Wiki Out of network patient responsibility form

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Mayzoo

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I went with my FIL to a doctor yesterday. It was a pain management doc, first visit, and only to schedule a one time nerve block. I am curious if this is normal/legal:

They insisted they were in network (and they are), yet they stated they would not see him unless he signed an "Out of network patient responsibility form." I let them explain the form to him while I stood there and listened. They tried to convince him that is was only a formality, and that it would not result in any additional charges to him. They told him this was just a form that he had to sign which allowed them to tell him if/when anything they wanted to do fell outside network benefits or if they dropped his insurance they could inform him of that.

After I balked, and explained to them this looked like a standard ABN to me, and told them that if he ever needed treatment that feel outside the network, they could address it at that time and he could sign at that time if he approved.

Ultimately, I would not allow him to sign it, and they saw him anyway, but I am now curious if this is now normal? I know it is not ethical to misrepresent what the form was actually for, and it is his legal responsibility to read it before signing it. It was in the middle of literally 20 forms and 9 places he was supposed to sign and 20 he was supposed to initial, so I am sure many patients just sign it.
 
Mayzoo said:
I went with my FIL to a doctor yesterday. It was a pain management doc, first visit, and only to schedule a one time nerve block. I am curious if this is normal/legal:

They insisted they were in network (and they are), yet they stated they would not see him unless he signed an "Out of network patient responsibility form." I let them explain the form to him while I stood there and listened. They tried to convince him that is was only a formality, and that it would not result in any additional charges to him. They told him this was just a form that he had to sign which allowed them to tell him if/when anything they wanted to do fell outside network benefits or if they dropped his insurance they could inform him of that.

After I balked, and explained to them this looked like a standard ABN to me, and told them that if he ever needed treatment that feel outside the network, they could address it at that time and he could sign at that time if he approved.

Ultimately, I would not allow him to sign it, and they saw him anyway, but I am now curious if this is now normal? I know it is not ethical to misrepresent what the form was actually for, and it is his legal responsibility to read it before signing it. It was in the middle of literally 20 forms and 9 places he was supposed to sign and 20 he was supposed to initial, so I am sure many patients just sign it.
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Good afternoon. I am familiar with practice operations. There is a lot going on in this story. Can you please tell me specifically what part you are questioning? Vanessa
 
vanessamoldovan said:
Good afternoon. I am familiar with practice operations. There is a lot going on in this story. Can you please tell me specifically what part you are questioning? Vanessa
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Is it common now for an office to require a new patient to sign an out of network responsibility form for an in-network office visit. It seemed to me that they wanted to get a "blanket" out of network responsibility form for the future just in case.
 
Mayzoo said:
Is it common now for an office to require a new patient to sign an out of network responsibility form for an in-network office visit. It seemed to me that they wanted to get a "blanket" out of network responsibility form for the future just in case.
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It would not be uncommon for a practice for have a patient sign a form that would ensure they pay the remainder of a balance in the event the insurance company processes the services as out of network. It would be odd to have the patient sign an OON form if they are definitely in network. However, insurnace companies are VERY precarious and unpredictable. I would understand the practice wanting to protect themselves by having the patient sign this type of form.
 
Seems to me this would be an opportunity to balance bill the patient if he has a signed out of network form on file. (?)
 
Without seeing the exact form, I think we're all kind of guessing here. I know there are practices that have a patient sign a form in case they refer a patient to another specialist, or testing.
Depending on insurance, there have been situations where the pain management doc might think it's a good idea for the patient to see GI as the pt reports pain is worse when constipated, and lately is more frequently constipated. The doc mentions his own GI as a great doctor to use, but does not issue any formal referral or anything. Pt goes to the GI, has the testing, and turns out the GI is out of network with the exact specific network. There are insurances that will hold the pain management doc financially responsible for the out of network GI bills, because pain management referred the patient out of network. While my personal opinion is that the responsibility should rest on the GI office and the patient asking, there are insurances that put that responsibility on the pain management doc as the one referring out.
This form may be for those types of situations. But again, just one of many possibilities.
 
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