Wednesday, November 30, 2016

Insurance Co-Pay plan setup

I had a question the other day from an office who had a patient with a new type of insurance plan that she did not know how to setup in Dentrix. Over the last year or so, I have been seeing a lot of new and interesting dental plans popping up around the country. The plans I am seeing the most are patient co-pay plans so I wanted to take a moment to help you with the setup. 

Most of us are used to the traditional plans that pay 100% on Preventative, 80% Basic and 50% for major dental treatment. These traditional plans are being replaced with unconventional, harder to manage dental plans. With a co-pay plan, the patient will pay a fixed dollar amount toward certain procedures and then the insurance plan will pick up the difference. Once you get it set up, the computer will take over and calculate the patient’s out of pocket on the ledger and treatment plan estimates. 

From the Insurance window on the patient family file, click on Insurance Data and enter in all the insurance demographic information and attach the correct fee schedule if it applies. If you want more info on using fee schedules, CLICK HERE. Then click into the Coverage Table section and this is where most of the setup will happen. 



First, select a different coverage table so it will show all the procedures instead of the categories. Next, highlight the procedure code where there is a co-pay applied, enter the amount in the co-pay box and click on Add. Do this for every procedure where there is a patient co-pay and also make sure that the coverage percentage is 100% (it will default to 100% but it doesn’t hurt to double check). The final step is to select the co-pay calculation method. In my example, I have selected the (total fee – co-pay) x cov% because this is the most common.

Now, if this co-pay plan has procedures that are not covered, you can either change the coverage % for that procedure code to 0% or enter the procedure in the Payment Table. Remember that the Payment Table overrides the Coverage Table so it would also be good to check to make sure the Payment Table doesn’t have anything in it that might throw off your estimates.


I hope this helps. Let me know if I can assist with any other odd insurance plan setup. I am happy to help.

1 comment:

  1. Thank you for sharing such great information. It has help me in finding out more detail about Insurance plans!

    ReplyDelete