Overview
When adding new procedures to a Treatment Plan in Denticon, the insurance estimation may appear entirely on the patient side — showing $0 on the insurance side — even when the patient has an active insurance plan with a fee schedule attached. This article explains why this occurs and how to resolve it.
Issue Description
New procedures entered on a Treatment Plan (TX Plan) are not estimating insurance benefits correctly. The fees are placed entirely on the patient side instead of being applied to insurance. The issue is specific to newly added procedures, while older procedures on the same plan appear to estimate correctly. The "Assign Benefits to Patient" option is not enabled on the affected patient.
Signs
- New procedures on the TX Plan show $0 on the insurance side and the full fee on the patient side.
- Older procedures on the same plan estimate correctly.
- The "Re-estimate" function does not correct the issue when re-estimating by a specific Phase ID (e.g., TID 1 – Phase 1).
- The issue persists across multiple browsers and computers.
- The patient's fee schedule is confirmed to be attached to the treatment plan.
Root Cause
This behavior is by design and is caused by how Denticon calculates insurance benefits at the Treatment Plan ID (TID) level. Each TID functions as an independent "bucket" for estimating benefits against the patient's annual insurance maximum.
When a patient's insurance maximum is already exhausted by procedures in one or more phases under the same TID, any new procedure added to a lower-numbered phase within that same TID will not receive insurance estimation — because the maximum is already fully allocated to the later phases. Denticon does not automatically redistribute estimates across phases when new procedures are added.
Example: If TID 1 has Phase 1 and Phase 2, and Phase 2 procedures have already used up the patient's $1,500 annual maximum, a new procedure added to Phase 1 will show entirely on the patient side. The maximum is already committed to Phase 2.
Resolution Steps
Option 1 – Re-estimate the Entire TID (Recommended)
When re-estimating, do not specify a Phase ID. Re-estimating by TID only (leaving the Phase field blank) forces Denticon to recalculate all phases together, redistributing benefits across the entire TID in the correct order.
- Navigate to the patient's Treatment Plan.
- Click Re-estimate.
- Enter the TID number (e.g., 1) but leave the Phase field blank.
- Confirm the re-estimate. Denticon will recalculate all phases under that TID together, applying benefits in order from the first phase to the last.
Note: Re-estimating by a specific Phase (e.g., TID 1 – Phase 1) only re-estimates that phase in isolation based on benefits already consumed by the other phases. It does not free up benefits from other phases to accommodate the new procedure.
Option 2 – Move the Procedure to Its Own TID
If the patient's insurance maximum is fully consumed by other procedures in TID 1 and those procedures are still planned, move the new procedure to a separate TID (e.g., TID 2 or TID 3). Each TID estimates independently against the patient's remaining benefits.
- Navigate to the patient's Treatment Plan.
- Locate the procedure that is not estimating correctly.
- Change its TID to a new or available TID number.
- Save the change. Denticon will estimate that procedure's benefits independently.
Option 3 – Mark Unneeded Procedures as Unaccepted
If some procedures in TID 1 are no longer planned or needed, mark them as Unaccepted. This removes them from the estimation calculation and frees up the insurance maximum for the remaining procedures.
Key Concepts: How TID Estimation Works
- TID (Treatment Plan ID): Each TID is an independent estimation bucket. Benefits are calculated per TID, not across the entire treatment plan at once.
- Phases: Phases within a TID are intended for multi-visit procedures (e.g., extraction in Phase 1, bone graft in Phase 2, implant in Phase 3). All phases under a TID are calculated together as one unit when re-estimating the full TID.
- Re-estimation scope: Specifying a Phase ID limits re-estimation to that phase only. Leaving Phase blank re-estimates the entire TID across all phases.
- Automatic recalculation: Denticon automatically recalculates within the same phase when items are drag-and-dropped and saved. It does not automatically recalculate across phases when new procedures are added.
Contact Support
If the steps above do not resolve the issue, please contact Planet DDS Support with the following information:
- Patient name and ID number
- Treatment Plan ID (TID) and Phase numbers affected
- A recording or screenshot showing the estimation discrepancy
- Confirmation of whether "Assign Benefits to Patient" is enabled or disabled
Additional Resources
- To submit a product enhancement request, go to Help > Submit Product Suggestions within Denticon.