Wednesday, July 26, 2017

Dealing with crazy insurance limitations

Insurance plans are driving us crazy! The benefit coverage creations that some of these plans are coming up with are just ridiculous. Because of that, you have to figure out how to enter it into the computer system so you can give your patients the most accurate treatment plan estimate possible. Some plans will cover only gold crowns on molar teeth while others won’t pay for gold crowns at all. I was in a pediatric office recently and one thing they struggle with on a regular basis is the sealant coverage because it is different and all over the board.

With these tips today, hopefully you can customize your treatment plan estimates for a patient and use your Dentrix software in a more efficient way.

First, let’s look at when an insurance plan will pay for a procedure on one tooth but not another because of plan limitations or patient frequency limitations. There is a way you can override the insurance plan coverage table and payment table directly. When you are in the patient chart or the treatment planner, double click on the procedure code and it will open up the edit window. As a note, this is also where you could put a procedure note or refer it out to a specialist.

In the upper right section of this window, you will see an Override Dental Insurance Benefits. You can put a check mark in the Prim Ins and then the insurance coverage. If they have secondary, you can do the same thing. This technique also works well if you are estimating over two benefit years or if the crown is paid on the seat date or if there is a missing tooth clause.

The next tip is if a procedure is not covered at all on this plan and would apply to any tooth number or any patient on this plan. The best way to handle these types of situations is by using the Payment Table. The Payment Table overrides the Coverage Table and is great for things like posterior composite downgrades, nightguard coverage, grafting, etc.

This type of data would apply to any patient that is on this plan and is not patient specific. Remember that the Payment Table will override the Coverage Table.

For more articles on insurance and estimating, click on the titles below . . .

Dayna Johnson, Certified Dentrix Trainer
Dayna loves her work. She has over 25 years of experience in the dental industry, and she’s passionate about building efficient, consistent, and secure practice management systems. Dayna knows that your entire day revolves around your practice management software—the better you learn to use it, the more productive and stress-free your office will be. In 2016, Dayna founded Novonee ™, The Premier Dentrix Community, to help cultivate Dentrix super-users all over the country. Learn more from Dayna at and contact Dayna at

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