PPO Percentage

[cneelley]

Could you please explain PPO percentage insurance plan type, when it should be used versus category percentage?

I am used to charging the patient the PPO fee, but sending the insurance company the UCR fee. This is what the insurance company expects of us.

Is this new type a way to charge the patient the full general fee and then later write off the over charges? I am assuming that the insurance estimates should be exactly the same as if we were using the category percentage type with a PPO plan?

Anyway, any help helps!

Thanks, Dr. Neelley

[jordansparks]

Right. You still set the PPO fee schedule on the InsPlan, but now it will show the provider UCR fee throughout the program and only use the PPO fee when calculating coverage. You no longer have to check the box to send out provider UCR fee on the claim. You do have to do a writeoff at the end with the new PPO functionality.

[drtech]

OK, I am setting up the PPO deal for the first time. Now let me make sure I am doing it right.
_____________________________________
Example: MetLife PPO
(Fee Schedules)
normal: usual fees | nothing in C/A box
MetLife PPO: actual ppo fees | A in box

(All done in the Individual Ins plan window on each patient)

Plan Type | PPO Percentage
Claims Show UCR fee, not billed fee | checked
Fee Schedule | none/normal (none defaults to your first, normal fee schedule right?)
Carrier Allowed amounts | MetLife PPO fee schedule
________________________

So, should the account now show the PPO fees and calculate pt portion based on this or how should it work? And then do i have the fee schedules set up right?

[jordansparks]

No. Nothing goes in the two extra fee schedules on the plan. Set the normal fee schedule of the plan to the PPO fee schedule.

[cneelley]

I think I see what PPO Percentage does. I noticed a discount column in the treatment plan whch has a number when there is a ppo plan and ppo percentage is checked in the plan. It calculates the difference between the general fee schedule and the ppo plan and shows the amount of the discount. Very Nice!!!

Now, I like the idea of showing discounts easily and immediately. So many patients ask , "Is that the charge with the discount included?????" Being able to get to that number quickly and easily is a very big help, and a big time saver!!! May keep some people coming back, more smiles for the front desk.

So, how about having a discount column even if there is no insurance plan?? I give discounts to many, most, of my patients who do not have dental insurance per say. A column with general fee schedule, a column with their fee schedule, and the discount column, and then total column??

Also, in the ppo percentage plan, you have it set to charge the patient the full general fee, not the PPO fee, and then later we must return to the account and write off the difference between the full fee and the ppo fee, if the patient is to get the benefit of reduced charges because he or she is in a PPO plan.

How about another PPO type of plan that charges the patient the PPO fee, not the general fee, and leaves the rest alone, discount column intact and general fees listed in the treatment plan?? Is that possible?? In the treatment plan, the patient could see how much he or she is saving by being on the PPO plan.

More requests. I hope I am not asking too much. Thanks for the improvements!!!

Dr. Neelley

[jordansparks]

The discount column will be enhanced later to make it useful for all patients, whether or not they have insurance.

[Nate]

I think having a discount column only would cause more problems with the front desk. Then everyone who does NOT get something in this column may think they can bargin the fees lower. Maybe simply giving it a different name may help. 'Adjustment column'. That way as discussed before on a different post, you could more easily adjust fees. For example send UCR, charge patient based on PPO fee, if for some unusual reason insurance pays based on the UCR and not PPO then you could make an adjustment in that column.

[drtech]

we already have an adjustment column...that is where we place discounts if we give them to people

[jordansparks]

The discount column is in the TP module, whereas the Adjustment column is in the Account module. Discounts would only be assignable to status of TP. Adjustments, as always, are only assignable to status of Complete.

[cneelley]

Is it possible to have off and on buttons in the treatment plan for general fee schedule, ppo fee schedule, and discount column, if desired?
As it is now, I have a fee schedule for many discount plans, that are not insurance. The treatment plan shows the fee, the discount fee schedule, and a discount column with all zeroes. So, even though there is a discount built in, the discount column shows zeroes. Not a big problem, we just have to explain to the patient that the disount is built in.

Dr. Neelley

[jordansparks]

We already have checkboxes for the fee and insurance columns. So you're just talking about being able to turn off the discount column, right? Yes, that seems very reasonable.

[cneelley]

Also, a column that can be turned off and on for the general fee schedule, so General fee left, then PPO fee next, then Insurance estimate, then discount, and finally total patient part?

Dr. Neelley

[jordansparks]

That column is history. It was just there as a temporary solution to the PPO problem.

[cneelley]

Oh Rats.

Did PPO percentage take it's permanent place?

Dr. Neelley

[jordansparks]

I suppose it did. Sorry. I didn't think anyone would miss it. There's only room for so many columns.

[mowgli]

I agree, it would be nice to be able to turn off the discount column when printing a treatment plan. Am working with v5.3.9, looks like this new PPO% feature is working great! Thanx, I'm sure many practices will appreciate this function.