Going out of network?

[Ligament]

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What are the pros and cons of going out of network? Any resources to learn how to do it well?

 

[Agast]

I think it would become difficult if you wanted to offer your patients more advanced procedures like stim or other implants. Anything with equipment costs. At least if it's just shots you can write off a good portion to keep people from strangling you when their insurance refuses to pay.

 

[myrandom2003]

I think it would become difficult if you wanted to offer your patients more advanced procedures like stim or other implants. Anything with equipment costs. At least if it's just shots you can write off a good portion to keep people from strangling you when their insurance refuses to pay.

Depending on their OON benefits you can still offer them those procedures. You can send your bill to the insurance company. You can also need to make a good faith attempt to collect the patient portion but do not need to send the patient to collections (I think about three statements). And if someone let the patients know they wont get sent to collections, then maybe they wont strangle you. I would still collect the copay though upfront. Depending on your fee schedule, maybe you can get close
to their patient responsibility with a he two medial branches or a couple of ESI.

The PPO insurances pay a percentage of charges after that I believe. Do the trial in office and send the implant elsewhere with this practice pattern.

 

[painfree23]

Im not sure I understand this. Can someone please explain why someone would do this?

 

[Analgesia108]

No Surprises Act Implementation: What to Expect in 2022 | KFF

The “No Surprises Act,” which establishes new federal protections against most surprise out-of-network medical bills when a patient receives out-of-network services during an emergency visit or from a provider at an in-network hospital without advance notice, will take effect next month. A new...

www.kff.org

 

[mid|ine]

I think a lot depends on how many employees in your area have benefits that include out of network care, and how many of your competitors are OON.

New Jersey has a ton of this, but Im not aware of anywhere else in the country this is common, and would expect a severe decrease in business if I tried it.

 

[Dr. Ice]

I think a lot depends on how many employees in your area have benefits that include out of network care, and how many of your competitors are OON.

New Jersey has a ton of this, but Im not aware of anywhere else in the country this is common, and would expect a severe decrease in business if I tried it.

Nj does or did, but horizon blue cross of nj has basically squashed this. A lot of the OON practices in the area have dissolved because they couldn’t make it anymore.

 

[10KHertz]

I’d just have patients sign an advanced benefis waivers, and charge them a negotiated rate. For instance , a supplemental ESI that Medicare won’t pay for, set a rate. Our pain society contacted Medicare and apparently they sent us an ABR form for Medicare patients . I believe that was their passive aggressive answer …