Ever been a bit stumped by how to handle an insurance scenario? This is the post for you. We’ll be reviewing some tips and tricks to help you manage various insurance intricacies in Open Dental.

Procedures Don’t Apply Toward Annual Max

Some plans may have procedures or categories (preventive, x-ray) that, when insurance pays out benefits, don’t apply toward the annual max. Create an Other Benefit for the procedure (or insurance category) with that category’s annual max. If it doesn’t have an annual max, enter a high number (e.g., 100,000).

Procedures Don’t Have a Deductible

If an insurance plan does not require patients to pay a deductible for diagnostic, routine preventive, or x-ray, there are preset fields for this in the Edit Benefits window. This is defaulted to $0, so it is already set to not apply the deductible. These fields usually only need to be changed if the insurance requires patients to pay a deductible toward these procedures. If they do, enter the deductible amount (if it’s different than the general deductible) or remove the zeroes so the boxes are blank – the plan deductible will then apply.

If you have other procedures or categories the deductible does not apply to, these can be entered as Other Benefits.

Select an insurance category or enter a Proc Code (make sure to select category None if entering a procedure code), then select the settings shown in the screenshot above.

Insurance Benefits Used Outside Your Practice

If your patient has transferred to your practice in the middle of a benefit year or you’ve referred out other procedures, then they’ve likely used some insurance benefits outside of your practice. It’s helpful to account for this so you can provide your patients with accurate insurance estimates.

Enter benefits used and deductible information in the Insurance Plan window, Adjustments to Insurance Benefits area.

If you charted referred procedures, make sure to mark them as “Existing – Other” as well, by right-clicking them from the Chart.
TECH TIP: Existing – Other procedures charted here will be saved without a date. If you would like to see existing treatment in the timeline slider on the odontogram, enter treatment dates.

For new patients coming to your practice who may have had other work done by a provider that could affect Frequency Limitations, you’ll want to enter Insurance History dates (you’ll usually get these from insurance). In the Family Module, double-click the Insurance History grid below the patient’s insurance details.

Enter the date of the patient’s last procedure (e.g., bitewing, exam, prophy) that was completed outside of your practice and covered by insurance. An Existing – Other procedure will be added to their Chart and Open Dental will account for the entered date when calculating Frequency Limitations.

Benefits Remaining

If you want to find out what benefits a patient has remaining, this can easily be found in the Treatment Plan below Set Priority.

Or in the Account Module when hovering over Ins Rem.

Tech Tip: Have you ever wanted to give your patient a Treatment Plan estimate that reflects estimates once the benefit year resets or a waiting period is over, but it’s not quite that time yet? Change the Estimates as of date in the Treatment Plan Module to update the date Open Dental is using for insurance estimates.

If you’re looking to fill in your schedule and need to find patients with benefits remaining on a wider scale, look to the Treatment Finder report. This reports patients with unscheduled treatment and can be filtered by patients who only have a certain amount of benefits remaining.

If you have any questions, call or chat with our helpful Support Team.

Information in this post reflects features available in Open Dental Version 23.1. For the most up-to-date information, please visit our manual.