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out of network

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laceyx08:
Ok thanks guys. I'm new to this and was under the impression that you could just submit a claim if you are out of network. Whoopsies.  :-[ 

DMK:
You actually can just bill a claim, even if you're out of network.  You're going to get new insurance companies all the time.

Just understand that the insurance company will respond with a W-9 request, and/or a request for additional information.  You can file the claim (thereby making sure it's filed timely) and then call or go online and submit the providers information.  The claim payment will be a little slower as all the information is processed, but at least then the claim is in process. 

Don't procrastinate just because you're unsure.  You can find out where and when and how to file claims with a new insurance company fairly quickly!

Sophrosyne:
As a side note, know that since your provider is not contracted with the insurance company, he/she is not required to write-off amounts above the insurance companies' allowable charge. In our office, our out-of-network patients pay us in full at the time of each visit. Then we bill their insurance* and the insurance pays the patient (if there is any payment to be made that is). This works well for us because in some cases, insurance companies will not make any payment to out-of-network providers.

*On the claim form we leave box 13 blank (indicating that the patient has not authorized the insurance company to pay us) and on box 27 select "No" (indicating that our provider does not accept assignment from that insurance company). This usually works although sometimes they pay us anyway and we have to send the check back with a letter telling them to send the money to the subscriber of the policy.

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