Insurance Remaining and Discounts

Insurance Remaining and Discounts

Insurance Remaining Calculations



Insurance Remaining grid, as shown above, appears in several places throughout Practice-Web, including in the lower right of the Treatment Plan Module , when you hover over "Ins Rem" in the bar at the top of the Account Module , and can be configured to appear on the Patient Dashboard. 

These calculations consider benefits remaining for the patient's current benefit year, which may or may not fall on a calendar year depending on the Insurance Plan .
  1. Primary: References calculations for the primary insurance, listed as an Order of 1 in the Family Module .
  2. Secondary: References calculations for the Secondary Insurance , listed as an Order of 2 in the Family Module .



Family Insurance

Occasionally, an Insurance Plan will have family benefit rules in addition to individual rules. For example, the plan may have a $50 individual deductible, but also a $100 family deductible, which means if the family, as a whole, pays $100 toward the deductible that year, no one else needs to pay toward their individual deductibles. These types of situations are reflected in the Family Insurance section at the top of the Insurance Remaining grid.
  1. Annual Max: The figure shown in the Annual Max box of the Family section is the total dollar limit insurance will pay toward a family's care during their benefit year. It draws the information from the Annual Max field in the Family section of the  Insurance Benefits window. If no benefit is listed there, this box will be blank. If the plan has multiple maximums, the lowest maximum will display. 
  2. Fam Ded: The figure shown in the Fam Ded box of the Family section is the maximum combined deductible the family will pay in any given year. It pulls the information from the General Deductible field in the family section of the Insurance Benefits window. If no benefit is listed there, this box will be blank. If the plan has multiple family deductibles, the first deductible entered will display. 

Individual Insurance

  1. Annual Max:  The figure shown in the Annual Max box of the Individual Insurance section is the total dollar limit insurance will pay toward a single person's care during their benefit year. It draws the information from the Annual Max field in the Individual section of the  Insurance Benefits  window. If no benefit is listed there, this box will be blank. If the plan has multiple maximums, the lowest maximum will display. 
  2. Fam Ded:  The figure shown in the Fam Ded box of the Individual section is the maximum combined deductible a patient will pay in any given year. It pulls the information from the General Deductible field in the individual section of the Insurance Benefits window. If no benefit is listed there, this box will be blank. If the plan has multiple individual deductibles, the first deductible entered will display. 
  3. Ded Remain: The Ded Remain field displays the remaining deductible amount for the benefit year. It considers both the family and individual deductibles and displays the lesser of the two.
  4. Ins Used: The Ins Used field provides the sum total of billed procedures with a status of Adjustment, NotReceived, Received, and Supplemental.
  5. Pending: Claim procedures with a status of NotReceived count toward the Pending figure. 
  6. Remaining: The Remaining field displays the amount a patient has left before reaching their annual max. It's calculated as: Remaining = Individual Annual Max - (Ins Used + Pending).

Dropped Plans - Insurance Used / Pending

If an Insurance Plan is dropped and then readded, the system will treat it as a wholly new plan even though it has the same benefit structure. That means it will automatically make the same benefits available for use again and the Insurance Remaining boxes will display incorrect information.  This must be manually corrected, first by adding Adjustments to the Insurance Benefits in the Edit Insurance Plan window. Then, by deleting any outstanding claims associated with the dropped plan and recreating claims under the new plan.

Treatment Plan Procedure Discounts



If you want to set the system up to discount a specific procedure in advance of an appointment for a specific patient, it can be done in the Treatment Plan Module . Bear in mind, however, that discounts added do not interact with insurance benefits and are intended for cash patients. Familiarize yourself with your local laws as well, as certain jurisdictions may have legislation that precludes the use of this feature in certain situations. 

Treatment Plan Procedure Discounts Setup

Discounts can be made by  percent or dollar amount based on the settings selected in Treatment Plan Module Preferences. Settings include the default:
  1. Adjustment type ( Procedure discount adj type).
  2. Discount percentage when a percentage discount is given (Procedure discount percentage).

Apply a Percentage Discount to a Treatment Planned Procedure


  1. Select the Treatment Plan you want to apply a discount to in the Treatment Plan Module .
  2. Highlight the procedures you'd like to apply the discount to or, to apply the discount to all procedures in the plan, do not select any.
  3. Click "Discount" in the toolbar at the top of the screen. The following dialog will display.
     
  4. Edit the percentage discount if needed and click "OK."


Note that the Discount column will then display the discount you've just added as well as any anticipated PPO write-offs. 

Apply a Dollar Amount Discount to a Treatment Planned Procedure

  1. Doubleclick on the procedure to open the Procedure - Financial Tab.
  2. Enter the discount amount in dollars in the Discount Field.



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