How does the ppo fixed benefit differ from PPO Percentage? I read the descriptions and it wasn't clear to me..? I've been using PPO Percentage, in what situation might I want to switch to a PPO Fixed Benefit plan def instead?
Thanks!
insurance plan types
Re: insurance plan types
This is useful when you have multiple locations where the PPO allowed fee differs by location but each procedure receives the same reimbursement rate at each location. Suppose that I have 3 locations and each location has a slightly different contract with the same carrier. At each location, the UCR fee for D0150 is $100 and insurance will always pay $45. However, the PPO contract has different allowed fees for each location which leads to different writeoffs and patient portions:
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Allowed Writeoff Patient Portion
Location A $60 $40 $15
Location B $50 $50 $5
Location C $45 $55 $0
Re: insurance plan types
Thanks for the response.