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.
In this setup, estimates and procedure fees will be based on the provider's fee schedule.
On the Insurance Plan, set the following:
Even if you are not contractually obliged to follow out-of-network fees, you can get more accurate insurance estimates by using them.
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.
Blue Book uses the history of allowed amounts to determine the fee used as the estimate.
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.