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Out-of-Network Insurance Plans

Set up an out-of-network Insurance Plan when you are NOT contractually obligated to reduce your fees. This is a traditional percentage insurance plan.

Out of Network Plan with No Fee Schedule
In this setup, estimates and procedure fees will be based on the Provider's fee schedule.

On the Edit Insurance Plan window, set the following:

  • Plan Type: Category Percentage
  • Fee Schedule: none (uses the provider's default fee schedule).




Out-of-Network Plan with a Fee Schedule

Even if you are not contractually obliged to follow out-of-network fees, you can get more accurate insurance estimates by using them.

  1. Create an out-of-network Fee Schedule for the carrier and enter the out-of-network fees.
  2. On the Edit Insurance Plan window, set the following:
    • Plan Type: Category Percentage
    • Claims show UCR fee, not billed fee: Check this box.
    • Fee Schedule: none (uses the provider's default fee schedule).
    • Carrier Allowed Amount: The carrier's out-of-network fee schedule.
    • Benefit Information: Percentages will be based on the out-of-network fee schedule. If the published fee schedule shows exact amounts that will be paid, set category percentages to 100%.

All fees on procedures will show the provider's fees, but the out-of-network fee schedule will be used for estimates.  Percentages will be based on the out-of-network fee schedule.  The patient is still responsible for amounts your office charges above the published fees. If desired, you can update out-of-network fees as you enter Claims and Payments.

 

 

 

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