Category Percentage Insurance Plan

Set up an out-of-network Insurance Plan Type 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 Insurance Plan, set the following:

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
    • Fee Schedule: none (uses the provider's default fee schedule)
    • Out of Network (old): The carrier's out-of-network fee schedule

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.

Out-of-Network Plan Using Blue Book

Blue Book uses the history of allowed amounts to determine the fee used as the estimate. See Insurance Blue Book Setup.

  1. Create a Manual Blue Book fee schedule for the carrier's known fees.
  2. On the Insurance Plan:
    • Plan Type: Category Percentage
    • Fee Schedule: None
    • Manual Blue Book: The carrier's out-of-network fee schedule

When Blue Book is enabled, Manual Blue Book is the only fee schedule available. The Manual Blue Book may or may not be the selected fee based on the Hierarchy setup in Insurance Blue Book Setup.