Treatment Plan Worksheet: Out-of-Network Insured Patients

When working with patients who have insurance but are out-of-network, clear communication about costs and payment options is essential. The first step is to enter the patient’s name and a description of the Treatment Plan (e.g., fillings or other procedures). It is helpful to bundle procedures when entering this information, as this approach ensures a streamlined and accurate presentation of the Treatment Plan. The case fee should be set according to the practice’s usual, customary, and reasonable (UCR) rates, as this is the fee applied in out-of-network cases, even though the insurance provider may reduce the amount they cover.

In the Dental Insurance dropdown, select “Out of Network.” This selection will prompt additional fields to appear, allowing the user to input the estimated insurance payment. Practice management software can assist in generating these estimates. For example, if the insurance is expected to pay $1,000, this amount should be entered. It is important to avoid using terms such as “maxes out” when discussing insurance payments with patients, as this language may cause confusion. Instead, focus on recommending the necessary treatment for the patient’s health, regardless of insurance limitations.

Next, determine if the case qualifies for a prepayment discount. If the practice policy allows a discount for full prepayment on Treatment Plans above a certain amount (e.g., $2,000), this discount can be applied to the patient’s balance. For example, a 5% discount on a $3,500 case would reduce the patient’s balance by $175, bringing the total to $3,325. Offering this discount encourages immediate payment, which can improve accounts receivable and reduce cancellations by fostering a psychological commitment. In the event of a cancellation, any prepayment should be refunded, but offering such a discount typically decreases the likelihood of cancellations.