Estimating Secondary Insurance

Secondary insurance estimating options are found on the Benefit Table window for an Employer/Plan. Access this window from the Estimating button on the Employer/Plan Definition window.

When working with the patient's secondary insurance, select one of the following options:

Estimate as if full fee is whatever primary doesn't pay.

Example:Example:

Patient's primary and secondary insurance both pay 50% on crowns. Regular crown fee is $600. PracticeWorks estimates primary will pay $300, secondary will pay $150, and patient pays $150.

Estimate as if coverage were primary, but only pay up to ESTIMATED BENEFIT minus what primary will pay.

Example:Example:

Patient's primary and secondary insurance both pay 50% on crowns. Regular crown fee is $600. PracticeWorks estimates primary will pay $300, secondary will pay $0, and patient pays $300.

Choose this option if you know there is a duplication clause and you don't expect secondary to pay anything.

Estimate as if coverage were primary, but only pay up to the FULL FEE SUBMITTED minus what primary will pay.

Example:Example:

Patient's primary and secondary insurance both pay 50% on crowns. Regular crown fee is $600. PracticeWorks estimates primary will pay $300, secondary will pay $300, and patient pays $0.

Choose this option if the plan coordinates benefits.

The default Secondary Insurance settings are defined in the Office Wide Defaults table.
(File > Preferences > Insurance Estimating.)