Incorrect fees with insurance fee schedule attached

[Mgostigian]

When we attach an insurance fee schedule, sometimes when we treatment plan things they get automatically put in at our office fee schedule. This has frustrated me and my staff as we are now giving incorrect treatment plans and submitting the office fees to insurance instead of the insurance fees. I know the difference and this is how I want to bill things out. In the edit insurance plan window we have plan type "Category Percentage" and "Claims show UCR fee, not billed fee" is NOT checked. Fee schedule is selected as the insurance fee schedule. So why is it still billing out our office fee?

Thanks,
Mike Gostigian

[Jorgebon]

Is there a possibility that some treatment may be planned before you enter the insurance info? This happens sometimes in my office, since we might schedule an appointment for a comprehensive exam, x-rays and prophy before we enter the insurance info. We normally remember to click on Update Fees in the treatment plan module, but sometimes we forget and we get our normal office fees on the claim.

[Mgostigian]

That has happened to us on a few occasions, but the issue we are having is a little different.

Insurance is entered. Proper fee schedule is selected in two different modules. We enter codes for a treatment plan and they go in as office fees. If the insurance fee schedule is selected, why is it still coming up as office fees?

[Jorgebon]

Other things that could cause the office fees to appear instead of the plan fees are defining a plan as "PPO Percentage" or if it's the claim that has the office fees, then the checkbox "claims show UCR fee, not billed fee."