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
.
Primary:
References calculations for the primary insurance, listed as an Order of 1 in the
Family Module
.
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.
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.
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
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.
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.
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.
Ins Used:
The Ins Used field provides the sum total of billed procedures with a status of Adjustment, NotReceived, Received, and Supplemental.
Pending:
Claim procedures with a status of NotReceived count toward the Pending figure.
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:
Adjustment type (
Procedure discount adj type).
Discount percentage when a percentage discount is given (Procedure discount percentage).
Apply a Percentage Discount to a Treatment Planned Procedure
Every insurance plan has one subscriber and can be attached to multiple patients, but a plan is never shared between subscribers. There is no limit to the number of plans a family can have. If a patient changes their coverage, the old plan is not ...
Benefit Information Benefit Information is found in the lower right of an Insurance Plan . The figures are used to calculate procedure and insurance remaining estimates. The details in the section apply to all subscribers of that particular insurance ...
When entering an Insurance Plan, an Insurance Plan Type that impacts estimates will need to be selected. There are five Insurance Types: Category Percentage, PPO Percentage, PPO Fixed Benefit, Medicaid or Flat Co-pay, and Capitation. The default ...
In the upper left of the Practice-Web Dental screen, click on "Setup." A drop-down menu will open. Click on "Insurance Categories" to bring up the following window. These are the insurance coverage categories for the practice. There are two setup ...
Patients can have unlimited insurance plans. The Insurance Plan listed second (Order 2) in the Family Module is considered secondary insurance, though can be changed by modifying the Order Number. Most insurances follow the "Birthday Rule." This ...