Two insurances fee schedules

[mfdental]

I have a quick question about fee schedules for a patient with two insurances.
So when a patient has two insurances, doesn't the lowest fee schedule out of both insurances apply?
In Open Dental, the patient's fee schedule is usually the primary insurance. However, I have a patient whose second insurance has a lower fee schedule. How do I make it so that open dental uses the secondary insurance fee schedule?

Thanks!
Jason

[jordansparks]

You would lower the fee you charge just because the secondary insurance has a lower UCR fee? I don't understand. Are these both PPOs, then? The bottom of this page
http://www.opendental.com/manual/cob.html
describes a situation with dual PPOs. It seems to be very similar to what you are asking, and it seems to indicate that you charge the higher fee, not the lower.

[mfdental]

I am contracted with both insurances.
I always thought that since you are contracted with both insurances, you are obligated to follow the contract.
Lets say a patient has insurance A as primary, and Insurance B as secondary.
If Insurance A's contracted fee is $150 for a procedure and insurance B's contracted fee is $100, I assumed that you cannot charge the patient $150, because you would be breaking your contract with insurance B.

In that case, Open Dental automatically uses the fee schedule for the Insurance A, since its the primary insurance. However, I need to use the fee schedule for Insurance B since I am contracted with them also.

Thanks,
Jason

[Jorgebon]

In that case you should make a primary claim with insurance A for $150, your contracted fee. Then you send a secondary claim to insurance B for any balance. The amount on the claim does not have to be your contracted fee. Since you have a fee schedule with insurance B that is lower, they will adjust any payment to pay any balance up to the plan's percentage of coverage. They will use your contracted fee of $100.
Jorge Bonilla, DMD

[jordansparks]

OK. But I think Coordination of Benefits Model Regulation written by the NAIC, in Section 3 Paragraph A.5.(c) clarifies that detail and makes it clear that you are actually to charge the patient the higher of the two fees. The other fee schedule comes into play when calculating writeoff. Now, having said that, I'm not quite sure without doing research what the behavior of Open Dental would be if the fee for Ins A was lower than Ins B. I think it might still use Ins A fee.