Wiki Gap Auth - How to collect

[Brittneybrookebarber]

If a patient has a gap auth are your required to accept the allowed amount for the service or are you able to charge the out of network fee?

 

[vanessamoldovan]

If a patient has a gap auth are your required to accept the allowed amount for the service or are you able to charge the out of network fee?

Can you please give more information on what a "gap auth" is?

 

[SheenaMcaloon]

A network gap exception can be granted by a health plan in order to treat a particular medical service as if it's in-network, even though it's done by an out-of-network provider. These exceptions are considered on a case-by-case basis. They can be granted if there are no in-network providers within a reasonable distance/time who can provide the care that the patient needs in a timely manner.