Estimating Insurance for Flat Fee Plans

The following table explains the insurance estimation calculations used for dental and medical flat fee 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 flat fee plans are:

Plan Type

Calculations

Dental Flat Fee Plan

Bluebook Entry

No Deductible

The estimated insurance payment equals the insurance payment entered in the bluebook.

In the example:In the example:The estimated insurance payment is $60.

Dental Flat Fee Plan

Bluebook Entry

Deductible Subtracted First

The deductible is automatically subtracted from the insurance payment entered in the bluebook.

In the example:In the example:The $25 deductible is subtracted from the $60 insurance payment entered in the bluebook. The estimated insurance payment is $35.

Dental Flat Fee Plan

Bluebook Entry

Deductible Subtracted Last

The deductible is automatically subtracted from the insurance payment entered in the bluebook.

In the example:In the example:The $25 deductible is subtracted from the $60 insurance payment entered in the bluebook. The estimated insurance payment is $35.

Dental Flat Fee 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 Flat Fee 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 Flat Fee 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.

Medical Flat Fee Plan

Bluebook Entry

Deductibles Do Not Apply

The allowed amount is subtracted from the fee. The difference is the write-off amount. The 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.

Medical Flat Fee Plan

No Bluebook Entry

Deductibles Do Not Apply

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.

TipTip

If the plan pays something other than a percentage of your fees, set up bluebook entries.
If the fees equal the percentage plan allotted amount, you do not need to set up a bluebook entry.