073, maybe adding a request for different per visit copays depending on the procedure.
Medicare Advantage plans and Medicaid plans are all jumping on the per visit copay bandwagon, and it's getting very complicated. OD needs to keep up with these new changes in the industry.

Jorge Bonilla, DMD
Jorge Bonilla DMD
Open Dental user since May 2005

ForrestGumpDDS
Posts: 177
Joined: Fri Oct 14, 2011 3:31 pm

Re: How do I set up a plan like that?

Post by ForrestGumpDDS » Tue Apr 09, 2013 9:19 pm

Thank you,
At least a good start. Let's see what can be done.

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