Checklist – When Patients Max Out Their Insurance Benefits

Do you have a system/protocol for when patients max out their insurance benefits for the year?

This is what I do!

1. Double-check that the patient maxing out is correct. I have had problems where the insurance denied a claim because of this, but the patient hadn’t maxed out or even come close to maxing out. I do a quick run through the patient’s account/ledger.

Did they have a lot of treatment at your office this year? Were they referred to a specialist? If all seems correct, I move on to the next step.

2. Check the patient’s maximum amounts in our software and update it if you need to. If a patient maxes out at another office, I need to update their maximum in the software so I can treatment plan and collect accordingly.

3. I make a pop-up note that expires the last day of the patient’s plan year (I.e., 12/31/2022), stating that the patient is maxed and will need to pay upfront for any remaining procedures until the plan renews again.

Just another added precaution so I can be reminded to have the patient pay up front!

4. Optional: I will usually make a note in any upcoming appointments to have the patient pay up front!

It’s important to be thorough when a patient maxes out their insurance benefits so that you can avoid any problems down the road.

I would also recommend enrolling in Front-Office Courses to learn more about how to handle this situation and other common front-office tasks.