Lately I have been seeing a few new insurance plans creeping up in the market. In Colorado, I have seen these new “EPO” Delta Dental plans that have a patient co-pay instead of the traditional coverage %. Then, when I was in Washington recently, the office showed me a plan where the patient pays a total dollar amount on certain procedures. These plans sound similar, but the setup is slightly different.
With the “EPO” plans, I would use the co-pay feature inside of the coverage table. The reason I would use the co-pay is that there is a different patient co-pay for every procedure code. View the image below to see the fields to use for this type of setup.
Then I have seen other plans where the patient pays $65 for the exam, X-rays, prophy, etc., or pays $800 for a crown, but nothing else is covered. In this situation, I would use the Payment Table because there is not a co-pay on every procedure code. Remember, the Payment Table will override the Coverage Table. Set the coverage % to 0 because anything that is not listed on the benefits sheet is not covered. See the image below for the fields to use with this setup.
Delta EPO's and Co-Pay plans, how to setup
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