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Creating coverage tables
The Family File's coverage table is a powerful tool that you can use to create treatment plan estimates that accurately reflect the actual benefits paid by an insurance carrier.
Most insurance companies provide the patient with a schedule of benefits declaring the maximum annual benefits for the individual, as well as for the entire family. The schedule of benefits also includes the deductible amounts, plan maximums, and the percentage of the usual and customary fee that the insurance company will pay. You can add this information to the coverage table.
In Dentrix, you can add a coverage table in three ways:
· Copy a coverage table from one insurance plan and then edit it to create another plan's coverage table.
· Add each category to the coverage table separately.
Notes:
· Updating or changing any benefit and coverage information will affect all patients who subscribe to the selected group plan.
· Select a Co-Payment Calculations for Ins. Portion menu option only when one or more co-pay amounts are entered in the coverage table. Usually, the patient portion owed is estimated by subtracting the calculated insurance portion from the amount for the procedure. When you use co-payments, the patient portion is the amount shown in the Co-Pay column of the coverage table, or less, for procedures in the category range (even if the amount is $0.00). The Co-Payment Calculations for Ins. Portion menu option you select is used to calculate the insurance portion for all procedures. When you use co-payments, the total of the patient portion and the insurance portion may be less than the procedure amount, depending on the option you selected and the percentage entered in the Cov% column.
To create a coverage table
1. With a patient selected in the Family File, double-click the patient’s Insurance Information block.
The Insurance Information dialog box appears.
2. Click Benefits/Coverage.
The Dental Insurance Benefits and Coverage dialog box appears.
3. Click the Coverage Table tab.
The Coverage Table for the selected patient appears.
4. To create a coverage table, do one of the following:
· Copy a coverage table from another insurance plan by clicking the Select Insurance Plan to Copy From button. Select an insurance company from the list, click OK, and then edit the table entries as necessary.
The Select Insurance Carrier dialog box appears.
· Click the Add button, and then enter each table entry manually.
The Coverage Table fills in.
5. Do one of the following:
· To save your changes, click Save.
· To undo your changes, click Undo.