

Patient and Insurance Calculations Below is an explanation of the math behind writeoffs, covered amounts, insurance estimates, and patient portion for innetwork (PPO) insurance. Sample fees:
Writeoff: The difference between your office fee and contracted PPO fee. Covered Amount: Subtract the deductible from the PPO fee (before applying the covered percentage). Insurance Estimate: Apply the covered percentage to the covered amount. Patient Portion: Subtract the insurance estimate amount and writeoff from the office fee. Downgrades Sample Fees
Writeoff: The billed code is always used for the PPO fee, so for a downgrade it uses the PPO fee for D2392 (composite). This is the last time the D2392 PPO fee is used. Deductible: Subtract the deductible from the PPO Fee for D2150 (amalgam), Insurance Estimate: Apply the covered percentage to the covered amount. Patient Portion: Subtract the insurance estimate amount and writeoff from the office fee. For more information about downgrades, see Procedure Downgrades.


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