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. If a client hasn’t met their deductible, you’ll still need to submit claims to the payer so they can apply the cost of services toward the client's deductible.

In this guide, we’ll cover:

• Billing a client as an In-network provider
• Billing a client as an Out-of-network provider
• Using Payment Reports for a client with a deductible

Billing a client as an In-network provider

If you are in-network with the client’s insurance payer and they haven’t met their deductible, your client will pay you the contracted or allowable amount the insurance payer would usually pay you.

For example, if your rate is $150 and the client’s deductible has not been met, the client will pay you the contracted rate of $95, and you’ll write off the remaining $55. To record this:

• Navigate to your client's Billing page
• Click Add Insurance Payment

• Set the payment Amount to $0

• Update the contracted amount in the Client Owes field
  • If your client has already paid you this copay amount, you’ll only charge them the difference

• Set the Insurance Paid amount to $0

• Click the blue spiral icon to calculate the Write-Off

• Click Save Payment
• Now, you can create an invoice for the $95 your client is responsible for. To do this:
  • Navigate to the client’s Billing page
  • Click Manage next to the appointment
  • Select Create invoice

• Click Save

This updates the Client balance to match the invoice, which will appear in the Client billing summary.

Next, collect payment from the client by following these steps:

• Click Add Payment in the Client billing box
• Choose the payment method of the client payment
  • Select Online card on file to collect payment within SimplePractice using the client’s credit, debit, or FSA/HSA card. For more information, see Processing Online Payments.
  • Select Cash, Check, or External card to record a payment you processed outside of SimplePractice

For more information on collecting payments from a client, see Adding a client payment.

Billing a client as an Out-of-network provider

If you're an out-of-network provider, you're not bound by a contracted or allowable amount with the payer. This means your clients pay you your full appointment fee when their deductible hasn’t been met.

In this case, you’ll need to:

• Change the Billing type for each individual appointment to Self-Pay to set the full appointment fee as the client's responsibility. To do this:
  • Navigate to the client's Billing page
  • Click Manage > Edit details 
  • Select Self-Pay from the dropdown menu

• Click Save

Note: Though you’re charging them as an insurance client, changing the Billing type to Self-Pay allows you to charge the client your full fee until their deductible has been met. For more information, see: Updating the billing details for individual appointments.

Using Payment Reports for a client with a deductible

If you’re enrolled to receive Payment Reports from an insurance payer, they’ll indicate on the report if an appointment was processed towards a client’s Deductible amount.

The status of the claim will also update to Deductible automatically.

Note: Deductible claims will sometimes receive the Denied status. For more information, see Claim reads "Denied" but the payer is saying it went to the client's deductible. 

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. However, the Client Owes amount will be updated on the client’s Billing page. 

You’ll still need to add a manual insurance payment using the information on the Payment Report. This will allow you to enter the correct Write-Off amount to clear out the insurance balance.

Until a write-off is manually added for a deductible appointment, the appointment’s Status will show as Pending in the claim’s Payment overview.

The Pending status indicates that the appointment fee hasn’t been fully covered by the combined client responsibility, insurance paid amount, and write-off. For more information, see Reviewing the Claim Details page. 

Note: If a payer paid for a portion of a claim and applied an amount to the client’s deductible, SimplePractice will automatically record an insurance payment and update the Client Owes amount on the client’s Billing page.