Creating a fee schedule for better estimates when not in net

[Cypresspd]

Is there a way to create a "Fee schedule" for the plans we are out of network for so that we can better estimate the pts co-pays? I know how to attach the fee scheduled when in-network for insurance purposes. Just looking for ways to be more accurate on treatment plans.

[rhaber123]

Creating a fee schedule for better estimates when not in network

We are in network only with Delta.
We created the following fee schedules:
- Standard Fee schedule ( the office regular fees)
- Delta Fee schedule (Premier)

We mainly need to know the out of network fee schedules. As it is impossible sometimes to know that, in my office, we created 4 ESTIMATED fee schedules, and we call the insurance company and ask few questions to figure out which estimated fee schedule to use, in the patient insurance module.

We created 4 additional Fee schedules based on a lower percentage than the standard fee schedule. Those fees were 85%, %50%, 25%, and 15% of our main office fees
These 4 new category fee schedules created were called:
- UCR Fees 85
- LOW 50 Fee Schedule
-Low 25 Fee Schedule
- Low 15 Fee Schedule

https://www.opendental.com/manual/feeschedules.html


OD has an option to increase or decrease fee schedules based on a certain percentage of your Standard fee schedule = FEE TOOLS
https://www.opendental.com/manual/feescheduletools.html

Next, we used the FEE TOOLS to export the reduced fees after we did the Percentage reduction ( 85%, %50%, 25%, and 15%)
and then Imported them again under the new Names we just created.

*** Export your STANDARD fee schedule and save it first before you start changing percentages, and keep it as a backup
*** remember to click UPDATE, to adjust your fees in all of the treatment plans

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When we get an out of Network patients, my receptionist will call the insurance and try to see how much the insurance will pay for the prophy, Exam , and a one surface filling.
Most of the times she can get that information from the insurance representative.

In general, our office fees are mostly higher than the UCR fees in our area.
After she receive the estimated fees that the insurance will pay for the above procedures, she will need to pick a percentage category that will be close to our fees.
she will pick one of these category percentage fee schedules of 85%, %50%, 25%, and 15% and enter it in the insurance benefits area

Plan Type: Category Percentage
Carrier Allowed: UCR Fees 85




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Now the treatment plans will give a close estimate to what the patient portion will be, and my receptionist have a large stamp "ESTIMATE" , and she use it all the times when she give a statement to a patient

This is not an accurate estimate, but it allows us to get as close as we can to that estimate, and the patient may have a balance to pay in the future, but it will not be a large balance.

[kezian]

Great Idea !!!

Thanks