A deductible is the amount the client pays out of pocket for eligible medical services before their insurance plan starts to pay toward their medical costs. You will still need to submit claims to the payer so that they can apply the services toward the client's deductible but that is as far as your responsibility goes. The payer's processing of the claim alone implies that the client will be paying you the amount. You do not need to communicate anything back to the payer after submitting the claim.
Below you’ll find information about managing deductibles in your account:
- In network providers
- Out of network providers
- How do deductibles work if I'm receiving Payment Reports?
Option 1: Your client will only pay you the contracted or allowable amount the insurance should have paid you.
Note: This is the most common way we see our customers working with deductibles.
Your rate is $150 → Deductible not met → Client pays you only the contracted rate of $95, and you write off $55.
In this scenario, you will need to enter an insurance payment in order to record the $55 write-off. The insurance payment will be for $0.
- Go to your client's Billing overview page.
- Click Add Insurance Payment.
- Update the amount that you wish to charge the client in the Client Owes field. If your client has already paid you this copay amount, SimplePractice will only charge them the difference.
When you return to your client's Billing page, you can now create an invoice for your client for the $95 your client is responsible for paying.
Option 2: Since you're an out-of-network provider, you're not bound by a contracted or allowable amount by the payer and your clients pay you your full appointment fee when the deductible isn’t met.
Your rate is $150 → Deductible not met → Client pays you $150.
In this case, you will need to:
- Change the Billing type for each individual appointment from Insurance to Self-Pay.
- Now the full appointment fee is the client's responsibility.
How do deductibles work if I'm receiving Payment Reports?
If you receive online Payment Reports from the payers, SimplePractice will send you a report with the claim marked Deductible.
Note: If you receive a payment report for a claim that was applied to the client's deductible, SimplePractice won't automatically record the $0 insurance payment. You still need to create a manual insurance payment using the information on the Payment Report so that you can enter the correct write-off amount.