How much are the administrative fees?

Administrative fees are based on a percentage of the allowed amount on a claim. The percentage will vary depending upon the business model of the contract and it may not apply to every contract. The typical contracted fee is 10%, but this actually works out to about 8.75% overall due to certain discounts on the fee. A discounted fee may be applied when coordination of benefits or Medicare is involved, or if part or the entire claim is applied to the deductible. We will not carry a fee forward from one claim to the next.

In some cases the fees are reduced to either 8% or 6%. In these cases, you will receive an invoice for the fee. It will not be deducted from the claim. The term summary sheet will explain the actual amount of the fee.