2 Patient Bill Estimates

The Patient Bill Estimates feature generates an estimate of a patient's potential out-of-pocket costs for a scheduled appointment using the Patient Bill Estimates AI Agent.

The following information outlines the process for self-pay, uninsured, and insured patients:

• For self-pay or uninsured patients, it calculates the estimated patient responsibility based on price (provider charge). If a self-pay contract is set up with a self-pay discount, it calculates the estimated patient responsibility by applying the self-pay discount.

• For insured patients, it calculates the estimated patient responsibility by applying the contracted payer rates and patient's insurance benefits added by the coverage agent using the eligibility check.

Note:

If a health plan participation or a payer contract is not set up for an insurance allocated to the patient visit, then the expected insurance payment is calculated at 100% of price (provider charge) and the patient responsibility is calculated as $0.