Insurance Benefits  

In the Ins Plan Edit window, there is a section at the lower right that stores the plan benefits.

Every benefit stored as a row in the database. The reason why we do it this way is because this is exactly how the data will be coming in from the insurance companies as the dental industry gradually moves to electronic benefit requests. This will allow you to have accurate benefit information on demand without making any phone calls, saving you huge amounts of time. For now, though, you must still call for benefits.

Click the Edit Benefits button.

Enter all your amounts in the boxes at the top. Keep in mind that leaving a box blank is not the same as entering a zero. Blank indicates that the amount is unknown. If you leave the Annual Max blank, then no calculations can be done to indicate how much is remaining in the Treatment Plan module.

At the upper left, there are boxes for Individual amounts and boxes for Family amounts. You can use one or the other, but not both.  If there is both a patient and a family deductible, then enter the patient deductibles above.  Then, put the family deductible amount in the notes section.  The treatment plans will show accurately because they are based on the patient deductible.  But if you are doing restorative work on multiple patients in a family, then you will have to manually edit the deductible amount on the third or fourth patient's insurance claim before sending.  If you forget to do that, then it will be caught when insurance pays and the eob shows 0 deductible.

The Calendar Year checkbox at the top applies to most of the benefits. The checkbox at the bottom is only used for the Other Benefits list. If not using calendar year, make sure that the InsPlan has an Effective Date set.  The starting month will be based on the effective date.

The simplified View box at the top should remain checked unless you are in a foreign country and are not using the typical American settings.

Other Benefits

There is a list in the middle of the window titled Other Benefits. You may notice when you first start using version 4.1, that your percentages show as rows in the Other Benefits list rather than in the boxes at the top. That's ok, and you can leave them there, or you can enter the numbers in the boxes at the top, and then push the Clear All button to remove the old ones from the Other Benefits list. Any new insurance plans that you enter will have the percentages stored in the boxes at the top.

The reason why you will see it like this is because we had to create a new set of Insurance Categories for compatibility. Any existing categories that you already had were hidden, but they are still functional. For this window to work as shown above, you should not make any changes to your Insurance Categories unless you really understand what you are doing.

So, you can usually ignore the Other Benefits list. The only time you might need to add something to that list is if you want to override a percentage for a family member. This can be necessary when you have an incentive plan, and each family member is at a different percentage.

Click the Add button.

You don't really need to understand this window. But if you are a power user and want to see how it works, uncheck the Simplified View box in the Edit Benefits window. Any benefits which you have entered in any of the boxes will then be displayes as they are stored in the database. You can double click on any of them to see how they are set up.

If you use the ADA Code override box, it will be for informational purposes only.  It will not actually override the insurance estimate for the specified code as you might expect.  That is planned for later.

Notes

Certain types of benefits are not easily codified, so they do not yet have a box. These types of benefits are just entered as subscriber notes for now. Examples of benefits which get entered as notes are:

Missing tooth exclusion (a clause that states that if a tooth was extracted before the patient became insured through them, that they will not cover any replacement teeth including a partial or a bridge)
Family deductible
Wait on major treatment (usually 6 months to a year)
Coordination of benefits.