At the moment I have an out of balance situation

because QEMM shows negative balances for cases where

I paid a bill in full... but was later reimbursed by

insurance payments.

Here is what I have experienced with this type of situation:

When I enter the insurance reimbursement, I specify that the "Paid To" is "Me" in the insurance payments panel.

Then the expense details panel shows My Total Responsibility is zero, My payments & Copays is the amount I paid (for example $20), and I have an additional line Insurance Reimbursements (for this example it's $20). The calculation is My responsibility - My payments + Insurance reimbursements = Balance. In this case the balance is zero.

However, I believe that the reporting aspect of this situation is not quite right. When you go back and look at the Expense Log for this claim, My Responsibility is zero, My Payments is $20, Balance is zero. This looks a bit odd to me because it looks like I paid more than I owed. However, if I were to enter a negative payment (the reimbursement I received) or reduce my original payment by the amount I received, then the Expense Details will be wrong... it says I owe the provider. So this is not an option.

So, I think the reporting side of the program has a problem. Does anyone else out there have an idea as to how to either interpret the log or do you also think it is perhaps missing something? Like My payments - Insurance reimbursements = My "TRUE" payments?
Bonnie

> At the moment I have an out of balance situation

> because QEMM shows negative balances for cases

where

> I paid a bill in full... but was later reimbursed

by

> insurance payments.

>

Here is what I have experienced with this type of

situation:

When I enter the insurance reimbursement, I specify

that the "Paid To" is "Me" in the insurance payments

panel.

Then the expense details panel shows My Total

Responsibility is zero, My payments & Copays is the

amount I paid (for example $20), and I have an

additional line Insurance Reimbursements (for this

example it's $20). The calculation is My

responsibility - My payments + Insurance

reimbursements = Balance. In this case the balance is

zero.

However, I believe that the reporting aspect of this

situation is not quite right. When you go back and

look at the Expense Log for this claim, My

Responsibility is zero, My Payments is $20, Balance

is zero. This looks a bit odd to me because it looks

like I paid more than I owed. However, if I were to

enter a negative payment (the reimbursement I

received) or reduce my original payment by the amount

I received, then the Expense Details will be wrong...

it says I owe the provider. So this is not an

option.

So, I think the reporting side of the program has a

problem. Does anyone else out there have an idea as

to how to either interpret the log or do you also

think it is perhaps missing something? Like My

payments - Insurance reimbursements = My "TRUE"

payments?

Bonnie

I have experienced the same problem. I believe that the problem is that the software cannot really take into account the differences between receiving care from a participating in network provider and a nonparticipating out of network provider. Typically a nonparticipating provider requires payment in full of charges regardless of the amount of insurance reimbursement. The problem appears to be compounded by the use of the field "provider write-off". The software seems to automatically assume that the provider - eg hospital or doctor - writes off the difference between the allowable and the provider's charges which, in the case of a nonparticipating provider, is generally not an accurate assumption. Another way of looking at this is that the software does not seem to understand the distinction between a true "provider write-off" where the provider forgives amounts legally owed and amounts which are disallowed by the insurer because they are in excess of the insurer's allowable charges. Generally, a nonMedicare nonparticipating provider will require the patient to pay any such disallowed amounts and will not write them off. I have written technical support about this issue and am awaiting a response.

I have experienced the same problem. I believe that

the problem is that the software cannot really take

into account the differences between receiving care

from a participating in network provider and a

nonparticipating out of network provider. Typically a

nonparticipating provider requires payment in full of

charges regardless of the amount of insurance

reimbursement. The problem appears to be compounded

by the use of the field "provider write-off". The

software seems to automatically assume that the

provider - eg hospital or doctor - writes off the

difference between the allowable and the provider's

charges which, in the case of a nonparticipating

provider, is generally not an accurate assumption.

The software's assumption is correct. The issue is that in the case you are describing, the value disallowed by the insurance company is not truly a "provider write-off". The provider write-off is what the provider actual writes off, not what any insurance company believes they should write off <barring the contractual obligation associated with in-network providers, which is off-topic anyway>.

Another way of looking at this is that the software

does not seem to understand the distinction between a

true "provider write-off" where the provider forgives

amounts legally owed and amounts which are disallowed

by the insurer because they are in excess of the

insurer's allowable charges.

That's because there is no distinction. If the provider forgives the debt, they write it off. If the insurance company contractually obligates a provider to not charge in excess of a certain dollar value, the provider must write that off too. If the insurance company disallows coverage for charges in excess of a certain dollar value then the extra amount is not a write-off, regardless of what an insurance carrier may print on their EOBs.

Generally, a nonMedicare

nonparticipating provider will require the patient to

pay any such disallowed amounts and will not write

them off. I have written technical support about this

issue and am awaiting a response.

I certainly hope you post back if you hear anything. I'm interested to know what the designers' stance on this is.

-Tony

Replies to this message

pncboy85 (Jul 9, 2008 1:53 pm)

Hard to believe this program has anything to do with Intuit. Unlike Quicken, the input is onerous, does not memorize repetitive transactions, like weekly visits to the allergist, physical therapy or whatever. I, too, pay for my out of network service in cash and when reimbursed the paltry sum the insurance company reluctantly pays out, the program doesn't care my cash out loss for income tax purposes. I note this discussion began over two years ago and remains open an unresolved. Shame on Intuit!

Unfortunately, there appear to be too many apologists for Intuit. Let's face the facts, the program is tedious, poorly written, not user friendly and most importantly, not up to Quicken/Intuit's normal standards. If one is unhealthy or older and requires the use of a program like a medical expense manager, the least this product could offer is a simple stream-lined, well-functioning product. This product is an abomination and hardly worth the effort of inputing the data. Stick with Quicken; it can do a better job and permits some customization.