Dentrix Ideas

Calculate dual insurance estimates CORRECTLY using Coordination of Benefits

The Treatment planner calculation for dual PPO insurance patients, only calculates the coverages as "Traditional" or (Duplication of Benefits).

This is not the standard for the dental insurance industry today! Every insurance that I see uses "Non duplication of benefits", which simply means the secondary insurance will not cover the remaining portion of the fee, and is left for the patient to pay.

Quick example:

Johnny (age 10) is dual covered by mom and dads insurance. Johnny needs a few fillings. Fillings are covered at 80% by both insurances. The Chart is entered with the treatment planned items, and clicking the [TxPlanner-Print Treatment Case] to give parents the estimate shows $0 patient portion. Which is not correct and gives a false estimate. If not understood and calculated manually, turns into "Hey you told me $0, but sent me a bill for $X.XX".

(Please see ADA Guidance on Coordination of Benefits attached)

This industry standard has been in effect for years, and as a leading Primary Dental Software such as Dentrix, this calculation is expected behavior. This would just need a little more calculating when a patient has dual coverage, and would benefit all Dentrix users in the USA.

  • Brian Travers
  • Mar 20 2024
  • Needs review
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