What To Do When a Patient Loses Insurance

We know these things happen...your patient's insurance policy termed. Mom changed jobs. They don't actually have that adult orthodontic benefit. What do you do when you've already activated the contract? Don't worry, we've got you!

1. Open the patient's chart; go to View > Patient Info or press Command I.
2. Click on the Contracts/Ledgers tab.
3. Double-click on the contract you wish to edit.
4. Note the amount in the Expected Insurance and Calculated Insurance fields. In our example, William's mom thought he was going to get $1500 from insurance, so that is how the contract was set up:

3. Now we know that William will only receive $750.
4. Talk to the patient/responsible party and figure out if they will pay the same monthly payment amount for more months OR pay a larger amount each month to make up for the insurance discrepancy.
5. William's mom decided that she will increase her monthly payments from $197.91 to $225.00.
6. DO NOT use Action > Change Expected Insurance.
7. 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.

8. Edit the remaining copay amounts, moving down the list carefully. Remember not to touch the middle column figures!
9. As you work you will see the lower right Calculated Insurance amount decreasing - that's a good sign!

10. Keep going until it the Calculated Insurance reaches the AMOUNT YOU WILL ACTUALLY RECEIVE FROM INSURANCE (and that may be zero!)
11. Look what happened with William's contract. At the end we had not quite yet gotten the Calculated Insurance to $750, so we had to add one more copay charge. When you have to add more Copay charges than Amount charges, you will need to zero out the amount in the Amount column to avoid increasing the Contract Total, which in this case is $6500:

12. In Williams' case, we had to make the last copay charge $100.00 to make the Calculated Insurance reflect as $750. Note how the Contract Total remains at its original $6500. This is very important!
13. When you are satisfied with your changes, click Record Contract.
14. 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.

15. You will now notice that the blue snapshot to the left of the patient picture reflects the new expected insurance amount. Good job!