Deductible payments
Answered
After you've submitted a claim and it is returned that the patients has to pay a deductible, is there another step for the clinician? Do we report the the insurance that the client made the deductible payment?
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Official comment
Hi there, Jirzia.
After you submit a claim and it gets returned with the "Deductible" status, you'll want to manually add an insurance payment to account for this in the system.
If you're an in-network provider, your client will only pay you the contracted amount the insurance should have paid you. In this case, you'll want to add an insurance payment with the total Amount at the top as $0, the Insurance Paid amount for the session as $0, the Client Owes amount as the contracted rate, and then the remaining amount from your total session fee as the Write-off amount. Here's an example from my test account:
Once you Save this insurance payment, you'll see a warning message that looks like this:
This is okay and you can ignore the message as it's just the system's way of making sure you didn't make a mistake.
You can now create an invoice for your client for the contracted amount your client is responsible for paying.
You can also learn more about this and what to do if you're out-of-network here: How do I bill clients who haven't met their deductible?
Let us know if you have more questions.Comment actions -
My issue is when the insurance company puts the full fee toward the clients deductible and there is no write off. I enter a $0 payment and then enter the full fee into the "client owes" column thus making the write off $0. The transaction doesn't show up as an insurance payment on the client's billing page or on the "Insurance Payments" page. Which makes it confusing to try to determine where the resulting full fee invoice on the client's billing page originally came from. On the other hand, if I have so much as a 1 cent write off ...then it will show up as an insurance payment. Am I doing something wrong in this situation?
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Hi Jan,
If the insurance company has put the full fee towards the client and there is no write-off, there's no need to enter in a $0 insurance payment. You would want to instead change the appointment billing type from Insurance to Self-Pay and then the full appointment fee would be the client's responsibility. Please refer to the section titled, "Out-of-network providers" in the guide linked above.
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In Client Edit, Insurance Info section, the field labeled Deductible: is it for the total deductible for the patient before coinsurance takes over, or for the amount per session that will be applied toward their deductible? I enter an amount in testing that is for the amt per session due from customer that will be applied toward their deductible, but the pop-up box that appears when you click on client's appt shows Client owes: $0. It needs to say owes $70 toward their deductible.
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Hi Laura,
In the Copayment field under the client's Billing and Insurance tab, you'll want to enter in the amount per session that will be applied towards their deductible, which is your contracted rate with their insurance payer. This deductible amount will automatically populate as the Client Owes amount for all sessions created moving forward. Remember to change your client's Copayment amount from your contracted rate to their actual copay once they've met their deductible.
You can also add the full amount of your client's deductible in the Deductible form field; however, this amount will not be automatically adjusted every time you bill insurance for your client. It will remain as a fixed number, which you can manually adjust if you choose to do so.
If your client's appointment is still showing a $0 Client Owes amount, or their normal copay, on the Calendar, it may be because that appointment is part of a recurring series that was created before you updated the client's Copayment amount. For recurring appointment series, we recommend that you delete the series and then create a new series so that the new deductible amount will apply.
If you have more questions, please send us a Help Request and we'll be happy to assist.
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Hi Erika,
The system is designed to automatically generate an insurance payment when a payment report (ERA) comes back showing a paid amount. For claims that go to Deductible or Denied, the payment report shows that the payer paid $0 because they are not issuing payment. Therefore, the system will not create an automatic insurance payment for claims with these statuses.
Additionally, not all payers send the appropriate data for claim statuses. Some payers will send the Denied status even if a claim went to Deductible. This is not technically inaccurate since the payer is still denying payment for claims that go to Deductible. However, since the statuses can vary, there isn't a way for the system to always recognize which claims a $0 insurance payment should be posted for (ones that actually went to Deductible even if the status may show Denied).
If you have further questions, please feel free to send our team a Help Request so we can clarify.
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Hi Lauren,
As long as the client's secondary insurance information has been added to their settings and indicated as such, you can do one of two things for the option to create a secondary claim to come up:
1. Add an insurance payment that takes care of the entire billed amount so that the primary claim gets marked as Paid
OR
2. Download the primary claim
If you have further questions, please send our team a Help Request and we can dig into this more.
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How do I make sure client gets credit for the deductible payment after the submission has gone through?
For example: Jane Doe has a deductible. The claim was submitted without knowledge of this, was accepted and paid $0. Jane now wants to pay the claim total, but wants to make sure it goes toward her deductible. How do I go about doing this when a claim has already been accepted and paid out?
