Wednesday, March 16, 2011

How to calculate co-payments for dental services?

I just got a job as a dental receptionist and they're asking me to calulate co-payments ....even though I know everything about scheduling appointments,recalls, word processing,etc. 'm not too familiar with insurances and billing and I have no idea how to calculate co-payments, anyone who works in a dental office and can give me an advice? please help me!!
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First you will need to have a break down of each patients insurance benefits. A standard plan will be thus: Calendar year maximum==$1,500.00 Calendar year deductible==$50.00 (family $150.00) Diagnostic and preventive covered at 100% Basic covered at 80% Major covered at 50% Say a patient needs a cleaning at $97.00 Full mouth x-rays at $135.00 Exam at $45.00 Resin filling # 5 mo at $235.00 Porcelain gold crown # 13 at $1,075.00 Total treatment estimate is $1,587.00 You would first subtract from the total of the amount that is covered at 100% (this would be $245.00) Then you take the remaining balance of $1,342.00 Subtract the deductible of $50.00 leaving a balance of $1,292.00 since there are two services covered at different percentages, you need to do each one separately: filling @ $235.00 is covered @ 80% so you need to figure out 20% of 235.00. Multiply 235.00by 20% and you will get $47.00 the crown is paid at 50% so just divide 1,75.00 by 2 which gives you: $537.50 Now add up the patients deductible, the 20 % portion for the filling, the 50% portion for the crown and you get $634.50. this is the patients ESTIMATED portion. When giving a patient a dollar amount that they will owe after insurance, always stress that it is an estimated portion and that insurance payments are never guaranteed. Good Luck with your new position EDIT: It always helps to ask for help, but i think they are testing you. And medical and dental insurance are NOTHING alike. The insurance company is not responsible for figuring out the patients portion but a customer service rep will help you with percentages. and there is no such thing as a set co-pay in a fee for service dental office, which is what it sounds like you are working in.
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