I am facing a situation where-in I have a Patient (who is the only one in the family) covered under an Insurance. The Benefits indicate the 'individual' deductible as $50 and 'Family' Deductible as '$150'. This Patient has had one Procedure done with us during 2009 calendar year and there was already a deductible charged for that Procedure. Two weeks ago, the Patient came in for a second Procedure and when a claim was created, It applied a deductible again. Does anyone know why that Happens in Open-Dental. Our office is on 6.4.12 version. Does the Family Deductible apply to the Patient once they their indiividual deductible is applied..that does not make sense . Appreciate your thoughts / clarifications on this...
You should not have the 50 and the 150 in at the same time you are either putting it in as an individual or you are putting it in for a family. So you need to take the 150 out and make sure all of the boxes are empty under the Family. That should fix the problem.
Cool. Thanks for that clarification. I will assume that what this means is that if I have more than one member in the family and if they have a $150 as a family deductible, the System would know that it is $50 (per Individual)...How does the System know that it is $50 and not $25 or whatever.
If you have 3 people in the family and you want them each to pay $50 of the $150 then you would put $50 in the individual.
If you set it up as a family deductable and you put in the $150 it will not evenly distribute the deductable because if only one family member comes in then they only get $50 for them instead they require $150 for family so that patient would have to pay the entire $150 before insurance would pay anything on a family plan
I think I explained that well if not please let me know.
Yeah, most plans primarily use the individual deductibles. Some have an additional family maximum, which means the total amount would max at $150 but from my experience always leaving the family deductible blank and filling in the individual deductible for everyone in the family seems to work 99% of the time.
It is also important to remember to fill in 0.00 deductible for preventative if it applies. Otherwise OD calculates a $50 payment for the first cleaning of the year. Most plans do not require the deductible to be applied to preventative.
. Appreciate your thoughts / clarifications on this...
