Apologies!The provider sees higher reimbursement at the cost of time/complexity. Billing in-network is pretty fast and straightforward (you are really enforcing pre-negotiated prices). However, out of network, you get to negotiate (within reason) on the value of services rendered.
Has that been your experience? The results I have seen indicate that OON reimbursement is generally greater than the in-network rate.Of course the results vary by state and by insurer.
why would they pay more No, it has always been less, and we can't bill the patient the balance. They have a maximum they can offer u, sometimes it will be equal to the Medicare allowable, but never more than what they would pay in net.
The other reason doctors and hospitals go out of network is that they can then make any deal they want with the patient. They CAN just take the OON amount from the insurance company. If the IC pays 80% of U&C it's MUCH more than the contracted rate so the provider comes out ahead, and the patient will come back. The provider can balance bill, but they should use the OON as a bargaining chip whenever possible.