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joedindo
Premolar III

"Estimated Payment" calculation

When posting a claim, does PW factor in the "Individual maximum amount" when calculating the "Estimated payment"?

For example, if a patient has three D6010 procedures, and their insco covers 50%, with a UCR of $1775, and a Max of $1700 all of which are available, shouldn't the estimated payment be $1700?  Math looks like this to me:  $1775 x 50% = $887.50.; three of those means $887.50 x 3 = $2625.00; this amount exceeds $1700 so the estimated benefits would be $1700. However, PW says $2625.00 in the "Insurance Claim Information" screen.IMG_3453.jpg