Billing > Billing

out-of-network billing

(1/6) > >>

gderilus:
I have a client that wants to bill out of network, don't providers get pay less when they bill out of network? She's a LMHC

This is what she asked me

" I've been researching other therapists and I see that many bill "out-of-network" so they don't have to become providers, and can work with any insurance company. It would allow us to take a lot more insurance clients".

I'm not sure what to tell her

 

Pay_My_Claims:
Out of network means you get less money from the insurance company, but you can balance bill the patients. Being out of network has an advantage because you don't have to accept the rate that they pay, but most carriers want to negotiate it for the patient. They know that if you bill 1000, and they only allow 800, and in net is 80% out of net 50%, they pay you 400 (out of net) (subject to patient ded etc) you can bill the patient the 600 bucks. Now on the flip, if in network you would have gotten 640 from the ins company with the patient owing 160. unless you collect up front, out of network can mean more patient balances for the provider.

blhoffman:
I agree with Pay_My_Claims, it is more patient billing ::)

I'm putting on my insurance/claims processing cap here with this statement. Many claims do come in for Out of Network in the area of LMHC. She is correct. Charlene hit the nail on the head. She isn't out money or paid less. She is just paid less from the insurance company but she does have the right then to collect the balance from the patient. This actually allows her to be paid for total billed amount, instead of a contracted rate.

I'm putting on my patient advocate/customer service hat now with this statement. Many many patient's do not understand the IN Network and Out of Network benefit, even today. Some know there is a difference and never ask. They just assume if they are accepted as a patient, see the doctor, therapist or whatever, they are in network. You have to make it abundantly clear to the patient you are not in network which would mean the patient is responsible for a large part of the bill, unless they have met their OON ded. or Out of Pocket Max.

That being said, there are patient's that are use to paying OON for this type of service in particular. I wouldn't let the fear of patient billing stop the practice from opening up to include OON billing. Just make this fact clear to the patient before services are rendered.

Pay_My_Claims:
Yes B, and whenever possible COLLECT UP FRONT!! It eliminates so much on the back end.

Michele:
Don't forget, not all policies have out of network benefits, so sometimes payment is $0.

Navigation

[0] Message Index

[#] Next page