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Procedure Fees and Insurance Estimates

Many elements contribute to the calculation of procedure fees and insurance estimates. If treatment plan or procedure estimates are inaccurate, below are some troubleshooting hints.

Fee Schedules:  Fee schedule can be set in several places and certain settings override others. See Fee Schedule Logic for an explanation of how a patient's fee schedule is determined.

  • Edit Insurance Plan window:
      - Fee Schedule: Make sure the correct one is attached.  If using the default fee schedule of the Provider, the selection should be 'none'.
      - Other Fee Schedules:  This is where co-pay and allowed (out of network) fee schedules are assigned.
  • Edit Provider window: The default fee schedule of the provider. Typically this fee schedule applies to patients who have no insurance or if a patient has an Insurance Plan with 'none' selected for Fee Schedule.
  • Edit Patient Information: Only patients with a discount fee schedule should have a fee schedule selection here  (e.g. cash only or Membership Plan). In most cases you will use the provider or insurance plan fee schedule.

If you recently updated a fee schedule, you may need to update fees. 

  • Global Update: In Fee Tools, click Update to apply fee changes to all treatment planned procedures at once.
  • By Treatment Plan: In the Treatment Plan module, click Update Fees in the toolbar. This will update fees for the selected patient only.

Insurance:  Below are items to check.

Claims already paid will affect insurance remaining.  See Insurance Remaining Estimates for more details about how remaining insurance amounts are calculated.

To see an example of the math behind downgrades, see Patient and Insurance Calculations.


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