Insurance Estimate not showing in Account Module

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Mgostigian
Posts: 37
Joined: Fri Mar 18, 2016 7:52 am

Insurance Estimate not showing in Account Module

Post by Mgostigian » Tue Sep 20, 2016 2:27 pm

We had a patient we did a buildup and crown on. In TP module it shows insurance portion and patient portion. Insurance is paying at 40%. When we set them complete, it shows the patient owing the entire balance. What are we missing here? Patient has $1200 of benefits remaining.

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Arna
Posts: 444
Joined: Tue Jul 09, 2013 3:16 pm

Re: Insurance Estimate not showing in Account Module

Post by Arna » Wed Sep 21, 2016 10:01 am

Probably. It'd be easiest to just take a look. Perhaps your claimprocs weren't created, or the benefit span is incorrect.
Entropy isn't what it used to be...

Arna Meyer

Mgostigian
Posts: 37
Joined: Fri Mar 18, 2016 7:52 am

Re: Insurance Estimate not showing in Account Module

Post by Mgostigian » Tue Sep 27, 2016 8:24 am

I'm not sure how to troubleshoot. We just had another patient, same thing.

Treatment plan shows insurance coverage for crown and buildup. Set both procedures complete. Now account module shows patient owes entire balance and insurance pays $0. Is this how the software is supposed to work? We've been un-completing the procedures and writing down the patient's portion to know what to actually charge the patient.

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Arna
Posts: 444
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Re: Insurance Estimate not showing in Account Module

Post by Arna » Tue Sep 27, 2016 9:20 am

No, it's not how it is supposed to work. Did you call support?
Entropy isn't what it used to be...

Arna Meyer

rhaber123
Posts: 415
Joined: Fri Dec 11, 2009 12:09 pm

Re: Insurance Estimate not showing in Account Module

Post by rhaber123 » Wed Sep 28, 2016 9:13 am

After you set it complete, and after you created an insurance claim:
now in the account module a claim is created , can you see the patient portion ? that's where it should be
- does it say here patient portion is $0 ?
- click on the performed procedure, did someone accidently check the box, do not bill to ins ?

Mgostigian
Posts: 37
Joined: Fri Mar 18, 2016 7:52 am

Re: Insurance Estimate not showing in Account Module

Post by Mgostigian » Thu Sep 29, 2016 7:21 am

It shows it correct only after we send the insurance claim. Why wouldn't it show it before you send the claim like it does in the treatment planning module? So my front desk has to send the claim before the patient checks out to know how much to collect unless she has a copy of the tx plan in front of her? Not sure I understand the logic of this.

rhaber123
Posts: 415
Joined: Fri Dec 11, 2009 12:09 pm

Re: Insurance Estimate not showing in Account Module

Post by rhaber123 » Thu Sep 29, 2016 12:01 pm

Once a procedure is completed, the patient owes the TOTAL fees.
If a patient has insurance, and to have the patient portion shows in the ledger, you MUST create a claim

If you do not want to create a claim,
IN THE ACCOUNT MODULE, click on the procedure that was completed, a new window open,,
in the1/3 bottom area, under Insurance Estimates and Payments, double click on the procedure here,
and that will open a new window that shows all the information that was in the treatment plan, and that you are asking for.

Another option,
this is what we generally do to all of our new patients who has insurance:
BEFORE the patient go into the operatory, and before YOU SET THE PROCEDURE AS COMPLETE
in the treatment plan, click on the procedure, set the priority to 1
the procedure is now at the top of the treatment plan, and highlited in GRAY
CLICK on save TP -- click on Print TP --- and we use a stamp.. "ESTIMATE"
Ask your patient to sign it. The patient is now informed before you start the procedure. Keep the original and give the patient a copy.
it is an authorization , after the patient was informed about the procedure and the fees, to complete the work

Mgostigian
Posts: 37
Joined: Fri Mar 18, 2016 7:52 am

Re: Insurance Estimate not showing in Account Module

Post by Mgostigian » Tue Oct 04, 2016 12:50 pm

Thanks rhaber. I guess our issue is that we are not creating the claim before the patient checks out. Seems kind of silly that it won't break it down to patient portion and insurance portion without first needing to create the claim. Seems like a no brainer. Perhaps consider this as an option in future versions of Open Dental.

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Arna
Posts: 444
Joined: Tue Jul 09, 2013 3:16 pm

Re: Insurance Estimate not showing in Account Module

Post by Arna » Wed Oct 05, 2016 9:30 am

It's worth submitting a feature request if you'd like to see the functionality.
Entropy isn't what it used to be...

Arna Meyer

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