How to set up Financial Policies for Corporate and Insurance Companies
Insurance Companies (including Corporate Financial Policies) can be easily set up in Clinicea. In such cases, payments are made by the Insurance Company, while there could be some contribution from the Patient also (also called CoPay). An Insurance Company may have a variety of Insurance Policies. Insurance Policies can cover the entire medical costs, part costs or treatment specific costs. Such Policies may also have annual, daily, or bill specific threshold limits, depending on the Patients subscription plan.
Let’s go over it with an example:
A Patient has subscribed to an Insurance Policy called Start-Up from the Insurance Company YourHealth. However, the Start-Up Policy does not cover entire medical costs and is restricted to certain rules.
_Start-Up Policy Rules:_
The Annual threshold limit is $5,000. Therefore if the annual medical costs of a Patients exceeds the $5000 limit, the Patient will have to pay the remaining costs.
The Daily Limit is $500. The Policy will cover a maximum of $500 per day. If the costs exceed this amount, the Patient will have to pay the balance.
There is a Patient Co-Pay rule. The Patient must pay part of the total Bill amount covered by the Insurance Policy, in a single bill. In this case, the Patient Co-Pay is set to be 20% of the total Bill amount or a maximum of $100 per bill.
It covers the costs for Service Items that include Consultations and Lab Tests. However, it does not cover Annual Check-ups.
The maximum amount covered for Consultation is $135, beyond which the Patient will need to pay the remainder.
There is a 10% Discount given by the Clinic to the Insurance for a Consultation Service. However, no discounts are available for a Naturopathic Consultation, which too is a type of service offered by the Clinic.
There is a preferential Drug Tariff too for those who have subscribed to this Insurance Policy.
Let us have a look at setting up the Insurance Company called YourHealth and the Insurance Policy called Start-Up:
1. Go to Tools | Address Book | +Add New.
2. An Address Book Details window will open | type in Name for the Insurance Company (Ex: YourHealth) | set Category as Corporate | fill in all other fields.
3. Now scroll down and click on +button beside Policies under Corporate Policies.
4. A Policy Details window will open.
Enter Policy Name (Ex: Start-Up)
Rules: set the Annual Limit (Ex: $5,000) and Daily Limit (Ex: $500)
Check On Corporate contribution can be set directly in Bill if you manually want to enter Insurance contribution for Corporate or Patient while Billing.
Set Patient Co-Pay amount (Ex: 20%), In a Single Bill Patient Pays and As long as the Patient contribution does not exceed (Ex: $100).
5. Set Service Items in one of the 2 ways
a. By adding a Flat Discount for all Services.
OR,
b. By Individually setting up the pricing of each service “ Select Service wise Discount. To add services just click on the + button. Then fill out the following fields.
Code: Some insurance companies have a set of codes for each service that they want you to use. This can be set up here. It is important to remember that all services across different policies of the same insurance company, will have the same service code ie a Consultation service with a service code SRCD11 for Policy 1, will also have the same service code SRCD11 for Policy 2 as long as both Policy 1 and Policy 2 belong to the same Insurance Company. This feature is inbuilt into Clinicea, to reduce errors in billing and to simplify Insurance Claiming.
Existing Price: It is the standard price of a service set by the Clinic. You do not need to enter it here again. It is for reference only.
Discounted Price: You can set the price you want to offer the Service for here. A 12.5% Discount is given to the Start-Up Policy for an acne treatment of $200. When the discount is set at 12.5%, the Discounted Price automatically shows the discounted price of $175. Also, in this case, rule no. 5 states $135 is the maximum that will be covered by the Acne Treatment.
Discount %: If instead of entering a flat amount, you want to offer a discount by %, you can do so here.
Max Covered Amt: You can set the maximum amount an insurance company will pay for a particular service item.
6. You can similarly set up Drug Tariffs or Inventory Prices.
a. By adding a flat discount for all Inventory Item
OR,
b. By Individually setting up the pricing of each Inventory Item. To add services just click on the + button. Then fill out the following fields.
7. In case you have made custom (employee) packages for a particular Corporate only, you can set up these too. If an employee belonging to that Corporate comes along to your clinic, in the billing section, only these packages will be available for your staff to pick from. This ensures that the list of packages is curated by your staff, eliminating clutter or the possibility of any error.
8. You will be redirected to Address Book Details window after clicking Save. The Start-Up Policy has been added, now click on Save.
