How to quote a downgraded composite?
Rosey has been diagnosed with 2 anterior fillings and one posterior. Upon looking at her DAAE benefit breakdown, you realize that she has downgrades on her posterior composites, how do you know how much she owes?
Rosey has a 80% basic coverage on her Aetna Insurance.
Your office has diagnosed her with 8/9 F and 15MOD
#8 and 9 are contracted at $124.00 each. Patient will be responsible for $24.80 per tooth
15 MOD is contracted at $198.00 however a 3 surface amalgam is contracted at 118.00. Patient will be responsible for $80.00 for the difference between the amalgam and the composite and 20% of the $118.00, equaling $103.60.
BUT WAIT…before you finish this treatment plan, you should check for an applicable deductible, maximums with any open claims deducted, and if any history exists on the diagnosed teeth. You never want to walk into a room to treatment plan without dotting your I’s and crossing your T’s.
Rosey has already met her deductible on her SRP, she has 805.00 remaining for the year, and no history on the three teeth.
It can be confirmed that patients copayment would be: $153.20 with all three teeth.
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