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In network or out of network?

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tk:
Hello, I am a Chiropractor's office in California and was wondering if it's better to be in or out of network with insurance companies esp. Blue Cross as far as reimbursements. TIA

Michele:
There is no right or wrong answer for participating.  You need to take many things into consideration and make the decision that best fits your office.  For example, is it an area where patients can afford to go out of network, what is the reimbursement rates for the carriers, do they pay out of network to the patient, etc.

Once you have all the info, evaluate it to see what would be best for your office.

Good luck
Michele

tk:
So generally reimbursement for out of network is higher than for in network patients, right?

PMRNC:
Not always! there are plans out there that will negotiate higher fee schedules but you have to be the one to initiate it, so when you first par with them ,your fee will be their standard In network fee based on schedule but also taking into account location, services, averages.. etc.
Get a good consultant to do the credentialing leg work for you, it's worth the extra money to have it done the right way plus they can help you and your attorney go over the contracts. Carriers will try and sneak things through contracts. Also keep in Mind BCBS has a pretty long wait to get out of network if you ever want to get out.

Linda Walker
PMRNC
www.billerswebsite.com

Pay_My_Claims:
The thing about being non par is you can balance bill the patient. It is far cheaper for a client to go in network as opposed to out. So you think hey I can make more being non par...well not really. Lets say you bill 100 and the ins company says the allowable is 60. In net the patient is covered at 90% and you receive 54.00 patient owes 6.00 Out of network, the allowable is still 60, and they cvg is 50%. They will pay you 30 but now the patient is responsible for 70.00 Why 70....because 30 would be his coinsurance, and the other 40 is patient responsibility because you can balance bill the patient. Unfortunately most providers don't collect up front, so now you are trying to collect that money, and have only received a portion of what you could have gotten as in net provider Also some payors (BCBS) will send payment directly to the patient, and you have to follow the EOB. We don't get notice that payment was made to them, we have to contantly check online. Also in addtion to what Linda said, about getting out of network with them (didn't know that) its hell getting in when it comes to DME. BCBS of NC has closed its panel!!

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