Deductibles 

The deductible is the amount that the patient must pay at the beginning of a new year before insurance will begin to pay. This is typically $50 and does not apply to preventive treatment. So a typical exam, xrays, and cleaning would be covered at 100%, and the patient would pay nothing. Then, when they come in for fillings, they would owe the $50 deductible at the first appointment. They would owe another $50 the first time they have treatment performed in the next benefit year.

There are two different ways of calculating a deductible. The following sections are very technical, and most users can skip them since they are not that important. Each Insurance Plan has a checkbox allowing you to select the calculation method, and there is also a global default in Setup Misc.

Standard Deductible Calculation
The deductible gets added to the patient portion of the estimate. As an example, if you have a $100 filling covered at 80%, then the patient portion would normally be $20. With this deductible calculation, the patient portion would be 20 + 50 = $70. This calculation method always works in the favor of the dental office, but might be off by $10 if the insurance company uses the alternate calculation. If you give the patient an estimate that shows they will owe $70 for the filling above, it will make sense to them, and they will gladly pay the estimate. By always assuming this type of calculation, it keeps the calculations simple and understandable, and there is less chance of a remaining balance after insurance pays. Some insurance plans do apply the deductible before the percentage, but that is not generally a problem either, because most insurance companies reduce the allowed payment based on UCR calculations.

But if they owe a deductible of $50, it is 50 + (50 * .2) for a total of $60. Note that this is NOT the expected 20 + 50. The patient will only have to pay an additional $40 instead of the expected $50. Now, if you have actually followed the math to this point, you have to realize that it is very unlikely that any patients will be able to understand this. They will see a $50 deductible and assume it means they have to pay an additional $50.

Alternate: Apply Before Percentage
The deductible gets applied before the percentage is calculated. For example, if you have a $100 filling covered at 80%, the patient portion would be 50 + (50 * .2) for a total of $60. Note that this is NOT the expected 20 + 50. The patient will only have to pay an additional $40 instead of the expected $50. Now, if you have actually followed the math to this point, you have to realize that it is very unlikely that any patients will be able to understand this. Order of operations is something non-mathematicians just don't think about too often. They will see a $50 deductible and assume it means they have to pay an additional $50. We recommend not using this alternate method, but it is here for offices who wish to use it.