Co-pay setup doesn't seem correct

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jdub
Posts: 12
Joined: Mon Mar 02, 2015 10:09 am

Co-pay setup doesn't seem correct

Post by jdub » Thu Jul 02, 2015 12:45 pm

I am trying to setup fee schedules for BCBS FEP. I have it setup and get correct estimates in the treatment plan, but the way I have to do it forces one to manually update the co-pay fee schedules any time that there is any change to any of the basic office fees. I am wondering if this is the way everyone does it or if someone has a better way.

How the plan works: There are two fee schedules, one with in-network provider maximum allowable charges, which are just like normal PPO fees, the other with maximum patient co-pays per procedure. There are not many covered procedures, maybe 30, there is no deductible, there is no maximum. We do want to track write-offs and the current setup is doing so.

How I have it setup:
Plan Type = PPO Percentage
Fee Schedule = a "Normal" type fee schedule
Patient Co-pay amounts = a "CoPay" type fee schedule
All coverage levels are set at 100%

The problem with this is that to make the CoPay fee schedule I have to start with a copy of the basic office fee schedule, then manually enter a co-pay amount for each covered procedure. This is fine the first time, but then if we change the office fee we have to manually change that fee in every co-pay schedule, or else start with new copies of the basic office plan and re-enter all the co-pay amounts. This is burdensome considering that we have several co-pay fee schedules for similar insurance plans.

Is this a bug, should it be a feature request, or am I just setting it up wrong?

If we leave the non-covered services blank or zero in the co-pay fee schedule then insurance estimates in the treatment plan are not correct. While the patient should be responsible for the full office fee, OD estimates that the insurance plan will pay the full office fee and there is no patient responsibility.

Thanks for your help

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