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/allowable 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.
- Click Add Insurance Payment (the usual way to add an insurance payment).
- Update the amount that you wish to charge the client ($95) in the Co-pay field. Don't worry if your client already paid you this copay amount. SimplePractice will only charge them the difference.
Now click the "reload" arrows to complete the write-off amount.(**Very important step**)
Do the same for any other session where the $0 payment applies.
Click Client's Name to return to the client's profile.
Now that you've told SimplePractice that insurance is paying $0, we need to create the invoice to bill the client for the difference that they owe. Click Uninvoiced.
Make any edits to the invoice (i.e. add a description that highlights the reason for this new invoice.)
You can now add a payment or click "x" to Close
You'll see the $0 insurance payment and the updated client balance. That's it. You're done.
If you will write off a portion of the client's session fee when the deductible isn't met, there are the steps you need!Go to the client's billing details page.
Note: After you save your $0 payment, you'll see the following warning message at the top of your screen: "The insurance payment has a total amount of $0..." Since you intended to add a $0 insurance payment, you can ignore the message.
When you return to your client's Billing page, you'll see that your $0 payment was applied to your appointments. You should see the co-pay of $95 + $0 Insurance in green + $55 Write-off.
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.