Open Dental Forum

Hi,
Some of our insurances only cover posterior amalgam and patients request composite instead. How can we get our treatment plan estimates to accurately calculate the patient portion? I believe we would need to add the difference between insurance composite fee and insurance amalgam fee to the patient portion, but I'm not certain how to have open dental calculate this automatically.

Can someone help?

Thanks in advance for any guidance,
Rick

If the insurance company does not cover posterior composites at all, follow these steps:
1. Setup an insurance category for posterior composites.
2. Enter your regular fees for posterior composites in the insurance company's fee schedule.
3. Enter 0% coverage for posterior composites in the Edit Benefits window.

If the insurance company has amalgam allowance for posterior composites, enter the composite fees in the schedule and create an allowed fee schedule with the amalgam fees in codes D2391 to D2394. You would have to make this a "Category Percentage" plan instead of "PPO Percentage" so you can use allowed fee schedules.
Jorge Bonilla, DMD

Or are you trying to downgrade the procedure? If so, read the section on Ins Substitution Codes on this page:
http://www.opendental.com/manual/procedurecodeedit.html

Thanks Jorge, that was exactly what I was looking for.