Wiki Out of Network Pricing Ideas

[pkoehler]

We are a outpatient clinic that does not contract with an insurance company. We will generally tell the folks we are out of network so they are aware and tell them we can send the claim in and do balance billing or they can pay privately. I would like to get away from balance billing and was wondering besides private pay what does other clinics do for a patient that may be out of network and sending the claims in

Thanks

 

[danskangel313]

We are a outpatient clinic that does not contract with an insurance company. We will generally tell the folks we are out of network so they are aware and tell them we can send the claim in and do balance billing or they can pay privately. I would like to get away from balance billing and was wondering besides private pay what does other clinics do for a patient that may be out of network and sending the claims in

Thanks

You have to charge the same amount for a service to every patient. The OIG recently issued findings after investigating this for quite a while and they determined it's a violation of the False Claims Act to charge a certain amount for some patients and a different amount for other patients. If you're considering offering a discount to any or all OON patients, you must do the same for all in-network patients (by contacting their insurance company).