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What to Do When You’ve Discovered a Patient is Out-of-Network

It’s not something that happens often, but despite intake process and office procedures, sometimes you may discover a patient is out-of-network after you’ve completed the appointment.

Healthcare is complicated and patients don’t always understand their coverage. A 2013 study published in the Journal of Health Economics found only 14 percent of consumers with private health insurance had an accurate understanding of the terms deductible, copay, co-insurance and out-of-pocket maximum.

Nevertheless, there are ways to navigate the situation, and more importantly, prevent this problem from happening in the future.

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1. Submit the claim

Depending on the type of coverage, the insurance company may pay a portion of the bill so always submit the claim in case.

2. Negotiate

When the insurance company makes their final decision, you can negotiate a payment plan with the patient or ask the patient to pay a portion for your time.

3. Request payment upfront

To avoid seeing an out-of-network patient, ask for full payment upfront. In fact, approximately 75 percent of healthcare and hospital systems practice point-of-service collections, or the practice of requesting payment when services are rendered, according to Richard Gundling, senior vice president at the Healthcare Financial Management Association.

Related Article:

5 Ways To Make Your Practice More Efficient

4. Always confirm coverage before the appointment.

Since policies are constantly changing, ask your staff to verify insurance coverage for both new and existing patients when appointments are made.

Insurance Checker helps speed up this process. With Insurance Checker, patients can decipher their insurance card, select the right insurance plan and get verified plan details before they book. Patients simply scan their insurance cards, see their real plan names, confirm their eligibility status and in many cases, their deductibles and co-pays as well.

5. Give patients the billing policy

Before the appointment, ask your office staff to email patients your financial procedures and remind them to bring their insurance cards and other important documents.

With a bit of extra time and effort to ensure all of your patients are in-network, you can continue to keep your practice moving forward.