Setting up a new insurance. Very similar to the HMO with supplementals as described in manual, except for it's a PPO and has deductible and yearly maximum.
So, the insurance has a maximum allowable charge, but the patient pays the portion based on the separate fee schedule rather than on percentage. The deductible and yearly maximum applies.
Also, I believe there might be downgrades, just to be sure I covered everything.
Just wanted to double check that I am setting it up right.
- Add a new plan to the patient, set it up as PPO, cathegory procentage, insurance pays 100.
- Create a copay schedule, set it to the patient copay amounts.
- Create a normal schedule, set the values to maximum allowable charge
- Check "show UCR"
- Uncheck "Do not downgrade", set the deductible etc
For example. My office fee for D2954=265, ins. MAC=207, patient copay=96, deductible =50.
So, I create and complete the procedure D2954 (AFTER setting the insurance as per above steps AND clicking "update fees" in the TP module).
This shows me D2954 with the balance of 207 in the account module. Creating the claim, and see ther as follows: Fee=207, Ins. fee=265, deductible=50, Ins estimate 61, Ins pays=0, write off=0.
The account module shows the appropriate patient balance of $146 (96 copay+50 deductible)
Where did I get it messed up?