Auto-billing for Copays, Deductibles, and Coinsurance

Healthie’s insurance billing automation allows you to automatically charge or invoice for patient responsibility amounts — including copays, deductibles, and coinsurance — as soon as an appointment is marked Occurred.

This guide walks you through how to configure your account to use this functionality.

Step 1: Enable Contracted Rates by Payer

Quick link: https://secure.gethealthie.com/settings/insurance

To accurately calculate coinsurance amounts, Healthie uses contracted rates per CPT code and payer.

1. Navigate to Settings > Insurance
2. Ensure "Enable Contracted / Allowed Rates by Payer" is turned ON

Step 2: Enable Auto-Charge and/or Auto-Invoice

Quick link: https://secure.gethealthie.com/settings/appointments

You’ll need to enable either Auto-Charge or Auto-Invoice, or both. Here’s how each works:

• Auto-Charge: Schedules a charge to the client’s card on file (2 days after the appointment)
• Auto-Invoice: Immediately generates an invoice (sent via email if the client has no card on file)

To enable:

1. Go to Settings > Appointments > Pricing > Payments & Credits
2. Turn ON:

• "Automatically Charge for Appointments"
• "Automatically Invoice for Clients" (recommended to have both ON)

Step 3: Link Appointment Types to CPT Codes & Insurance Billing

Quick link: https://secure.gethealthie.com/settings/appointment_types

1. Make sure "Automatically create CMS 1500s" is enabled under Settings > Insurance
2. Navigate to Settings > Appointment Types
3. Edit each relevant appointment type
4. Under the Pricing section:

• Associate a CPT Code
• Turn ON "Enable Insurance Billing"
• This ensures Healthie knows which appointment types to trigger insurance billing automation for.

Step 4: Add Contracted Rates in Services

Quick link: https://secure.gethealthie.com/settings/services

To support accurate coinsurance calculations, set contracted rates for each payer:

1. Go to Settings > Services
2. Locate or add the CPT code for the appointment
3. Click "Edit"
4. Under Insurance-Specific Pricing, add the contracted rate per payer.

Example:

If CPT 97803 has a contracted rate of $100 for Aetna, and a client has 10% coinsurance, Healthie will automatically calculate the client’s responsibility as $10.

More details on setting your Service Rates by Payer can be found here. 

Step 5: Add Patient Responsibility in Client Profile

1. Go to the Client Profile > Actions > Profile > Insurance Section
2. Edit the Primary Insurance Policy
3. Set the Patient Responsibility Method:

Copay (flat fee)

Unmet deductible

Coinsurance (%)

Step 6: Book and Complete an Appointment

1. Create a new appointment for the client
2. Select an insurance-billable appointment type
3. Ensure "Enable Insurance Billing for This Appointemnt" is checked
4. After the appointment, mark the session as Ocurred

What Happens Next

• If Auto-Charge is enabled and a card is on file, a charge is scheduled for 2 days later.
• If Auto-Invoice is enabled and no card is on file, an invoice is immediately generated and emailed to the client.
• The client will see the charge or invoice based on the copay, deductible, or coinsurance amount entered in their insurance profile.

You can view charges and invoices under Billing > Payments or Billing > Invoices.

FAQs 

Will clients be notified?

Yes. Clients receive an email notification when an invoice is generated or when a payment is processed — provided they have a valid email address on file.

You can always View Client Notifications to track the automated emails and notifications sent to a client if you’d like to verify.