Billing > Billing

out-of-network billing

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Jdmontee:
Ok, I understand the in network as all of my providers are in network and only see in network patients,  I just acquired this provider who is out of network with most insurances and I wanted the clarification regarding out of network. The previous posts to yours were a bit confusing.  Thanks for the clarification Linda :)

Thanks!

Joanne

DMK:
I know I'm probably beating a dead horse, but Linda I would greatly appreciate your input on this.

A patient has surgery.  The hospital, surgeon and the lab are all in network.  The patient pays the deductible and/or co-pay per the insurance contract.  The anesthesiologist is out of network.  The eob comes back and the allowed amount for a participating provider is all that the anesthesiologist gets paid.  The U&C is considerably more.  Is the anesthesiologist LEGALLY OBLIGATED to collect the difference, or can they accept the allowed amount for a participating provider since everyone else involved in the procedure was in network, and the patient was not informed that they were out of network?

All of the anesthesiologists in our town went out of network so that they would be allowed to work at the one hospital in town who dropped all insurance except Medicare.

Thanks!  Dina

PMRNC:

--- Quote ---The U&C is considerably more.  Is the anesthesiologist LEGALLY OBLIGATED to collect the difference, or can they accept the allowed amount for a participating provider since everyone else involved in the procedure was in network, and the patient was not informed that they were out of network?
--- End quote ---

Anything over U&C/R&C is patient responsibility.. You can however ask the provider to send in an appeal.
 

DMK:
Thanks Linda! 

Zeecy:
From a patient's point of view... I try to avoid using doctors that are out of network.  It's just too complicated & I never know what the insurance will pay & I end up owing much more out of pocket than if I use a physician that is in network.  I guess that's logical, but I just thought you might want to keep that in mind before deciding how to do the billing.

What I'm trying to say is, unless I'm missing something, it might not be in the doctor's best interest as far as attracting patients goes. 

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