Treatment Plan Module Insurance 

This page tells about  how the insurance amounts are calculated in the lower right hand portion of the Treatment Plan module and at the upper right of the Account module, in the hover panel.

Family Insurance
There are two columns, one for primary insurance, and the other for the secondary insurance.  The primary insurance corresponds to the left-most plan within the Family module.  The secondary insurance corresponds to the plan second from the left within the Family module.

Annual Max: Shows the family annual maximum coverage.  The value comes from Insurance Benefits with Type set to Limitations, Quantity Qualifier set to None, Time Period set to CalendarYear or ServiceYear, Coverage Level set to Family, and Proc Code blank.  If there are no matching benefits, the Annual Max box will be blank. If there is exactly one matching benefit, then the Annual Max box shows the benefit Amount.  If there are multiple matching benefits, then the Annual Max box shows the smallest benefit Amount.

Fam Ded: Shows the family deductible.  The value comes from the Insurance Benefits with Coverage Category set to None or General, Type set to Deductible, Quantity Qualifier set to None, Time Period set to CalendarYear or ServiceYear, Coverage Level set to Family, and Proc Code blank.  If there are no matching benefits, the Fam Ded box will be blank.  If there is exactly one matching benefit, then the Fam Ded box shows the benefit Amount.  If there are multiple matching benefits, then the Fam Ded box shows the benefit Amount that was first entered.

Individual Insurance
There are two columns, one for primary insurance, and the other for secondary insurance.  The primary insurance corresponds to the left-most plan within the Family module.  The secondary insurance corresponds to the plan second from the left within the Family module.

Annual Max: Shows the individual annual maximum coverage.  The value comes from Insurance Benefits with Coverage Category set to None or General, Type set to Limitations, Quantity Qualifier set to None, Time Period set to CalendarYear or ServiceYear, Coverage Level set to Individual, and Proc Code blank.  If there are no matching benefits, the Annual Max box will be blank. If there is exactly one matching benefit, then the Annual Max box shows the benefit Amount.  If there are multiple matching benefits, then the Annual Max box shows the smallest benefit Amount.

Deductible: Shows the individual deductible.  The value comes from the Insurance Benefits with Coverage Category set to None or General, Type set to Deductible, Quantity Qualifier set to None, Time Period set to CalendarYear or ServiceYear, Coverage Level set to Individual, and Proc Code blank.  If there are no matching benefits, the Deductible box will be blank.  If there is exactly one matching benefit, then the Deductible box shows the benefit Amount.  If there are multiple matching benefits, then the Deductible box shows the benefit Amount that was first entered.

Ded Remain: Shows either the family deductible remaining or the individual deductible remaining, whichever is lowest, for the current benefit year.  The family deductible remaining is calculated by taking the value from the Fam Ded box and subtracting any deductibles applied to any family member for the current benefit year.  The individual deductible remaining is calculated by taking the value from the Deductible box and subtracting any deductibles applied to the currently selected patient for the current benefit year.  Only Claim Procedures with status Adjustment, NotReceived, Received, and Supplemental are considered.

Ins Used: Shows the total insurance used for the currently selected patient for the current benefit year.  Only Claim Procedures with status Adjustment, Received, and Supplemental are considered. If the insurance plan includes a benefit Limitation for a Category other than None or General, or for a particular Proc Code, and the Quantity Qualifier is None, and the Time Period set to any of CalendarYear, ServiceYear, or LifeTime, then codes within the given category or equal to the Proc Code will not affect the Ins Used.

Pending: Shows the total insurance pending amount for the selected patient for the current benefit year.  Only Claim Procedures with status NotReceived are considered. If the insurance plan includes a benefit Limitation for a Category other than None or General, or for a particular Proc Code, and the Quantity Qualifier is None, and the Time Period set to any of CalendarYear, ServiceYear, or LifeTime, then codes within the given category or equal to the Proc Code will not affect the Pending amount.

Remaining: Indicates the amount of insurance remaining.  Calculated by taking the amount in the individual Annual Max box minus the amounts in the Ins Used box and Pending box.

Insurance Used vs Pending
If you drop an Insurance Plan, then add a new identical plan, Ins Used and Pending will appear to show show incorrect amounts if the dropped plan is associated with any paid or pending claims in the current benefit period.  This is because claims associated with the dropped plan are not used in the calculations.  To adjust the amounts, follow these steps.

1. For the new plan, add an Adjustment to Insurance Benefits on the Edit Insurance Plan window. Enter the total insurance that has been paid to date, and the total deductible that has been used.
2. In the Account module, review all sent Claims and collect data for any claims attached to the dropped plan that are still outstanding.
3. Delete outstanding claims attached to the dropped plan. 
4. Recreate the Claims for the new plan.