Insurance Plans Glossary

Allowed Amount: The allowed amount is the amount the insurance carrier deems is allowed to be charged for a procedure. The Coverage Percentage in the plan will calculate the insurance portion based on the allowed amount.

Coordination with other carriers: Coordination with other carriers can be standard or non-duplicating.

• Standard Coverage: The secondary carrier will cover the percentage another carrier has paid up to the total allowed.

• Non-Duplicating Coverage: The secondary carrier's coverage is only calculated from the percentage left unpaid by the primary insurance.

Copay: The copay is usually collected at the time of the visit. The Patient is responsible for the copayment amount.

Deductible: If a deductible is entered, the patient is responsible for all charges until the deductible is met.
Deductible Applies To: Specifies whether the deductible applies to each patient, 1 patient, 2 patients, and so on. Deductibles can also be calculated accumulatively. Lifetime deductibles do not renew on the renewal date.

Estimating On / Off: If Insurance Estimating is off, the charge is in Patient Portion until a claim is created. The portion will be in Insurance Portion when claims are created and will remain in Insurance Portion until all claims are closed.

Flat Rate Coverage: Enter a specific amount insurance will cover for a given fee for each code.

Insurance Coverage Percentage: Each procedure type has a coverage percentage that the insurance pays. It may or may not apply to the deductible.

Insurance Portion: The amount for which it is estimated the insurance will be responsible.

Participates: If the provider participates, any fee amount greater than the allowed amount is written-off.

Patient Portion: The amount for which it is estimated the patient will be responsible.
 
Remaining Coverage: Once the deductible is met, MacPractice will estimate the insurance will pay until the remaining coverage is gone.

Renewal Date: Upon the renewal date, the Remaining Coverage and Deductible are reset to the information in the plan. Renewal dates are given in month and day; the year does not apply.

Write-off: This amount is written off and not charged to a patient as the provider generally participates in the plan and agrees to the allowed amounts. If you participate with a plan, the write-off is included in the Insurance Portion when Insurance Estimating is turned on. If you do not participate in the plan, it will be put in the patient portion. Write-offs are always calculated from the fee minus the allowed amount.

For additional terminology, please see our Glossary.