Providing free resources and useful informations for Physicians,
Office Managers, Medical Billers and Medical Coders
Going Out of Network with the Insurance Company?
Here are the Things you need to Consider Before you Finally Decide for it.
Read What's NEW
would like to mention:
1. The provider or the group practice is no longer happy with the contracted rates or
because their contracted rates keep on changing;
2. Timely filing limit is also one reason;

3. Reimbursement Policy Guidelines (bundling services into one payment)

But Before you go out of network, here are the things you might consider and
take a look at:

1. As you know, not all your patients has out of network benefits. You have to understand
that because of this, your existing patients must be transferred to another provider or
facility that accepts in-network benefits. Otherwise, out of network deductible/coinsurance
might be incured by your patients.

2. Your patients population might decrease due to the patients' being without an out of
network benefits.

3. Some insurance company would send the payment check for your rendered services
made payable to their member or your patient because you are an out of network provider;

4. On following claim status, some insurance company will not disclose a more detailed
information regarding the claim status (especially denial and rejection) not unless the
patient (their member) will call them to follow up the claim status;

I do think the best action to do it -- before terminating your contract with the insurance
company is to try to

Talk to your provider relations manager in the area. Discuss your intention of going out of
network and ending your contract. Tell them your reasons why you want to terminate the

I know the insurance company will be willing to negotiate your contracted rate or your entire
contract as a whole! Especially if they know it will affect their "members" -- your patients!

Now, if in the end, you still have decided to terminate the contract. Just make sure you
inform your patients ahead of time and bluntly explain to them your reasons why you are
terminating the contract with their insurance company.

Explain it to the patients what and how this will affect them. The financial responsibility they
might incur for being out of network. Let them sign your financial policy and let them
understand fully the policy. If they decide to go somewhere else, you have to assist and
help them move to another provider or facilty who is in network with their insurance

Now with regard with the patients who has no out of network benefits, make sure you assist
and help them move to another provider or facilty who is in network with their insurance
company as well.

The true concern here are your patients. Let them understand the situation if they go out of
network. I think a good, clear and open communication with your patients is very important
as you become an out of network provider for your patients.

Good luck. I hope this article helps.

Any questions for me, I will try to get back to your question. Please use the
"Contact me"
page to contact me.

Thank you and have a great day!