Problems with Obamacare Plans - How to Enter into System

[BHavenKidsDent]

Hello all,

I did a search through the forums about this topic, but I was unable to find any current posts on this matter. We're a pediatric dentist office, and we're also a fee for service practice that deals directly with insurance. We're now about 3 months into Year Two of these new Affordable Care Act (Obamacare) plans, and I've definitely been scratching my head at what to do with them.

These plans are only offered to pediatric patients until age 19 years old. Some plans work exactly like stand-alone dental plans. However, there are these other plans that are considered "embedded" into the medical plan. Meaning they don't work anything like dental plans, they work exactly like medical plans. Coming from the State of Georgia, our governor decided not to open a State Health Exchange. We deal directly with the Federal Version of all of these plans.

We typically see that either ALL benefits are subject to the yearly medical deductible (between 6,300 and 12,000 for individual & 12,000 to 24,000 family). Sometimes preventative benefits are not subject to the deductible. Basically no one gets any benefits if all benefits are subject to the deductible, so i'm still having to collect everything up front anyway.

My main question has to do with how to enter this type of plan into Open Dental's Existing insurance window. I've been trying to just leave the maximum blank (most plans do not have an out of pocket maximum) but some of these plans have an out of pocket max. I do not believe there is a way to reflect this in the current software configuration of open dental, so how would we go about this currently? Will I just have to estimate everything manually?

My next question has to do with the actual deductible. I leave the dental maximum blank, and enter the astronomically high deductibles into the deductible window. However, when I tried to set the co-pays to their specified amounts, open dental was still calculating everything as if they had a traditional stand alone dental plan, and not one of these new plans. So in order to get everything up front, I had to zero out all of the co-pay percentages, and call the insurance carrier every time that patient comes back to verify if they've met their deductible (a huge pain).

Is there any possible solution for this, or is there one in the works with open dental currently? I appreciate your time.