9. Once Saved, you will automatically be directed to Address Book and the Insurance Company YourHealth will appear here.
Please have a look at How to assign a Patient’s billing to an Insurance
Let’s go over it with an example:
A Patient has subscribed to an Insurance Policy called Start-Up from the Insurance Company YourHealth. However, the Start-Up Policy does not cover entire medical costs and is restricted to certain rules.
_Start-Up Policy Rules:_
The Annual threshold limit is $5,000. Therefore if the annual medical costs of a Patients exceeds the $5000 limit, the Patient will have to pay the remaining costs.
The Daily Limit is $500. The Policy will cover a maximum of $500 per day. If the costs exceed this amount, the Patient will have to pay the balance.
There is a Patient Co-Pay rule. The Patient must pay part of the total Bill amount covered by the Insurance Policy, in a single bill. In this case, the Patient Co-Pay is set to be 20% of the total Bill amount or a maximum of $100 per bill.
It covers the costs for Service Items that include Consultations and Lab Tests. However, it does not cover Annual Check-ups.
The maximum amount covered for Consultation is $135, beyond which the Patient will need to pay the remainder.
There is a 10% Discount given by the Clinic to the Insurance for a Consultation Service. However, no discounts are available for a Naturopathic Consultation, which too is a type of service offered by the Clinic.
There is a preferential Drug Tariff too for those who have subscribed to this Insurance Policy.
Let us have a look at setting up the Insurance Company called YourHealth and the Insurance Policy called Start-Up:
1. Go to Tools | Address Book | +Add New.
2. An Address Book Details window will open | type in Name for the Insurance Company (Ex: YourHealth) | set Category as Corporate | fill in all other fields.
3. Now scroll down and click on +button beside Policies under Corporate Policies.
4. A Policy Details window will open.
Enter Policy Name (Ex: Start-Up)
Rules: set the Annual Limit (Ex: $5,000) and Daily Limit (Ex: $500)
Check On Corporate contribution can be set directly in Bill if you manually want to enter Insurance contribution for Corporate or Patient while Billing.
Set Patient Co-Pay amount (Ex: 20%), In a Single Bill Patient Pays and As long as the Patient contribution does not exceed (Ex: $100).
5. Set Service Items in one of the 2 ways
a. By adding a Flat Discount for all Services.
OR,
b. By Individually setting up the pricing of each service “ Select Service wise Discount. To add services just click on the + button. Then fill out the following fields.
Code: Some insurance companies have a set of codes for each service that they want you to use. This can be set up here. It is important to remember that all services across different policies of the same insurance company, will have the same service code ie a Consultation service with a service code SRCD11 for Policy 1, will also have the same service code SRCD11 for Policy 2 as long as both Policy 1 and Policy 2 belong to the same Insurance Company. This feature is inbuilt into Clinicea, to reduce errors in billing and to simplify Insurance Claiming.
Existing Price: It is the standard price of a service set by the Clinic. You do not need to enter it here again. It is for reference only.
Discounted Price: You can set the price you want to offer the Service for here. A 12.5% Discount is given to the Start-Up Policy for an acne treatment of $200. When the discount is set at 12.5%, the Discounted Price automatically shows the discounted price of $175. Also, in this case, rule no. 5 states $135 is the maximum that will be covered by the Acne Treatment.
Discount %: If instead of entering a flat amount, you want to offer a discount by %, you can do so here.
Max Covered Amt: You can set the maximum amount an insurance company will pay for a particular service item.
6. You can similarly set up Drug Tariffs or Inventory Prices.
a. By adding a flat discount for all Inventory Item
OR,
b. By Individually setting up the pricing of each Inventory Item. To add services just click on the + button. Then fill out the following fields.
7. In case you have made custom (employee) packages for a particular Corporate only, you can set up these too. If an employee belonging to that Corporate comes along to your clinic, in the billing section, only these packages will be available for your staff to pick from. This ensures that the list of packages is curated by your staff, eliminating clutter or the possibility of any error.
8. You will be redirected to Address Book Details window after clicking Save. The Start-Up Policy has been added, now click on Save.
9. Once Saved, you will automatically be directed to Address Book and the Insurance Company YourHealth will appear here.
Please have a look at How to assign a Patient’s billing to an Insurance
Updated on: 15/06/2023
Thank you!