I have an issue that I feel should have a simple solution, however I am asking for your hands.
We signed up with Federal Employees Plan and one of them has following features:
- The insurance has a fee schedule (they call it maximally allowable charges, or MAC)
- Pt. pays a co-pay of $25 for all and any procedures listed in MAC list during the visit
- The insurance pays 100% of MAC deducting $25 (which is suppose to be paid by the patient) from the check
- Any procedure that is not on the list - not covered, the pt. pays my office fees
The only solution I see is to set PPO %-age plan to 100% coverage, Normal fee schedule st to MAC values, AND override one of the procedures manually with subtracting $25 from insurance estimate. Then it'll leave the account with $25 balance upon completion and after the insurance pays the account will have zero balance.
Is there any way to automate it?