Wiki Payment rules for mutliple procedures for out of network md's

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jlcheritage

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I hope someone can answer this question....I have a doctor saying that because he is out of network he should not be held to accept the multi procedure reduction...Is this true? Help...
 
Yes, this is true. An out of network provider (as long as we're not talking about a governmental plan) is entitled to 100% of his billed charges, from whatever source. If he wanted to accept the insurance company's rules, he would go in-network.

Now, before you bill the patient (because that's who is going to pay, not the insurance company), make sure the doctor knows what he is asking the patient to pay.
 
SharonCollachi said:
Yes, this is true. An out of network provider (as long as we're not talking about a governmental plan) is entitled to 100% of his billed charges, from whatever source. If he wanted to accept the insurance company's rules, he would go in-network.

Now, before you bill the patient (because that's who is going to pay, not the insurance company), make sure the doctor knows what he is asking the patient to pay.
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I loved your answer! I mean, do doctors realize what they are asking of a lot of folks who have an income less than $100K/year? How about less than $50K/year?
 
fwnewbie said:
I loved your answer! I mean, do doctors realize what they are asking of a lot of folks who have an income less than $100K/year? How about less than $50K/year?
Click to expand...

To expound a little, yes, the patients should check to make sure the surgeon is in network. Conversely, I think the doctors office has a duty to do the same, so there are no surprises.

Here in California we have a "no surprises" law where if you are at an in-network hospital, whoever sees you in that hospital must be paid as if they are in the network. It's not like you can ask the radiology department, hey, before you do that portable chest xray on me, are you in my network? Unfortunately, this does not apply to ambulance companies, and our local ambulance refuses to contract with anyone (except Medicare) because they have a monopoly on the ambulance calls so they have no reason to go in network. Our county has deemed them the sole responder for 911 calls (and there isn't anyone else anyway), so you're stuck with a huge bill for ambulance calls. It's disgusting. But I digress...
 
SharonCollachi said:
Yes, this is true. An out of network provider (as long as we're not talking about a governmental plan) is entitled to 100% of his billed charges, from whatever source. If he wanted to accept the insurance company's rules, he would go in-network.

Now, before you bill the patient (because that's who is going to pay, not the insurance company), make sure the doctor knows what he is asking the patient to pay.
Click to expand...
Thank you for the information. I will inform the MD regarding billing the patient. But now we have a whole other can of beans we have to open..lol..thanks again
 
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