what is a deductible?

[maryh320]

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Hi everyone,

I recently started working in a dental office doing some front office work and I ran into a couple questions.

I have no idea how deductibles work? does anyone know what is it meant by "Meeting a deductible". Let's say the annual deductible is $25, do patients have to pay their copayment AND the $25 deductible? and what circumestance is a deductible met?


Sorry I am really confused with the concept of deductible, I would really appreciate if anyone can explain it to me before I make any billing mistakes. Thanks so much!

Mary

 

[Qafas]

A deductible is the amount that a patient/client has to meet, before the insurance kicks in. For instance, if I have a $500 deductible per year for my health insurance, I'll have to pay the first $500 out of my pocket; then the insurance will pick up. The co-payment is usually not applied towards the deductible, but that might be different depending on the place. Perhaps you should check with whomever you are working for to clarify things more.

 

[ShawnOne]

For those people who are interested in this topic, I posted the following on the pre-dent board. Its my experience with how insurance typically works with dental offices.

Here is an example situation.

Patient has 50 dollar deductible, 0% copay on prevent/diagostic, 25% on restoritive, 50% on major. $1000 max per year

Actually, first things first, make sure you check thier eligability, and also check it EVERY time the patient returns. You'd be surprised how many people's insurance will discontued for whatever reason. Also check to see if they are over the limit. Never assume. (Take if from me! 😡 )

So the patient come in and gets an exam, xrays, and a prophy. Lets say your fees are $200. The patient should pay $50 to cover the deducible (which needs to be paid every year) and insurance will pay the remaining 150 (0% copay). Now lets say they also need a class two filling. The office fee is, say $200, the insurane will pay 75%, so another 150. The office is supposed to collect the remaining 25% from the patient, which is the co-pay.

ADDED:

Now the patient comes in and needs a root canal, post, build-up, crown. For this type of treatment x-rays are necessary to request "authorization". A reviewer at the insurance company will review the request and either give approval or not. When approved, the patients comes back and get the service. At this point, the deductible is already met, so the patient is responsible for co-pay, which is typically 50% for major procedures.

Please feel free to comment if anybody has anything to add or correct.