Open Dental Forum

A pt is coming in with union benefits, the first one we've had with this new plan. It's not a PPO, the pt. does not pay a copay according to a percentage of the allowed fee. Rather, there's a fee schedule of what the insurance pays for a given procedure, then there's a corresponding schedule of what the patient owes for the same procedure. As far as I can tell, there's no set percentage formula, it's kinda procedure by procedure. There's no annual max or pre-authorization required, so in a way it's like a FFS schedule, but we get payment from the patient and from the union.
There would have to be two fees for every procedure code?
How does one go about entering such a plan type and fee schedule.

Thanks.

Charlie

One fee schedule would have the combined ins plus pat portion. That would be the fee you are actually going to charge the patient. That would be the fee schedule for the ins plan. Then, create another fee schedule of type "Allowed". On the ins plan, set this second fee schedule as the allowed fee schedule. This is actually an easy fee schedule setup to calculate, because there is no complex math anywhere.

So is the Allowed fee schedule the portion we collect from the patient, or the portion we expect to get paid by the insurance?

For that matter, when do you set a fee schedule as C=Copay?

Sorry. I didn't mean Allowed fee schedule. I meant co-pay fee schedule. See the bottom of http://www.open-dent.com/manual/insplan.html