Quote a treatment with visits, insurance and fees paid to others

Some care is sold as a written quote: the surgeon's fee, the hospital, the anesthesiologist and a few follow-up visits, often paid in part by a major medical insurer. A treatment plan is what a patient gets when they approve that kind of quote. It lists the visits to book, what the patient owes you, and, when an insurer pays you directly, what the insurer owes you.

You build the quote in Quotes, the same place you quote a made-to-order job. A quote whose lines are all Custom item lines works exactly as before and becomes an order. As soon as one line is a Service with visits, approving the quote creates a treatment plan instead.

This article explains how a plan quote is built, how the insurance split is worked out, and the Private notifications setting that keeps clinical detail out of messages. It describes how Zelun works out the amounts; it is not tax, insurance or legal advice.

1. The services you will quote are in your catalog and not archived. A service line can only use an active service.
2. A client record for the patient, as for any quote.
3. If an insurer is involved, the insurer's authorization letter to hand. Zelun does not talk to insurers; you type in what the letter says.
4. Decide who collects each fee. For each line you choose between We collect it, We collect it for someone else, and The patient pays them directly.

Build the quote

1. In Quotes, press New quote and choose the client.
2. For each line, open Line options. Choose Service with visits for a visit the patient will book, pick the Service, and set the number of Visits and the Days after the previous visit (for example 7 for a check-up a week after surgery). The price is the total for all the visits; Zelun suggests the service price times the visits and you can change it.
3. Tick This is the main visit (for example the surgery) on the one line that is the main visit. A main line has exactly one visit, and a quote has at most one main line. If you tick none, the first visit is the main visit.
4. For a fee that is not yours, choose We collect it for someone else (you take the money and settle with them yourself) or The patient pays them directly (the patient pays the hospital or specialist, and Zelun never charges it), and type Who is paid. A service line is always collected by you.
5. Tick Covered by insurance on the lines the insurer covers. A line the patient pays directly cannot be covered.
6. Under Who pays what you see what you collect for yourself, what you collect for others, what the patient pays others directly, and, with insurance, what the insurer pays and what the patient pays you.

Add the insurance

1. Tick This quote has insurance coverage.
2. Type the Insurer, choose The insurer pays us directly or The patient pays us and claims a reimbursement, and enter the Deductible, the Coinsurance (%) and, if there is one, the Coinsurance cap. Optionally add the policy number and the claim reference.
3. Set the Authorization: Not requested, Pending, Authorized (with the Authorized amount if the letter gives one) or Denied.
4. Zelun takes the covered lines you collect, subtracts the deductible, applies the coinsurance (up to the cap), and limits the insurer's share to the authorized amount. A denied authorization means the insurer pays nothing. For example, 55,500 pesos covered with a 10,000 deductible, 10 percent coinsurance and a 20,000 cap leaves the insurer 40,950 and the patient 14,550.
5. When the insurer pays you directly, the patient's deposit and balance are worked out on the patient's share only. When the patient pays you and claims a reimbursement, the patient pays the full amount and the insurer's share is shown as an estimated reimbursement.

Keep track of the plan

1. Open Treatment plans from Quotes, or from a client in Clients. Each plan shows the patient, its status, the next visit, and what the patient and the insurer still owe.
2. Pick a plan to see its visits, the deposit and balance, the insurance split and the amount the insurer owes you.
3. When the insurer sends its authorization letter or changes it, use Update the insurer's authorization. Zelun recalculates the shares, keeps a paid deposit as it is, and tells the patient their share changed.
4. When the insurer pays you, use Record the insurer's payment with the amount, the date and a reference. If the insurer pays less than expected, the plan shows paid short and how much is missing. Zelun never adds that shortfall to the patient's bill: you decide what to do.
5. To cancel an active plan, use Cancel plan, give the reason, and say how much you keep for visits already given, with a reason for it.

Keep clinical detail out of messages

1. Go to My business, then Messages and notices, and open Private notifications.
2. Tick Keep clinical detail out of messages to your clients.
3. From then on, messages and calendar invites say "your appointment", "your quote" or "your plan" instead of naming the service, the items on a quote or the insurer, and Zelun stops using AI to write them. The date, time, place, amounts and links stay.

• The patient reviews the quote on a page that groups what they pay you from what they pay others directly, shows the visits of each service line, and, with insurance, shows the insurer's share and their own share. The amounts are labelled an estimate until the insurer has authorized.
• The patient only sees the last four characters of the policy number.
• After approving, the patient gets a plan page with their visits and what they owe, and a message with the link.
• With Private notifications on, their messages never name the treatment.

• Marking a hospital line as covered. A line the patient pays directly cannot be covered, because Zelun does not collect it.
• Expecting Zelun to invoice what you collect for someone else. Those fees are shown to the patient, but you settle them with the other party yourself.
• Typing a deductible for the whole policy year. Enter the deductible that applies to this bill, as the authorization letter states it.
• Expecting a shortfall from the insurer to reach the patient. It does not; it only shows on the plan.
• Forgetting that a plan quote is not an order. It does not appear in the order pipeline.

Quotes for made-to-order jobs, visit notes, and the messages Zelun sends are covered in the related articles.