Open Dental Forum

Hello,
Another HMO question.
How do writeoffs calculated with HMO type insurance in OD?
I set no "normal" fee schedule, proper co-pay schedule, type=Capitation, and "do not substitute codes".
Now, if the co-pay schedule has a positive dollar amount for any given procedure, then I see a write off to that amount and a correct patient portion in treatment plan.
If the co-pay schedule has no value, I see the write off in the full amount o my office fee. So, basically, the treatment plan show write offs on all non-covered procedure, which is not an expected behavior. I thought it should only happen when I explicitly put "0" in the co-pay fee schedule.
Should an empty string behave the same as "0" in co-pay schedule when dealing with capitation?

Generally, whenever a fee is not entered for a code, we treat it as if the amount for that fee was $0. You bring up a good question about how to mark a procedure code as non-covered for a capitation plan. I'm going to look into that and post back to you.

Ok, great. I thought that I was getting crazy.
I was trying to show my manager what she was doing wrong because i clearly remember it was working when the same plan was setup as a ppo "normal+copay" and remember specific instructions for the co-pay to be set as "0" in order for the writeoff to work correctly. Now I understand...

It looks like the best way to mark a procedure as "non-covered" is to set the copay fee equal to your office fee. Then the writeoff would be $0 and the patient would be responsible for the entire portion.

Thank you.
Any plans for the future to add this "non-covered" calculations into the engine?

As of right now, there are not any plans to add this. So far there is not a feature request for this. As far as I can tell, capitation insurance plans are not used by many of our users.