Insurance Predetermination

[jenteeth]

This may be a dumb question, but here goes!  I received insurance approval for a predetermination, but am not sure how to enter it on "Enter Insurance Approval" page on the Treatment Plan.  Our fee is $1360, the "covered amount" is $995, benefit amount is $497.50, patient estimate is $862.50.  What amount goes in the top "Predetermination" spot?  Which amount goes in the "Approved Amount" spot?  Sorry, I'm a newbie at this!!  Thank for your help!

[sonyap]

@jenteeth BE CAREFUL when doing this.  We learned several years ago not to enter this information because it will override everything else in the system - including the amount the patient has remaining in benefits.  So if the patient has $83 remaining, but the pre-d says that ins is paying $450, your checkout screen is going to show insurance est of $450.

[mbusinelle · Accepted solution]

The approval amount is the amount approved by the insurance company to be paid.  That would be $497.50.  The Predetermination spot will be $497.50.  In this case, there is only one procedure so the amounts match.  

In a case where you have mulitple procedures, the amounts for amount approved would be each line item approval amount, and the predtermination amount would be the total all together. 

Hope this makes sense.

[tshaw]

@debi_peterson @tsalcido any suggestions?