Insurance Estimating

[carolyn621]

I hope someone can help explain this

This plan has not annual maximum, therefore the 999,999 and no deductible. We are out of network.

This is the insurance estimating:

The patient copay should be $239.20.

Help in resolving this issue because this is not the first time.

[jdowner]

Hello @carolyn621

for something like this, i would need to connect in and take a look at a few different things that could affect the tx plan showing the patient having remaining benefits available.

To start, if you go to the patient's clipboard and click on the insurance button what does it show their used/remaining benefits totals are?

[tshaw]

Hello @carolyn621,
I apologize for the delay. Let me tag @jdowner to see if he has any information on this.

[sonyap]

@carolyn621I don't know how / why PW is calculating that the patient's max has been met. When was the last time you reset benefits and then ran a benefits recalculation? I agree, this should not have to be performed in this situation, but I wonder if that would make a difference.

[carolyn621]

Benefits are reset at end of the month and totals recalculator are done same time. Just a response on this forum or a call to the office from SUPPORT would be nice.