General Category > General Questions

In network or out of network?

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Michele:
The reimbursement for out of network is not usually higher, it is the amount that you can bill the patient that is higher.  Most patients want to go where their cost will be lower, not higher.  And as Charlene said, you then have the job of collecting from the patient.  There are a few companies that actually pay higher for out of network, but not many in my area. 

Michele

PMRNC:
You will also get lucky every now and again by negotiating with an OON plan to GET in network benefits. When I did ped's there were some carriers you could get to pay the circumcisions In Network.

Linda Walker
PMRNC
www.billerswebsite.com 

Pay_My_Claims:
OOUch @ circumcision!!!

dfranklin:
I mentioned to one of my doctors who is all Non-Par about what I read here and that he would be more profitable if he became PAR...I used the example previously posted by "Pay_My_Claims"....here is what my doctor's response was:

"A solution to this would be to bill the Pt full fees, superbill them to submit to their Ins and notify the Pt that any reimbursement their Ins. company sends them - they keep. "

What should I say to that?  Seems like yeah..that is one way of doing it but I think he would end up with a higher patient A/R and/or a lower patient base as they will not all be able to come up with all the fees before service is rendered.....what do you think?

Wouldn't this also cut me out of the loop somewhat?  I guess I would bill on the upfront collection from the patient and then just submit the claim...I would not have to follow up as it would be the patient responsibility then as we would have no idea of the results....We would not be acepting assignment...

Responses?

THanks!

PMRNC:
The doctor could tweak that idea and it could be done successfully but with the patient paying at the time of service, NOT waiting. Converting to a cash practice is not always easy, it takes the front office and the billing department on the same page as the doctor. If claims are high dollar, it might not work out so well because as you mentioned he's patient A/R would accumulate and it's harder to collect at that point. If he did assignment of benefits on the high dollar claims and the office verified benefits and eligibility, he could collect the out of pocket at the time of visit. Example: patient has Aetna, doctor is non-par, patient calls in for an appt, gives her insurance info, office verifies eligibility/benefits, office can then call patient, tell them to expect to pay $XX.XX and completes the paperwork with assignment of benefits as well.

As for cutting you out of the loop, it depends on your contract. If your contract is for a % of all revenue collected than it shouldn't cut you out, you will still be tracking the payments in order to keep the books properly. If your contract is for insurance payments only (I don't recommend this) than it gets sticky because who's tracking payments? My rule was, I track it I get paid, I've seen some offices keep track of their cash-pay and billing company keeps track of insurance, however then you have two sets of books and that's not good for any business, let alone a medical practice.

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