Author Topic: Can a single group have in and out of network providers?  (Read 1158 times)

Christy

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Can a single group have in and out of network providers?
« on: September 18, 2019, 06:59:40 PM »
I have a group practice of one provider. The provider wants to add/ hire another provider to her group. If an insurance company, for example BCBS is not adding any new providers in the zip code, how would that work? Existing group owner provider is  already INN, but panel may now be closed for new providers.

The group would have one in network and one out of network provider?

many thanks!
Christy
« Last Edit: September 18, 2019, 07:01:32 PM by Christy »

kristin

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Re: Can a single group have in and out of network providers?
« Reply #1 on: September 19, 2019, 12:30:19 AM »
Yes, that is correct. The existing provider would be in-network, and the new provider would be OON. I recently had this exact situation with Humana, in Illinois. Their panel is currently closed to new podiatrists in Illinois. So while my existing provider who has been in practice for 38 years is in network, her two new associates are unable to credential with Humana and are OON. When patients with Humana call, we have to explain this, and allow them to schedule with the provider who is in-network, and if that isn't possible, they have the option of scheduling with one of the other two docs who are OON, or seeking services elsewhere with an in-network provider.

Christy

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Re: Can a single group have in and out of network providers?
« Reply #2 on: September 20, 2019, 10:46:14 AM »
thank you!!!!!!!!!!!!!!!!!!!!! :)