What to Do When a Patient's Insurance Benefit Increases
What do you do when you've started a contract for a patient and they inform you that their insurance benefit went up? We've got you!
The first time you deal with this, please call Tops Support (770.627.2527). Once you have walked through it with a Support member, you can use this article as a reminder of the process!
- Open the patient's chart; go to View > Patient Info or press Command I.
- Click on the Contracts/Ledgers tab.
- Double-click on the contract you wish to edit.
- In our example, patient Jules Jones started with an insurance benefit of $1000. She now has a $1500 benefit. We now need the Expected Insurance and the Calculated Insurance to show $1500 in her contract worksheet:
- Talk to the patient/responsible party and figure out if they will pay the same monthly payment amount for fewer months OR pay a smaller amount each month now that their insurance benefit has increased.
- Jules's mom decided that she will decrease her monthly payments from $250.00 to $230.00.
- DO NOT use Action > Change Expected Insurance.
- Instead, in the contract worksheet, double click on the next copay charge and edit it to the new copay amount. DO NOT change the amounts in the middle column.
- Edit the remaining copay amounts, moving down the list carefully. Remember not to touch the middle column figures!
- As you work, you will see the lower right Calculated Insurance amount increasing - that's a good sign!
- Keep going until it the Calculated Insurance reaches the AMOUNT YOU WILL ACTUALLY RECEIVE FROM INSURANCE.
- In Jules's case, we had to make the last copay charge $210.00 to make the Calculated Insurance reflect as $1500. Note how the Contract Total remains at its original $6580. This is very important!
- When you are satisfied with your changes, click Record Contract.
- This window will come up; don't be scared! This is Tops asking you if you meant to change the expected/calculated insurance, and if you want the Expected Insurance on the top left to change to match your new Calculated Insurance number. Go ahead and click Change.
- You will now notice that the blue snapshot to the left of the patient's picture reflects the new expected insurance amount. Good job!
