Setting Up Insurance > Handling Insurance Plan Information > Understanding DMO/Capitation Plans
The following table explains the insurance estimation calculations used for dental and medical DMO/Capitation plans. The calculations show the estimations when the deductible is subtracted first or last.
The calculations are based upon the following example: The fee is $88, the allowed amount is $75, the bluebook insurance payment is $60, the coverage is 80%, the copayment is $30, and the deductible is $25.
The insurance estimation calculations used for dental and medical DMO/Capitation plans are:
|
Plan Type |
Calculations |
|
Dental DMO/Capitation Plan Bluebook Entry No Deductible |
The estimated insurance payment equals the insurance payment entered in the bluebook. |
|
Dental DMO/Capitation Plan Bluebook Entry Deductible Subtracted First |
The deductible is automatically subtracted from the estimated insurance payment entered in the bluebook. |
|
Dental DMO/Capitation Plan Bluebook Entry Deductible Subtracted Last |
The deductible is automatically subtracted from the estimated insurance payment entered in the bluebook. |
|
Dental DMO/Capitation Plan No Bluebook Entry No Deductible |
The copay is automatically subtracted from the fee. |
|
Dental DMO/Capitation Plan No Bluebook Entry Deductible Subtracted First |
The copay is automatically subtracted from the fee. The $25 deductible is subtracted from the difference. |
|
Dental DMO/Capitation Plan No Bluebook Entry Deductible Subtracted Last |
The copay is automatically subtracted from the fee. The $25 deductible is subtracted from the difference. |
|
Medical DMO/Capitation Plan Bluebook Entry Deductibles Do Not Apply |
The estimated insurance payment equals the insurance payment entered in the bluebook. |
|
Medical DMO/Capitation Plan No Bluebook Entry Deductibles Do Not Apply |
The copay is automatically subtracted from the fee. |