Discount plan questions for OD team

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Pruce Dental
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Discount plan questions for OD team

Post by Pruce Dental » Tue Jun 06, 2017 11:54 am

Why can you not have a discount plan and insurance plan on the same patient? I have several patients that have both. If their employer offered insurance plan is weak they have purchased a discount dental plan too for the non-covered services etc. For the services covered by insurance I would like OD to bill the discount dental plan fee to the insurance plan.

I offer a 10% senior discount off of all treatment and want to set this up neatly in OD but can't as OD exists now. Insurance companies require that we give their members the same discount too. If I could set up a senior discount in OD on patient's with an insurance plan on the same patient I could get the correct totals to bill to the insurance plan right?
Robert L. Pruce, DMD
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allends
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Re: Discount plan questions for OD team

Post by allends » Tue Jun 06, 2017 12:14 pm

Coordinating benefits with discount plan coverage is very difficult. Essentially a Discount Plan would need to be treated like an insurance plan in the program. This means that our logic that calculates insurance estimates would need to be enhanced to consider this new "type" of insurance plan. There are multiple other hurdles that would need to be crossed: patients with multiple insurance, patients with different types of insurance (PPO, Category Percentage), when to apply the discount, before or after insurance has found what it will pay for, (in your example you apply the discount to all treatment for seniors, but PPO requires specific fees so this wouldn't be possible).
The other major reason was we needed to release something to everyone that they could use right then. The feature wouldn't have made it into that version if we had attempted the more complicated version.
Allen
Open Dental Software
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Pruce Dental
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Re: Discount plan questions for OD team

Post by Pruce Dental » Tue Jun 06, 2017 5:58 pm

Think your making it way more complex than necessary. OD needs to check if there is a discount plan before doing an insurance calculation. If so, it takes the new discount fee number and then follows all calculations the way it currently does. Discount fees should always be taken off first so you are billing the insurance the discounted fee too. Insurance plans all say if we give a discounted fee we need to bill the discounted fee to them. In my example with the 10% senior discount I always manually adjust the fees on the insurance claim screen by 10% but the insurance plans or PPO members never see the discount because the PPO writeoff is way greater than the 10% senior discount. Only the patients with no insurance plan see the discount in their wallet. I spoke to one large insurance company years ago about offering a 10% senior discount and even thought every PPO fee on their schedule was 30-60% less than my 10% discount fee they still insisted that i had to show that there members were billed 10% less on each claim or I was violating my contract with them.they read me the riot act over this...seems ridiculous
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allends
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Re: Discount plan questions for OD team

Post by allends » Thu Jun 08, 2017 8:05 am

What you described covers the scenario in which you would want to discount every procedure regardless of insurance, but it has been requested that the feature allow only discounting procedures that the insurance will not cover. That specific feature has problems, but the real problem is the complication of actually adding this to our insurance logic. Every change to that logic presents possible bugs with a feature that should be pristine. It may seem simple as far as the idea of the feature goes, but the implementation is quite complicated.
Allen
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Pruce Dental
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Re: Discount plan questions for OD team

Post by Pruce Dental » Thu Jun 08, 2017 6:01 pm

"It has been requested..."

Exactly who requested this way?

You could do it the way I suggested and then on the individual procedure code level or insurance plan level add an option to not discount the individual code or insurance plan?
Robert L. Pruce, DMD
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allends
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Re: Discount plan questions for OD team

Post by allends » Fri Jun 09, 2017 5:07 pm

It doesn't really matter who requested it because features are treated the same regardless of who requests them.
"...but the real problem is the complication of actually adding this to our insurance logic. Every change to that logic presents possible bugs with a feature that should be pristine. It may seem simple as far as the idea of the feature goes, but the implementation is quite complicated."
Everything you have suggested involves changing that logic. The feature as it is currently written didn't need to change our insurance logic since it works independently of an insurance plan.
Allen
Open Dental Software
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Re: Discount plan questions for OD team

Post by Pruce Dental » Sat Jun 10, 2017 8:08 am

Reason I asked who was because I placed several hundred dollars and all 100 of my votes on feature request #622 several years ago for discount plans hoping that someday I would not have to manually go into every patient account and calculate the 10% senior discount and then add the adjustment and then manually go into each insurance claim window and manually calculate and modify the insurance billed amount on each individual procedure.

