Billing clients who haven’t met their deductible

A deductible is the amount a client pays out of pocket for eligible medical services before their insurance plan begins to pay toward costs. When a client hasn’t met their deductible, you’ll still submit claims so the payer can apply the service cost toward the deductible.

• 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’re in-network with the client’s insurance payer and the deductible hasn’t been met, the client pays the contracted or allowable amount the payer would normally pay you.

For example, if your rate is $150 and the client’s deductible hasn’t been met, the client pays the contracted rate of $95 and you write off the remaining $55. To record this:

1. Navigate to your client’s Billing page
2. Click Add insurance payment

3. Set the payment Amount to $0

4. Update the contracted amount in the Client Owes field
   • If the client already paid this copay amount, only charge the difference

5. Set the Amount to $0

6. Click the blue spiral icon to calculate the Write-off

7. Click Save Payment

You can now create an invoice for the amount the client is responsible for and collect 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. When the deductible hasn’t been met, clients pay your full appointment fee.

To charge the full fee, you’ll change the billing type for each appointment to Self-Pay:

1. Navigate to the client’s Billing page
2. Click Manage > Edit details
3. Select Self-pay from the dropdown menu

4. Click Save

Note: Though you’re charging the client as an insurance client, changing the Billing type to Self-Pay allows you to charge your full fee until the deductible is 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, they’ll indicate on the report if an appointment was processed towards a client’s Deductible amount.

A claim processed towards a client’s deductible will also receive the Deductible status. 

The Payment Report will update the client’s responsibility to their contracted rate and write off the remaining portion. The client’s responsibility, also known as the allowable amount, can then be charged. If the client already paid a portion of this before the claim was processed, you’ll charge them the difference.