Treatment Plan Worksheet: In-Network Insured Patients

When working with in-network (PPO) patients, it is important to clearly communicate treatment costs and the patient’s financial responsibility. The Treatment Plan Financial Worksheet provides a clear, step-by-step approach to help navigate this process. To begin, enter the patient’s name, the reason for the Treatment Plan (whether it’s for a full Treatment Plan or a specific procedure), and the total UCR (Usual, Customary, and Reasonable) fee. While you won’t charge this amount to insured patients, including the UCR fee is essential for building a comprehensive explanation for the patient and to highlight the cost savings from their insurance coverage. Once you select the in-network insurance option, additional fields specific to in-network insurance scenarios will appear. These fields will allow you to accurately reflect the financial adjustments based on the patient’s insurance.

Next, enter the fee after the insurance plan’s discount has been applied. For example, if your standard crown fee is $1,500, but the insurance fee schedule allows only $900, enter $900 as the reduced fee. This field should reflect the new, lower fee that the insurance has determined, rather than the discount amount itself. Enter the amount you estimate the insurance will pay. For example, if the insurance is expected to cover $450, input that amount. The worksheet will automatically calculate the patient’s out-of-pocket cost and display their total savings. This breakdown is important for the patient to see, so ensure you highlight the savings when presenting the Treatment Plan. Additionally, use the “Add Notes” section to personalize the worksheet for the patient. This could include appointment reminders, instructions for follow-up steps, or additional context about the treatment. Personalizing the Treatment Plan helps ensure that the patient feels that it is tailored to their individual needs.

Before requesting a signature, review the financial details with the patient. For example, you might say:

“Your treatment fee totals $3,560, but with your insurance, you’ll only be responsible for $1,490, which is a savings of over $2,000, or 58%. This is excellent coverage, and I’m glad we can offer you such significant savings. Let’s go ahead and finalize everything today, and we’ll get your appointment scheduled. It will take two visits to complete the treatment.”

This approach sets clear financial expectations, highlights the value of the patient’s insurance, and positively frames the conversation.