Tuesday, September 7, 2021

Understanding the Treatment Plan Estimate

Have you ever looked at the estimates on a patient's treatment plan and wondered how those figures are calculated? When the patient has two of the same procedure codes in the same plan, why do they show different estimated amounts? Is there a deductible owed? Is there a payment table override? Has the patient exceeded their maximum benefits?

Dentrix G7.5 has an explanation for you!

After installing Dentrix G7.5 Update 2, you'll notice that the Treatment Planner includes a small triangle to the left of each procedure. Click that triangle to expand additional information about how the insurance benefit is calculated for that procedure.


Here are some examples of messages you may see in certain scenarios:

Payment Table

  • Payment Table Paid amount is used will display when the procedure is listed in the Payment Table and that amount will be used as the insurance estimate. 

Deductible

  • An estimated deductible is owed will display for the procedure where the deductible will be subtracted from the estimate.
  • The deductible is estimated to be met; no deductible is applied will display for the other procedures.
  • Use Dental Plan Maximums and Deductibles is not selected will let you know that the Treatment Planner is not displaying deductibles because the feature is turned off.

Maximum Benefits

  • The individual or family maximum benefit is estimated to be reached. Estimate is reduced displays with the procedure that tops out the patient's maximum benefits.
  • The individual or family maximum benefit is estimated to be reached displays for procedures not receiving payment after maxing out the benefits.
  • No secondary insurance coverage. Estimate = 0.00 displays if a patient does not have secondary insurance coverage.

Dentrix will also indicate the mathematical formula being used to calculate that procedure's estimate. Here are some examples:
  • Primary Estimate = Fee * Coverage %
  • Payment Table Paid amount is used.


Additional Information

  • The explanations and messages mentioned above will only appear onscreen in the Treatment Planner. They do not print on any reports.
  • You can expand or collapse all explanations at once by changing the setting under View > Show Treatment Plan Insurance Help Text.



To learn more about the new features in Dentrix G7.5, and prepare your team for the upgrade, watch this on-demand webinar recording.

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