Did I need to bid more on the feature? Is this feature being investigated by OD actively or pushed to the back burner and not going to be addressed for years?

Writing the logic so discounts are only given on services not covered by insurance depending on how this is implemented ..well wont this get offices in trouble with PPO contracts and be in direct violation of the PPO contract?

I still don't get it...even if I gave a PPO member a 20--30% discount and billed the PPO 20-30% less nobody is seeing that saving and the office is not loosing a dime...all they are doing is placing a 20-30% discount on the account screen and posting 20-30% less on the writeoff column so only those without insurance coverage actually see the savings and at the same time one is in compliance with the insurance company that says you have to give their members the same discount price you give others???

Even if you do implement the feature yous saying that it won't work for allowing the discount on all services anyways correct?....It will only be written to serve the other office correct?

I know that you do not give timetables on new features but this has been bugging me for several years...I cannot find staff that can remember to check who is over 60 for the senior discount and remember to manually on the fly calculate 10% off the total bill and post the adjustment before giving a walkout statement and then remember to manually go back and change the fees billed on the insurance claim screen before hitting the submit button. I need to change something..either need a solution, drop the senior discounts all together or start looking at other PMS software which I don't want to even think about doing...
Robert L. Pruce, DMD
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dgraffeo
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Re: Discount plan questions for OD team

Post by dgraffeo » Tue Jun 13, 2017 8:13 am

Perhaps there's a misunderstanding, but the Discount Plans are for people who do not have any regular insurance plans. They are meant to be an entire replacement for an insurance plan so that people without insurance plans can come in, get work done, and then get billed an amount that is a discount on the office's UCR fees (which is why it works so nicely, they are separate systems). The office is swallowing this discount in its entirety, but at least they have more patients get work done. What you are asking for is a discount on individual procedures with patients that have a normal insurance plan, and that is why it's so difficult. Modifying insurance plan logic in any way, shape, or form is incredibly difficult. Our insurance plan logic is several thousands of lines of code long and incredibly important to have accurate. I'm sure we're looking into it, or have in the past, but I hope you can understand how changing insurance plan logic is not something we jump on very quickly. It would affect everybody in some way, so is not something to be undertaken lightly.
"To understand what recursion is, you must first understand recursion."

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cmcgehee
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Re: Discount plan questions for OD team

Post by cmcgehee » Tue Jun 13, 2017 8:43 am

Would it work to use a patient specific fee schedule? You could create a fee schedule named Senior Discount that is 10% less than your office fees and assign it to any patient over 60. You would still be submitting the decreased fee to the insurance which sounds like it is what you need to do, and the patients without insurance would benefit from the discount. The discount wouldn't show up in the account module or on statements which would be a disadvantage, but at least you are charging the amount you want to charge.
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JLM
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Re: Discount plan questions for OD team

Post by JLM » Tue Jun 13, 2017 11:04 am

Would it work to use a patient specific fee schedule? You could create a fee schedule named Senior Discount that is 10% less than your office fees and assign it to any patient over 60. You would still be submitting the decreased fee to the insurance which sounds like it is what you need to do, and the patients without insurance would benefit from the discount. The discount wouldn't show up in the account module or on statements which would be a disadvantage, but at least you are charging the amount you want to charge.
Just a heads up... This is how we do it in our office and OD doesn't consistently honor the fee schedule setting on the "Edit Patient Information" page. I have had to manually change fees for uninsured patients in a number of instances when UCR fees come up instead of the "senior" fees. The last instance I recall, I deleted and re-entered the procedures after verifying the Fee Schedule setting to verify that the alternative fee schedule was being ignored. All of these patients are uninsured patients. Unfortunately, I haven't been able to reproduce it in order to submit a useful bug report.

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Re: Discount plan questions for OD team

Post by Pruce Dental » Tue Jun 13, 2017 3:28 pm

I know you can change the fee schedule etc ...But why have a discount if nobody sees it or knows they got it? Dentistry is expensive..if I charge $1000 for a service and then knock off $100 well $900 in the patient's eyes is still expensive.If they can't see the discount on their statement and know they got it why give $100 away especially when the patient still feels overcharged?
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Re: Discount plan questions for OD team

Post by Pruce Dental » Tue Jun 13, 2017 3:40 pm

Still confused how your applying the discount plan...

"Perhaps there's a misunderstanding, but the Discount Plans are for people who do not have any regular insurance plans...."

