It is the second week of October. Somewhere in the patient base are people with a crown on the treatment plan and most of a $1,500 annual maximum still unused. On January 1 that money goes back to the carrier. This page sizes the opportunity.
How the figure is worked out
Count patients who have both treatment planned and benefit remaining in the current plan year. Take the average remaining benefit per patient. Multiply the two for the total benefit at risk. Then multiply by the share of those patients who book when told, to get the part you can realistically schedule.
In words: benefit at risk equals patients with remaining benefit and planned treatment, times average benefit remaining. Bookable revenue equals benefit at risk, times the share who book, plus the patient portion they pay on top.
Worked example: 42 patients, average $900 remaining, 25 percent book. At risk: 42 times 900, which is $37,800. Bookable: $9,450 in insurance benefit, plus whatever patient portion sits on those plans.
The calculator
Where to find the patient count
You need patients who meet three tests: active insurance, benefit remaining this plan year, and a procedure still at treatment-planned status.
Open Dental: the Treatment Finder (under the Reports menu) filters by remaining insurance benefit and planned treatment, which is exactly this list. Dentrix: the Unscheduled Treatment Plans report gives the treatment side, and remaining benefits show in the Family File insurance block per patient; combining them is manual unless you use the Treatment Manager. Eaglesoft: insurance benefit tracking sits with the patient’s insurance record and the outstanding treatment reports; expect to merge two lists.
Average remaining benefit: your software stores the annual maximum and benefits used per plan when claims are posted, so the remaining figure is only as good as your claim posting. If a claim from July was never posted, the patient looks richer than they are.
What the result means
The at-risk total is found money, not recovered money. It is recovered only when the treatment is booked, completed and the claim pays. Start calls in October; by late November the schedule fills and the lab turnaround on crowns runs out of year. The end of year benefits guide has a call order and the unused benefits letter page has templates.
Calibic’s Insurance benefits list (LIVE) shows the patients with remaining benefit and open treatment, with the dollar figure, every morning from October onward, and adds them to the Daily Huddle when they are on the schedule. Sending the reminder is ROADMAP. Read-only toward your practice software. See insurance benefits, claims and AR.