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Insurance Estimating Overview

Insurance Estimating provides an estimated amount an insurance company might pay toward a charge based on the patient's insurance plan. With Insurance Estimating, an estimated patient and insurance portion are made as the charge is entered. Without Insurance Estimating, the entire amount of a procedure will be added to the insurance portion once a claim is created and the remaining balance will only be moved to the patient portion after the claim has been paid or closed.

As Insurance Estimating is configured, coverages, allowed amounts, flat rates, and so on are added to the Insurance Company reference by plan, where the insurance percentage is associated to a Procedure Type.

Insurance Estimating should only be considered an estimate that can only be as accurate as the information entered within MacPractice. An insurance carrier may not pay as estimated. For the most accurate estimates, understand the Insurance Estimating Formulas through which estimates are calculated and the unique fields within the Insurance Company Reference, from which the formula variables are derived.

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