Estimated Out of Pocket Calculator

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The Estimated Out of Pocket Calculator allows you to estimate the amount a patient will need to pay out of their own pocket. It can calculate the patient's deductible amount, coinsurance amount, or the combined deductible and coinsurance amount. (This features is not available within the Credit Card Plus secure payment window.)

 

Note: The Estimated Out of Pocket Calculator does not appear within the Credit Card Plus secure payment window.

 

On the Add Prepayment Plan page, click Estimated Out of Pocket Calculator

 

When you schedule a self-pay appointment, click Estimated Out of Pocket Calculator on the Appointment Saved page.

 

On the Patient Actions Bar, click Billing, and then click Collect Patient Payment. On the Collect Payment page, click Estimated Out of Pocket Calculator

 

 

 

The "Estimated Out of Pocket Calculator" feature must be enabled for your practice.

 

This features is not available within the Credit Card Plus secure payment window.

 

Note: If your practice does not use Credit Card Plus for E‑payments, the link to the Estimated Out-of-Pocket Calculator is available on the Collect Payment page only. This is for security reasons.

 

 

 

  1. Call the patient's payer or ask the patient for the patient's deductible and paid-to-date amounts.
  2. Display the Estimated Out of Pocket Calculator in one of three ways:
    1. On the Add Prepayment Plan page, click Estimated Out of Pocket Calculator.
    2. When you schedule a self-pay appointment, click Estimated Out of Pocket Calculator on the Appointment Saved page.
    3. On the Patient Actions Bar, click Billing, and then click Collect Patient Payment. On the Collect Payment page, click Estimated Out of Pocket Calculator.

    For the Calculation Type field, the Deductible option is selected.

  3. Estimated Allowable Amount — Enter the estimated allowable amount for this procedure.
  4. Deductible Amount — Enter the patient's deductible amount (obtained by the phone call to the payer).
  5. Deductible Paid to Date — Enter the paid-to-date amount (obtained by the phone call to the payer).
  6. Other Amount — If there is any other amount you would like to include, enter it here.
  7. Click anywhere on the page. The patient's estimated amount appears in bold green the Estimated Out of Pocket Amount field and cannot be edited.
  8. Notes — Enter any notes about this calculation.
  9. You can click Print This Page to format the results for print. Follow the procedures for printing in your practice.  
Note: The Estimated Out of Pocket Calculator also calculates a "total payment amount due today" using the percentage amount in the Percent Due Today field. The default value in this field is 100. To recalculate the Total Amount Due Today amount, edit the percentage in the Percent Due Today field and click anywhere on the page outside the input fields. The new amount appears in bold green.

 

 

  1. Display the Estimated Out of Pocket Calculator in one of three ways:
    1. On the Add Prepayment Plan page, click Estimated Out of Pocket Calculator.
    2. When you schedule a self-pay appointment, click Estimated Out of Pocket Calculator on the Appointment Saved page.
    3. On the Patient Actions Bar, click Billing, and then click Collect Patient Payment. On the Collect Payment page, click Estimated Out of Pocket Calculator.
  2. Calculation Type — Select the Coinsurance option. The available fields change.
  3. Estimated Allowable Amount — Enter the estimated allowable amount for this procedure.
  4. Coinsurance Percentage — Enter the patient's coinsurance percentage for this policy.
  5. Other Amount — If there is any other amount you would like to include, enter it in the field.
  6. Click anywhere on the page. The patient's estimated amount appears in bold green the Estimated Out of Pocket Amount field and cannot be edited.
  7. Notes — Enter any notes about this calculation.
  8. You can click Print This Page to format the results for print. Follow the procedures for printing in your practice.  
Note: The Estimated Out of Pocket Calculator also calculates a "total payment amount due today" using the percentage amount in the Percent Due Today field. The default value in this field is 100. To recalculate the Total Amount Due Today amount, edit the percentage in the Percent Due Today field and click anywhere on the page outside the input fields. The new amount appears in bold green.

