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  1.    #1  
    This program was written for my personal use as I work for health insurance company. Every day I find myself struggling to calculate how much to pay the provider while keeping in mind the deductible, out of pocket max, and payment ratio. A couple years ago I created an excel app that completed the calculation for me and I chose to port this to the Pre as my first distrubuted application. Not many people at all will use this for it's intended purpose but I'm sure there is at least one other person out there who could use this.

    How it works

    This program is written to calculate how much payment goes to the provider from the insurance company and how much comes from the patient to the provider. You type in the total deductible (abbrev. ded), how much of the ded has been used, the total out of pocket (abbrev. opx), the used opx, the allowed amount for the service or claim, and the payment ratio in decimal format.

    Keep in mind that when entering the ratio you are inputting it as how much payment comes from the insurance company to the provider, not how much comes from the patient. For example, if the company pays 80% of the allowed amount and the patient pays 20% of the allowed amount, input the ratio as .8.

    This, being my first real program, is in the very beginning stages and I'm sure there are many updates to come.

    This is open source so feel free to use the code as you please and i would highly appreciate if anybody could give me any tips on improving my application.

    Latest update: Version 1.0.0 8/14/09
    Calculations are now exact, copays have been added.
    A big thank you goes out to remix2000 for coming up with the new icon. /salute.
    Last edited by raelos; 08/15/2009 at 09:07 PM.
  2. garylee23's Avatar
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    #2  
    I too work in the insurance industry as a producer, but I feel this app may be lost on those that don't have access to actual provider discounts. Then again, there's nothing like being caughtplaying with your pre at work and saying, "I AM working!"

    Nice app tho. I'll be using it.
  3. #3  
    "sometimes I feel like....Somebody's watchin me~!"

    love the googly eyed money as the icon hahaha

    Thanks for this.
    SCK Manager
  4.    #4  
    Thanks guys!

    I put in a couple figures today that didn't add up, so I need to alter the calculation function a bit. The update will be posted either today or tomorrow.
    Here are the specific figures I put in.
    500 ded, 490 met. 200 opx,199 met, 60%, 900 allowed amount
    Final provider payment: $53400
    Final patient share: $10.

    I will alter the payment function to just get the allowed amount and subtract the patient share. This should work out well.

    ** EDIT **
    Just updated. posting new version, 0.6.0 now.
  5. Mikewardo's Avatar
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    #5  
    I am very interested in your program as i am a health care provider. I havent downloaded it yet because i havent seen any reviews that say it works and wont crash my pre. I have read what it is intended to do and it looks like it may be more advanced than what i need. That being said can you taylor it to meet my needs as well as a provider? It may be as simple as allowing it to function and arrive at a calculation without completeing all fields.
    for example i usually need to calculate peoples share of cost.
    Deductible total-deductible paid= remaining deductible
    cost of service-remaining deductible= pt responsibility
    % ie 80/20 or 50/50 of pt responsibility of pt responsibility= final pt responsibility
    i know this inst very clear.
    pt has a %500 deductible of which $250 has been met the cost of the service is $1000 and its covered at %50/50
    500-250= 250 remaining(pt responsibility)
    1000-250=750 @ %50=325(pt responsibility)
    250 (remaining deductible)+325(%50 pt responsibility)=$575 total pt out of pocket
    if this is still unclear let me know. my use again would be to calculate Share of cost by the patient. thanks
    PS palmdoc wrote me the cranio app and its in my launch bar, used daily, yours will be too. then ill just have to get my office staff pre's, ill thank you in advance for them
  6.    #6  
    My program should work fine for your purpose. I would recommend holding off for a couple days on using it though as there are still a few kinks in the calculation. I don't think the program is too advanced for your need, but rather just right. The only option it sounds like you don't need is the total out of pocket max, but you can just set this as 0 used of $9999 dollars or something of the sort.

    In terms of the new calc function, I will be working on this at work today to see if I can work out the bugs. It seems to mess up if little or none of the deductible has been used.
    I'm definitely adding in an error checking function though, where if the result doesn't match, it will alert you to do the calculation manually and send a message to me with the figures you used. If you can give me another day or two it will be up to par for using in the office.

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