I just upgraded to v 2.1.1.2 - this is the first time
with v2 - previously made a few entries in V1... I
don't see a way to enter 'coinsurance' charges that
are separate from 'deductibles'. My insurance
(healthnet ppo) separates these and they do not count
coinsurance payments towards the deductibles (they
are counted in max oop).
What about co-pays? Are they counted towards your deductibles and/or max OOP? This may affect the usefulness of my answer below.
When I enter the
transactions according to the normal procedure, QMM
counts the coinsurance portion of my responsibilities
towards the balance left in my deductible - which is
wrong. i.e. according to QMM i will reach my deductible
sooner that is really the case. I took a quick look
at the method you suggest for treating 'copays' but i
got too confused and am not sure it addresses this
particular issue. Coinsurance is calculated AFTER the
'allowed' amount is calculated so it's not as clean
as just taking a 10.00 (or equiv) copay off the
top... any suggestions would be appreciated. - Dan
The best I can come up with is pretty ugly, so I'm glad you're open to "any" suggestions. All of the numbers below are fictitious, but were chosen to help see how the specific values flow through the system.
Here's the base scenario:
You have a doctors appointment for which you are billed $77.00.
You have a co-pay of $10.00.
The allowed amount by your insurance is $66.00, which leaves the provider write-off of $11.00.
The insurance company pays $10.40, and expects/requires you to pay $40.00 towards your deductible and $5.60 in co-insurance.
QMEM setup:
Let's say you already have "HealthNet PPO" set up as an insurer. Create another insurer called "HN-coinsurance" that is an exact duplicate of "HealthNet PPO" except that the deductibles for this insurer are $0. I don't know if they have to be $0, but that's what I'm currently working with.
Create the expense for the visit, and go immediately to the Expense Detail screen.
Enter a Service line for "Doctor Visit".
Enter the Amount Billed as 71.40: which is $77.00 - $5.60, in other words the real amount billed minus the co-insurance.
Enter the Provider write-off as $11.00, which is real.
Enter the insurance payment for the insurer "HealthNet PPO" for $10.40
Enter another Service line for "Doctor Visit".
Enter the Amount Billed as $5.60: the co-insurance amount
Enter an insurance payment for the insurer "HN-coinsurance" for $0.00.
Enter your $10.00 co-pay and your $45.60 payment as usual.
Doing things this way should let your deductible amount for "HealthNet PPO" be correct. However, it will split your OOP values across the two insurances. Therefore, to see how you are doing on your OOP Max progress, you'll have to run two OOP Max reports using the
Deductibles/OOP Max report <one for the real insurer and one for the fake one> and add the two values together yourself.
The other drawback to this approach is that you have to enter
every service twice. Can be very time consuming depending on the health history of your family.
Personally, I'm not entirely thrilled with how the deductible and OOP Max tracking works right now. It doesn't seem configurable enough for the variety of ways that insurers deal with these numbers, so I use them to see when I'm getting close, then manually do the calculations in Excel with the help of the Cost Calculator to see the exact moment at which I cross the deductible and OOP lines. Once I know I'm on the other side, I set a reminder for December 29th so that I remember to start paying attention to the numbers again.
-Tony