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Hi Kristen, I'd be happy to help. Because a claim has been submitted for this session for your full fee, the contracted amount that insurance would typically pay you for the session has been applied to the deductible. The client responsibility is your contracted rate with the insurance payer and cannot be adjusted.
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When you are an in network provider & you submit a claim that is applied to the deductible for the full charge amount you still need to be able to mark the claim as processed to deductible for accounting reconciliation and communication with the client. They want to know their claims have been submitted and processed by the insurance company. You can just make them self pay. At some point their deductible may be met and the insurance will start paying.
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Hi Kristin and Leanne,
I'd be happy to clarify how in-network providers are able to bill clients for their contracted rate and make sure that these payments are applied towards their deductible.
Filing a claim for a client with a deductible will automatically have the billed amount apply towards their deductible. There is no need to change the session from Insurance Pay to Self-Pay.
If you're enrolled in automated Payment Reports, or electronic EOBs through SimplePractice:
- The status of a submitted claim will be updated to indicate that the client owes money towards their deductible. The claim's status may be processed as a "Deductible," or "Denied" claim; however, the Payment Report details will indicate how much the client owes for each session due to their deductible.
Here is a screenshot:
If you're using paper EOBs to manually add insurance payments:
- You'll want to use this information to add a $0 Insurance Payment for sessions being applied to a client's deductible. When you add a $0 insurance payment, make sure to still enter the write-off amount.The difference between your private-pay rate and the contracted rate will be reflected as the write-off.
- The claim's status will now update to "Paid," making the client's responsibility your contracted rate with their insurance payer.
Here is a screenshot:
If there isn’t a write-off amount, this is probably because you’ve billed the insurance payer the exact contracted rate you have with them. If you’re an in-network provider, you’ll want to bill your insurance payer more than the allowable or contracted amount.
There isn’t a way to add a $0 insurance payment without adding a write-off. Furthermore you can’t add a write-off and make the entire billed amount the client’s responsibility. If the client owes, insurance paid and write-off amount add up to be more than the billed amount, per session on the claim, the claim will never update to Paid.
We typically only recommend marking sessions billed to insurance as self-pay, when you’re filing courtesy claims for your clients as an out-of-network clinician.
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Ruth:
The point all of us are trying to make is we are in network providers and have to bill insurance to allow the clients deductible to be applied. Our charge amount happens to be equal or less than the insurance allowed amount so the full charge amount is applied to the deductible. We are NOT out of network billing as a courtesy. We need to have a way to mark the claim as paid or processed. We need record of the remittance advice so the claim doesn't continue to be seen as outstanding & the client needs to knows we have billed for the session.
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Hi Kristen, I understand that you’re an in-network provider, and that you’re looking for help updating your claim statuses in SimplePractice. Please review the previous comments in this thread regarding how to add a payment and calculate the write-off to mark a claim as paid. I’ll reach out to you over email to go over this in greater detail.
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Hi,
I understand how to make the payment look like it’s paid but my question is this:
I billed the insurance my rate which is higher than what the contract rate is, let’s say 100. Since my client has not met their deductible insurance responded that this would go to the deductible. Then since I am in network I billed the client for the contract rate and they paid. Now how to I tell insurance that only the value of the contract rate should be applied to the deductible and not the $100 I originally billed?Thanks
Leanne -
Leanne,
You don't need to tell the insurance anything else. Example say you billed a 90837 @ $100. The insurance contracted rate is $77.97. The EOB states $77.97 is the clients responsibility for deductible & your contractual obligation (write off amount) is $22.03. You've already billied and they have processed and applied the contract rate to the clients deductible.
Hope that helps!
Kristin
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Are you sure they consider you in network with that plan? Usually when that happens the EOB will still show an allowed amount but then it shows a non covered amount and has the client responsible for both. If this is the case they consider you out of network for that clients plan. There are times you are contracted with an insurance company but not every plan they cover.
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I understand now that I can put the amount that a client will owe for the deductible in the copayment field. However, I did not know this previously so I have invoices for sessions that say zero owed when actually, they need to pay their deductible amount. Because I collect the amount owed toward the deductible at the time of insurance rather than waiting for insurance to come back, I want past invoices to reflect that. Is there a way to change previous to reflect the co-pay/deductible amount owed rather than saying 0 owed?
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is there a way MANUALLY to make the system state "deductible" once you enter that the insurance put the fee towards the clients deductible? Once I switched to Electronic payments that shows up, however I have a few that I manually entered and they still show up in my claims as 'accepted' rather than paid-- and I followed all of the above steps.
thanks!
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