Insurance Parameters
New PatientPatient pays 100% until met
Insurance pays 100% after this
%
Patient pays 20% after deductible
Amount patient is paying up front only
Amount patient is paying up front only
Results Summary
Days to Deductible
4
$3,000 met
Days to OOP Max
38
$7,500 met
Total Patient Cost
$7,500
over 55 days
Exp. Total Revenue
$26,000
not including additional payment plan
Days at 100% Coverage
17
$13,600 (52% of total revenue)
Program Phase Summary
PHP25 days · $800/day
Patient Cost
$6,400
Exp. Revenue
$13,600
IOP30 days · $450/day
Patient Cost
$1,100
Exp. Revenue
$12,400
Phase Breakdown
— 55 total days projectedCo-ins
OOP Met
Deductible Phase (4d)Co-insurance Phase (34d)OOP Met
Phase 1 — Deductible
4 days
Patient pays 100% · $3,000 total
Phase 2 — Co-insurance
34 days
Insurance pays 80% · Patient pays 20%
Phase 3 — OOP Met
Day 38+
Insurance pays 100% from this day forward
Day-by-Day Breakdown
55 days| Day | Program | Phase | Est. Allowed | Insurance Pays | Cumul. Patient | Remaining OOP |
|---|---|---|---|---|---|---|
| 1 | PHP | Deductible | $800.00 | $0.00 | $800.00 | $6,700.00 |
| 2 | PHP | Deductible | $800.00 | $0.00 | $1,600.00 | $5,900.00 |
| 3 | PHP | Deductible | $800.00 | $0.00 | $2,400.00 | $5,100.00 |
| 4 | PHP | Deductible | $800.00 | $160.00 | $3,040.00 | $4,460.00 |
| 5 | PHP | Co-insurance | $800.00 | $640.00 | $3,200.00 | $4,300.00 |
| 6 | PHP | Co-insurance | $800.00 | $640.00 | $3,360.00 | $4,140.00 |
| 7 | PHP | Co-insurance | $800.00 | $640.00 | $3,520.00 | $3,980.00 |
| 8 | PHP | Co-insurance | $800.00 | $640.00 | $3,680.00 | $3,820.00 |
| 9 | PHP | Co-insurance | $800.00 | $640.00 | $3,840.00 | $3,660.00 |
| 10 | PHP | Co-insurance | $800.00 | $640.00 | $4,000.00 | $3,500.00 |
| 11 | PHP | Co-insurance | $800.00 | $640.00 | $4,160.00 | $3,340.00 |
| 12 | PHP | Co-insurance | $800.00 | $640.00 | $4,320.00 | $3,180.00 |
| 13 | PHP | Co-insurance | $800.00 | $640.00 | $4,480.00 | $3,020.00 |
| 14 | PHP | Co-insurance | $800.00 | $640.00 | $4,640.00 | $2,860.00 |
| 15 | PHP | Co-insurance | $800.00 | $640.00 | $4,800.00 | $2,700.00 |
| 16 | PHP | Co-insurance | $800.00 | $640.00 | $4,960.00 | $2,540.00 |
| 17 | PHP | Co-insurance | $800.00 | $640.00 | $5,120.00 | $2,380.00 |
| 18 | PHP | Co-insurance | $800.00 | $640.00 | $5,280.00 | $2,220.00 |
| 19 | PHP | Co-insurance | $800.00 | $640.00 | $5,440.00 | $2,060.00 |
| 20 | PHP | Co-insurance | $800.00 | $640.00 | $5,600.00 | $1,900.00 |
| 21 | PHP | Co-insurance | $800.00 | $640.00 | $5,760.00 | $1,740.00 |
| 22 | PHP | Co-insurance | $800.00 | $640.00 | $5,920.00 | $1,580.00 |
| 23 | PHP | Co-insurance | $800.00 | $640.00 | $6,080.00 | $1,420.00 |
| 24 | PHP | Co-insurance | $800.00 | $640.00 | $6,240.00 | $1,260.00 |
| 25 | PHP | Co-insurance | $800.00 | $640.00 | $6,400.00 | $1,100.00 |
| 26 | IOP | Co-insurance | $450.00 | $360.00 | $6,490.00 | $1,010.00 |
| 27 | IOP | Co-insurance | $450.00 | $360.00 | $6,580.00 | $920.00 |
| 28 | IOP | Co-insurance | $450.00 | $360.00 | $6,670.00 | $830.00 |
| 29 | IOP | Co-insurance | $450.00 | $360.00 | $6,760.00 | $740.00 |
| 30 | IOP | Co-insurance | $450.00 | $360.00 | $6,850.00 | $650.00 |