 

 

  1. Call the patient's payer or ask the patient for the patient's deductible amount, paid-to-date amount, and coinsurance percentage.
  2. Display the Estimated Out of Pocket Calculator one of three ways:
    1. On the Add Prepayment Plan page, click Estimated Out of Pocket Calculator.
    2. When you schedule a self-pay appointment, click Estimated Out of Pocket Calculator on the Appointment Saved page.
    3. On the Patient Actions Bar, click Billing, and then click Collect Patient Payment. On the Collect Payment page, click Estimated Out of Pocket Calculator.
  3. Calculation Type — Select the Both option. Additional fields appear.
  4. Estimated Allowable Amount — Enter the estimated allowable amount for this procedure.
  5. Deductible Amount — Enter the patient's deductible amount (obtained by the phone call to the payer).
  6. Deductible Paid to Date — Enter the paid-to-date amount (obtained by the phone call to the payer).
  7. Coinsurance Percentage — Enter the patient's coinsurance percentage for this policy.
  8. Other Amount — If there is any other amount you would like to include, enter it here.
  9. Click anywhere on the page. The patient's estimated amount appears in bold green the Estimated Out of Pocket Amount field and cannot be edited.
  10. Notes — Enter any Notes about this calculation.
  11. You can click Print This Page to format the results for print. Follow the procedures for printing in your practice.

Note: The Estimated Out of Pocket Calculator also calculates a "total payment amount due today" using the percentage amount in the Percent Due Today field. The default value in this field is 100. To recalculate the Total Amount Due Today amount, edit the percentage in the Percent Due Today field and click anywhere on the page outside the input fields. The new amount appears in bold green.

 

 

 

 

The Calculator is most useful for practices with a large population of self-pay patients, or patients with high-deductible plans or coinsurance plans.

 

The calculations work like this:

  • Deductible: athenaOne subtracts the deductible paid to date from the deductible amount. If the result is zero, the patient is estimated to owe nothing. If the result is greater than zero, athenaOne compares the result to the estimated allowable amount, and returns whichever amount is lower.
  • Coinsurance: athenaOne multiplies the estimated allowable amount by the coinsurance percentage.
  • Both (deductible and coinsurance combined): athenaOne subtracts the deductible paid to date from the deductible amount, then subtracts the result from the estimated allowable amount. The final result is then multiplied by the coinsurance percentage.

 

Calculation Type

Select one of the available options (Deductible, Coinsurance, or Both) to determine the type of calculation you want to perform.

Note: The fields available in the Estimated Out of Pocket Calculator change depending on the Calculation Type you select.
Estimated Allowable Amount

The maximum amount that a payer will pay a provider for a given service plus the patient responsibility amount (e.g., copay, coinsurance, or deductible). This is also expressed as the charge amount (i.e., the amount the provider charges for a given service) minus the contractual adjustment.
Deductible Amount

The amount of money the patient must pay each year to cover medical expenses before the insurance policy begins to pay benefits. This may be calculated per person or per family. (Appears for Deductible and Both Calculation Types.)
Deductible Paid to Date

The amount of money the patient has already paid towards their deductible amount. (Appears for Deductible and Both Calculation Types.)
Coinsurance Percentage

A fixed percentage or amount of the charge amount paid by the patient. (Appears for Coinsurance and Both Calculation Types.)
Other Amount

Any other amount of money you would like to include in the calculation.
Estimated Out of Pocket Amount

Based on the inputs in the fields above, displays the patient's estimated out of pocket amount. This field cannot be edited.

Percent Due Today

The default in this field is 100. To recalculate the Total Amount Due Today amount, edit the percentage in Percent Due Today field and click anywhere on the page outside of the input fields. The new amount appears in bold green.

Total Amount Due Today

Based on the inputs in the fields above, displays the total amount to be collected from the patient that day. This field cannot be edited.

Notes

A free-text field in which you can record any information you may wish.

Note: Any text that you enter in that field will print but it will not be saved. To permanently save a note in the patient's file, go the patient Quickview and enter it in the Patient Notes field.

 

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