Estimates Are Not Meant to be Accurate That is Why They Are Called Estimates

Trying to collect an estimated coinsurance from a patient can be challenging if the patient wants an exact figure.  If you are in network or out of network, the insurance companies do not guarantee the amount of payment to be your estimate.   Explaining to the patient that the insurance company reserves the right to decide payment based on the policy provisions set forth by the employer, the insurance company’s agreement and the covered benefits along with the exclusions and frequency limitations.  All of these factors that are considered prior to issuing the insurance check have little to do with the quality of care or the necessity of the care for the patient.

Many practices enter only the standard fee schedule of the dentist even though they are in network for PPO plans.  Most dental software programs allow the PPO network fee schedules to be added and used per individual to calculate a patient’s coinsurance which can easily be demonstrated in a printed treatment plan but not on the ledger.  The claim can still be filed with the standard fee schedule as preferred by all insurance companies.  The problem arises and get complicated when you post to the ledger after receipt of the EOB.

It is important to update your standard fee schedule yearly and to do so when allowed for all in network plans to avoid adjustments to correct an undercharge.   I find that many practices have not updated their fees in several years for fear of losing patients even though the insurance company UCR for the area is higher than the dentist standard fee schedule.

Dentrix has been trying to solve the problem of “accurate estimates” and has introduced Dentrix Ascend.  You are allowed to enter the PPO fees and it will only apply them to the insurance estimate, not into the ledger.  This can give an insurance estimate on the treatment plan but it doesn’t enter these reduced fees into the ledge.  When posting the business manager can follow the EOB and enter the total adjustment without additional calculations or the worry of undercharging patients.  

Insurance filing and posting can be very complicated and avoiding the loopholes sometimes left to experts who can save thousands of dollars just by understanding the posting of payments and understanding the language of EOBs.   Pick up your phone and call eAssist today for help in this often explosive part of your practice.


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