Estimating Insurance for PPO Percentage Plans
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Setting Up Insurance > Handling Insurance Plan Information > Understanding Preferred Provider (PPO) Plans

Estimating Insurance for PPO Percentage Plans

The following table explains the insurance estimation calculations used for dental and medical PPO percentage plans. The calculations show the estimations when the deductible is subtracted first or last.

The insurance estimation calculations used for dental PPO percentage plans are:

Plan Type

Calculations

Dental PPO Percentage Plan

Bluebook Entry

No Deductible

The allowed amount is subtracted from the fee. The difference is the estimated write-off amount. The estimated write-off amount is added to the insurance payment entered in the bluebook.

In the example:In the example:The $75 allowed amount is subtracted from the $88 fee, leaving $13. The $13 difference is added to the $60 insurance payment entered in the bluebook. The estimated insurance payment is $73.

Dental PPO Percentage Plan

Bluebook Entry

Deductible Subtracted First

The deductible is automatically subtracted from the allowed amount. The difference is multiplied by the coverage percentage. The product is added to the write-off amount (allowed amount subtracted from the fee).

In the example:In the example:The $25 deductible is subtracted from the $75 allowed amount, leaving $50. The $50 difference is multiplied by the 80% coverage percentage. The $40 product is added to the $13 estimated write-off amount ($88 - $75). The estimated insurance payment is $53.

Dental PPO Percentage Plan

Bluebook Entry

Deductible Subtracted Last

The allowed amount is multiplied by the coverage percentage. The deductible is subtracted from the product. The difference is added to the estimated write-off amount.

In the example:In the example:The $75 allowed amount is multiplied by the 80% coverage percentage, leaving $60. The $25 deductible amount is subtracted from the $60, leaving $35. The $35 difference is added to the $13 estimated write-off amount ($88 - $75). The estimated insurance payment is $48.

Dental PPO Percentage Plan

No Bluebook Entry

No Deductible

The coverage percentage is automatically multiplied by the fee.

In the example:In the example:The 80% coverage percentage is multiplied by the $88 fee. The estimated insurance payment is $70.40.

Dental PPO Percentage Plan

No Bluebook Entry

Deductible Subtracted First

The deductible is automatically subtracted from the fee. The difference is multiplied by the coverage percentage.

In the example:In the example:The $25 deductible is automatically subtracted from the $88 fee, leaving $63. The 80% coverage percentage is multiplied by $63. The estimated insurance payment is $50.40.

Dental PPO Percentage Plan

No Bluebook Entry

Deductible Subtracted Last

The coverage percentage is automatically multiplied by the fee. The deductible is subtracted from the product.

In the example:In the example:The 80% coverage percentage is multiplied by the $88 fee, leaving $70.40. The $25 deductible is subtracted from $70.40. The estimated insurance payment is $45.40.

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