Out of Network Insurance and Practice Managers questions

pkoehler

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How many of you are Practice Managers and is there a different spot in this forum you all use to have questions answered ? Next if you are out of network with an insurance company can you take each individual plan they offer and decide if you want to accept it as out of network ( Medicare is a given)

Any info would be welcomed

Thanks
 
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How many of you are Practice Managers and is there a different spot in this forum you all use to have questions answered ? Next if you are out of network with an insurance company can you take each individual plan they offer and decide if you want to accept it as out of network ( Medicare is a given)

Any info would be welcomed

Thanks

If you're OON, then you're OON period. The payer controls who is or is not in their network; the only leverage you have as an office or facility is through contracting with the payer. A patient's insurance policy might have different coverage for OON providers, such as higher deductibles or OOP costs, which the payer keeps track of for each patient. That's between the patient and the payer, so you're no party to that agreement and can't make changes to it.

If you are interested in joining the payer's network, you'd need to contact them and discuss the option of accepting only certain plans as in-network. In other words, you need a contract in place that says you're able to accept plans A, B, and C but not plan D, E, and F for a certain payer.
 

PVAzCPC

Networker
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I am a Practice Manager, and I had the same question about this particular forum, as well. This forum is titled "Practice Management", but looks like the term "General Discussion", as the sub-category, has over-shadowed the actual PM title. I've learned how to use the "Search this forum" for PM related info. :)
 
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