How does Petey handle insurance?
FAQ about how Petey understands and discusses insurance with leads
For Petey setup and configuration guidance, click here.
For a daily Petey workflow guide, click here.
How do I set up my insurances for Petey?
You set them up in Settings > Payer Groups. Make a group for each insurance you take and each one you don't, name each group the way a patient says it out loud, and mark the group In-Network or Out-of-Network. Those groups are what Petey uses to answer callers.
Step 5 of Petey Configuration & Setup walks through all of it, including which plans need to be added inside a group so Petey recognizes them.
What does Petey do when a caller gives their insurance?
Petey looks for it in two passes: first your payer group names, then the individual plans inside those groups. Whichever pass finds the match, Petey answers based on how you marked the group it landed in.
| What the caller names | What Petey does |
|---|---|
| Something that matches a group marked In-Network | Confirms you're in network with that carrier and continues to booking. |
| Something that matches a group marked Out-of-Network | Tells the caller that carrier isn't currently in your network, then offers to schedule anyway and explains that your team will verify coverage before the first visit. |
| Anything Petey can't match to one of your groups | Tells the caller it isn't seeing that plan, then offers to schedule and explains that your team will verify coverage when they follow up. |
The appointment is offered in every case, and the call becomes a lead on your dashboard.
Where does the insurance the caller gave show up?
Today, Petey asks for insurance to tell the caller whether you're in network, but doesn't save the plan to the lead. What the caller said is in the call recording and transcript attached to that lead.
Insurance is collected the same way it was before Petey: on the confirmation call. That's the Contact the patient to confirm step of the daily routine in the Petey Workflow Guide, alongside referral documents and consent forms.
We're out of network with some carriers. Will Petey turn those patients away?
No. Petey tells the patient their insurance is out of network but the patient can still proceed to schedule. She tells them your team will go over the details before the first visit.
Call those patients before their visit. They have an appointment and were told to expect follow-up, so use that call to go over their benefits, your self-pay pricing, or a referral elsewhere.
Why didn't Petey recognize the name of the insurance shared by the patient?
What the caller said didn't match one of your group names, and it wasn't one of the plans inside those groups either. Three reasons that happens:
- You don't have a group for that insurance yet. Petey only recognizes insurance you've set up in Settings > Payer Groups.
- Check your payer group and plan names. Can you find this payer in your payer list (Settings > Payers)? If yes, is it associated with a payer group (Settings > Groups)? If Petey finds a plan not associated with a Payer group, she'll tell the patient she can't find it but that someone will follow up after scheduling.
- The name contains two of your groups. If a caller has UnitedHealthcare Medicare Advantage, and you have one group named Medicare and another named United Healthcare, Petey can't tell which one they mean, so it doesn't use either. Making a third group for the full plan name fixes it.
Step 5 of Petey Configuration & Setup walks through naming your groups and when a plan needs to be added to one.
A carrier we don't accept isn't in our payer list at all. Does Petey know we're out of network?
Petey will say she's not sure but that someone will follow up after scheduling. If you want Petey so specify an insurance as out of network, make a payer group for it and mark that group Out-of-Network. Step 5 of Petey Configuration & Setup shows how.
What happens with callers who don't have insurance?
Petey quotes your self-pay rates, as long as you've entered them under AI Agents > Petey > Self-Pay Pricing Details. Leave that blank and Petey has nothing to offer a caller without coverage.
Does Petey verify the patient's benefits?
Not today. Petey matches the carrier name against your payer groups to answer the caller's network question, with her main goal of making booking evals as quick and seamless as possible. Then, your team validates any insurance details, authorization or referral requirements as part of their daily workflow. Review our recommendation in the Petey Workflow Guide.