Calculating Dental Insurance Payments
now we're going to talk about calculating insurance payments and calculating patients out-of-pocket payments we are going to start by using either Trojan database the software database or real time in the computer in your office the fast break down benefits the insurance website or be phone call when we call breakdown benefits this is the Trojan database and in this first landed here.
we put the name the employer This is page 1 a church in database retail benefits for the employer and that insurance company be plan maximum is fifteen hundred dollars per person per year and the deductible is fifty dollars per person per year and healing bases usual customary and reasonable when calculating percentage.
we first must convert the percentage to a decimal number and we can achieve that by moving the decimal point to places to you don't last so eighty percent equals point 800 50 percent equals point file and 20 percent equals point2 I'll then after that we multiply the dollar amount by just small number so one hundred dollars times point2 so equals twenty dollars well 150 dollars times play 30 equals 485.
now let's get started with some scenarios patient a is going to have eighty three surface nood filling no deductible fifty dollars has not yet been met for this year.
The doctors charge is one hundred dollars the usual customary and reasonable or at UCR is one hundred dollars the UCR minus the deductible is fifty dollars me insurance payment is eighty percent I'll UCR minus the deductible so that is fifty dollars times eighty percent equals 40 dollars the total insurance payment for a one hundred dollar restoration is 40 dollars the patients total cost out of pocket for the restoration is fifty dollars minus the deductible in 20 percent up the UCR enables ten dollars plus fifty dollars for the deductible the total out-of-pocket equals sixty dollars patient B is going to eighty non-participating dentist and having a tree service MOT filling the fifty dollar deductible has not been met the doctors charge is 150 dollars that you see our usual customary and reasonable is one hundred dollars to 20 percent out UCR which is the one hundred dollars minus the deductible is ten dollars the total out-of-pocket equals 110 dollars.
which is the fifty dollars over UCR plus fifty dollar deductible plus the ten dollars which is 20 percent I'll UCR efficiency is going to eight participating provider the fifty dollar deductible will be here has been met the doctors charge 483 service MOT feeling is 150 dollars and he is also thing you see our the insurance payment is eight-percent or 120 dollars the patient's out-of-pocket is thirty dollars please be sure to study chapter 4 your online curriculum and check for more scenarios.
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