A patient has reached their "Max" (Annual Maximum) for the calendar year. What does this mean for any additional dental work they need before January 1st?, The insurance company will cover 100% of all remaining costs., The clinic must offer a 50% discount by law., The patient must pay 100% of the costs out-of-pocket., The plan automatically switches to a DHMO network., How does a Maximum Out-of-Pocket (MOOP) limit differ from a traditional Annual Maximum (Max)?, MOOP applies only to out-of-network dentists., MOOP dictates frequencies, while Max dictates standard fee schedules., Once a patient reaches their Max, the insurance stops paying; once they reach their MOOP cap, the insurance covers 100% of subsequent covered costs., MOOP is only used for preventative care like routine cleanings, If an uninsured patient cannot afford treatment, what internal solution should you promote, and what is its maximum potential savings?, Medicaid / Quest (Up to 50% savings), Delta Dental PPO (Up to 40% savings), Hawaii Family Dental Membership Savings Plan / HOALA (Up to 60% savings), HMSA Flex Plan (Up to 30% savings), What is one of the most common reasons dental claims are rejected or denied in billing?, Misidentifying the roles of Subscriber, Guarantor, and Relationship to Subscriber., Failing to scan the patient's driver's license., Collecting the copay at check-in instead of check-out., Booking the appointment 48 hours in advance., Scenario: A dependent child is covered under both parents' dental plans. Mom’s birthday is September 14, 1988. Dad’s birthday is March 22, 1985. According to the Birthday Rule, which plan is primary?, Dad's plan, because he is older by year., Mom's plan, because September comes after March., Dad's plan, because March comes earlier in the calendar year., Either plan can be chosen by the front desk team., Which of the following is a common error when entering treatment plans for dual-coverage patients in Denticon?, Forgetting to check if the secondary plan applies its own deductible., Assuming the secondary plan automatically pays 100% of the leftover balance., Ignoring frequency limitations of the plans., All of the above.

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