Let’s face it, even if you have the latest information about what the in-network plan pays for the services that you are doing your estimate based on, it doesn’t mean you will get paid that way. It is far more accurate though to calculate the co-insurance with actual payment numbers because you will get closer to the true payment. Patient’s want actual, well so do you. It would make your job at the desk so much easier if insurance was more transparent in how they intend to pay for services. The truth is you must collect “estimated” co-insurance not “actual” co-insurance.
If you are out of network with a plan that says it will pay 80% of a $100.00 charge think again if you think asking for $20.00 will suffice. Insurance companies pay less because of deductibles, least expensive alternative treatment, bundling, frequency limitations, pre-existing conditions and other policy limitations. If you instead ask for a 30% co-insurance for procedures covered at 80% such as fillings and a 60% co-insurance for procedures usually covered at 50% such as crowns you will not only increase your cash flow because these numbers are more accurate but you will also decrease billing costs and collection activity. So, you send a small refund check to the patient. They would rather get that than a bill and more apt to return to your practice for further care.
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