Even after inputting the correct downgrade code for a one-surf post composite because there's only room for one filling downgrade(D2140) on the exceptions page, the patient's estimate still calculates patient portion to be 20% instead of 32%. I cannot get these to work right. Here is the downgrade formula for fillings: Amalgam fee x insurance estimated percentage divided by composite fee: UHC's one surf amalg is$89. Ins states it will pay 80% but wait, there's a downgrade. So you take $89 x 80% and then divide it by the same-surface composite fee of $104, which gives you the actual estimate of 68%. Insurance companies tell their subscribers that they pay 80% and stick to it, but never ever let them know about the downgrades. In my book, insurance companies should have been crucified over this a long time ago, and I'm sorry you're having to deal with it now. Anyway, a computer should be able to easily compare and calculate these, but I'm still having to do it manually...even after the major insurance upgrade. You simply cannot use D2140 for all fillings; that's not how downgrades work. It's a one surface composite downgraded to a one-surf amalgam, a two-surf composite downgraded to a two-surf amalgam, etc...(unless insurance is really trying to rip their subscriber off).
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Would be nice if there could be a bridge built in that when we choose and option of downgraded fillings it would pull the comparable amalgam fee from the fee schedule. It is too much to add all of these in for every plan individually
agree. You give us a range for the codes, but not a range for the alternate benefit.