Insurance

Insurance Plans Part 1: Common Plan Types

Insurance Plan

Setting up insurance plans correctly and using updated fee schedules is key to getting accurate treatment cost estimates. More accurate estimates contribute to higher case acceptance rates and help build good relationships with your patients. In this post, we’ll discuss how to set up four common plan types. Also see Part 2 in this series, which covers more complex plan types including Medicaid and Capitation plans.


Not sure what type of plan you have?

See our Insurance Plan Type Flowchart!

Tech Tip: Create fee schedules to ensure the most accurate estimates.
See this video for how to create and edit fee schedules.


PPO Percentage

PPO Percentage Plans are the most common insurance plan type, used for in-network plans where write-offs are tracked. These plans calculate write-off estimates and patient portions using the UCR fees and insurance fees.

Use the setup below:

Insurance Plan types PPO_Writeoffs

PPO Percentage without write-offs

If you are in-network with an insurance plan but are not tracking write-offs, use the setup below:

Insurance Plan types PPO_NoWriteoffs

PPO Fixed Benefit

PPO Fixed Benefit Plans are used when the insurance is paying a fixed amount for each procedure. These plans calculate write-off estimates and patient portions using fixed benefit amounts, insurance fees, and UCR fees.

For PPO Fixed Benefit plans, use the setup below:

Insurance Plan types PPO_FixedBenefit

Category Percentage

When you are not in-network with an insurance plan, set the plan type to Category Percentage. These plans can use an out-of-network fee schedule to calculate more accurate patient portions. If you do not have an out-of-network fee schedule, you would not link anything under Carrier Allowed Amounts.

For out-of-network plans, use the setup below:

Insurance Plan types_Out of Network

If you need help troubleshooting how write-off estimates and patient portions are calculating, feel free to reach out to us, we’re here for you!

Don’t miss Insurance Plans Part 2: Complex Plan Types, which covers more complex plan types including Medicaid, Flat Co-Pay, and Capitation plans.

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