An indemnity plan functions as a PPO, but there is a set amount for a service that either the patient or insurance is responsible for. Indemnity plans are useful when a provider would otherwise be out of network with an insurance plan.
How to Setup an Indemnity Plan
- Attach either PPO or UCR fee schedule to carrier.
- Setup Insurance Plan type as Indemnity.
- Set all plan coverage percentages to 0%.
- Attach either a SmartFee or Patient Co-pay type fee schedule to the plan.
- Use a SmartFee type fee schedule when insurance pays a flat fee for service. When set up this way, the fee on the SmartFee fee schedule will be subtracted from the fee on the carrier’s fee schedule, and the patient will be responsible for the difference.
- Use a Patient Co-Pay type fee schedule for when the patient pays a flat fee for service. When set up this way, the fee on the copay fee schedule will be subtracted from the fee on the carrier’s fee schedule, and the insurance will be responsible for the difference.
Indemnity Plan with a SmartFee Fee Schedule
Carrier/UCR fee (Fee Schedule attached to Carrier) =$200
Insurance fee (SmartFee type fee schedule attached to Plan)= $50 for D0150.
Patient is responsible for $200- $50= $150.
Indemnity Plan with a Patient Copay Fee Schedule
Carrier/UCR fee (Fee Schedule attached to Carrier) =$200
Patient fee (Patient Copay type fee schedule attached to Plan)= $50 for D0150.
Insurance is responsible for $200- $50= $150.