Are we talking about an in-house plan where somebody signs up for a year for $XXX dollars and gets 2 free cleanings and 10-20% off all other services etc...or are we talking about giving anyone without insurance that we want a discount on their crown etc if they have no insurance? In the second situation all PPO plans in the US have in their contract that their members get the lowest price right??? Even in the first situation wasn't there a time not too long ago that some of the big insurance companies were giving offices with an in house plan a hard time insisting that their members got the discount too?
Robert L. Pruce, DMD
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dgraffeo
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Re: Discount plan questions for OD team

Post by dgraffeo » Tue Jun 13, 2017 3:46 pm

It is the second scenario. It is only usable for patients that don't have normal insurance. There was demand for it, so it seems people give discounts on even PPO plans (or don't use PPO plans? Not sure how those work). Additionally, when completing a procedure for a patient that is using a discount plan, it creates an adjustment for the difference between the UCR fee and the discount fee. Adjustments show up on statements.
"To understand what recursion is, you must first understand recursion."

David Graffeo
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Nate
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Re: Discount plan questions for OD team

Post by Nate » Tue Jun 13, 2017 4:49 pm

Have you tried creating another insurance fee schedule that is 10% less than your standard fees. That process is easy because OD can do it for you. Then enter 0% coverage if its a discount plan. So when you treatment plan a crown for someone it will show your standard fee and the discount fee you are offering. Simple enough.

If they have an insurance and you are still offering an additional 10% off.... well I guess that is just insane because you have already discounted it 20-30% with the insurance discounted rate. I would not offer any further discounts. But I guess you could have their primary insurance (real company like Aetna). Then add a secondary insurance (your 10% office discount you created above). Then treat it like 2 insurances.

I would stick with the 10% discount for seniors without insurance only. If they have insurance they are getting benefit of insurance plus the benefit of reduced fees already.

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Re: Discount plan questions for OD team

Post by Pruce Dental » Wed Jun 14, 2017 1:38 pm

Nate...

Yes I am giving the PPO patients a 10% senior discount too but not giving it to them at the same time...

Lets look at the math here...

My prophy fee is $92...I take off $9.20 and bill the PPO $82.80 for the prophy...the insurance PPO UCR is $43 (seriously it is $43 in PA with United Concordia)...I am not getting more than $43 with the PPO right so who cares if I bill the PPO $92 or $82.80 ...I am just changing the PPO writeoff column 10% if I give the discount...When I pass the 10% discount on to a PPO it is just absorbed in their writeoff..nobody sees the money..it is just air..

If you ask why I am doing this give United Concordia provider relations a call and ask them about giving discounts to only non-insured patients and they will read you the riot act..I have a chain of emails from them where I did the math as above and even wrote out the PPO write off numbers in 2 columns and they insisted I could not advertise a senior discount without giving it to their members...and they made it clear that if there was any discount really owed to them that if and when they audited my office they were going to recoup the funds between all of their members should have received...
Robert L. Pruce, DMD
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Re: Discount plan questions for OD team

Post by spsheffield » Thu Jul 13, 2017 1:14 pm

I know I'm a little late in adding to this conversation, but I have to agree with Robert on this one. I put up a fight about this when Open Dental first introduced the "Discount" button, that could show a discounted fee on the treatment plan. But it doesn't change the fee that is sent to insurance. So, for example, I have had a few times when I wanted to charge a particular patient less for a crown for whatever reason. I would enter the discount so they could see the full price and how much was being discounted, but if they have insurance it only discounts the patient portion, not the UCR fee (which is expressly forbidden by insurance contracts). The new "discount plan" works in the same way, by simply adding an adjustment to the patient's account to discount the amount owed by the patient, and does not alter the UCR fee. This makes it impossible to use in conjunction with any insurance plans without violating your insurance contract. If there were a way for the program to discount the UCR fee before it is considered for sending on a claim, that is what we need!!! Otherwise we risk violating our insurance contracts by discounting only the patient portion.

Pruce Dental
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Re: Discount plan questions for OD team

Post by Pruce Dental » Thu Jul 13, 2017 4:07 pm

LOL...

I actually moved on...I dropped our senior discount and started an in-house membership plan...

I hit a brick wall and saw this was not going anywhere anytime soon....life is too short ..I am not fighting city hall...
Robert L. Pruce, DMD
www.prucedental.com

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