Current-version note:
Insurance now uses configurable coverage plans instead of one reimbursement percentage. If the video shows the older percentage field, use the written workflow below.
🎥 Tutorial guide
Billing for Insured Patients
When a patient has an active policy with an Insurance Coverage Plan, billing evaluates each item against the plan's benefits, exclusions, limits and requirements before dividing responsibility between the insurer and patient.
💳 How the invoice is split
🏢 Insurer liability
Calculated from the highest-priority matching benefit after exclusions, deductible, usage restrictions and monetary caps are applied.
👤 Patient liability
The remaining net amount, including non-covered services, deductible, copayments, amounts above caps and tax.
📋 Before finalising the bill
- Confirm that the correct patient policy and Insurance Coverage Plan are selected.
- Confirm that the policy, plan and membership are active and within their dates.
- For subscription plans, confirm that the membership bill is paid or formally waived.
- Enter referral or authorisation codes and attach required forms or evidence.
- Review the explanation shown for every covered, limited or excluded item.
🔎 Understand the coverage status
- Approved: the calculated insurer liability is ready for reconciliation.
- Pending Requirements: estimated coverage is saved and usage is reserved, but approved insurer liability remains zero until evidence is approved.
- Unconfigured: the policy has no coverage plan, so no automatic insurer contribution is applied.
- Denied: insurer liability remains zero and reserved usage is released.
⚠️ Avoid billing errors:
Add and verify insurance information before finalising the bill. Finalised bills retain their calculation snapshot, while plan changes apply to future and unfinalised bills.
Learn the complete insurance workflow
See the Insurance Coverage Plans guide for configuration steps, calculations and worked examples, then use Billing and insurance reconciliation to record provider payments.