Alternative Benefit: Changing Composite to Amalgam

[Nate]

It seems the latest version will make this change automatically. Under Lists-> Setup->Procedure Codes you can change this option to apply to all posterior, just molars, or just 2nd molars. My question is can you change it according to the insurance plan? For example maybe most Cigna and Aetna PPO's will make this alternative benefit change, but most Delta and Metlife PPO policies will cover the posterior composite without downgrading it to an amalgam benefit.

Are there settings that will allow you to apply this Alternative Benefit to certain insurances or certain patients where the policy applies? I would imagine a very beneficial place to have it would be in the Family Module under the Insurance info. That is where the front office would either type or check the option if available as to the patients individual insurance policy. Another place that would be convenient to toggle the feature on or off would be under the Treatment plan module where you often update fees or make changes to insurance estimates when necessary.

[Nate]

Are there settings that will allow you to apply this Alternative Benefit to certain insurances or certain patients where the policy applies? I could not find the answer in the online manual.

Thanks for any info

[Jorgebon]

I think that for now, it's an all or nothing thing. I'm sure that eventually this feature will be refined so that it can be applied to only some plans.

[Nate]

So are you using this alternative benefit feature? Do you find it is makes estimates more accurate or are you finding that you over charge some patients more?

[Nate]

ok... maybe I found the answer, it is a planned feature.
Found this on the planned features and near the top
'Amalgam/composite substitution disable on certain insplans'

Sounds like that was what I would want. Hope it can be changed in the 'Treatment Plan' module and the 'Edit Insurance Plan Window'