Handling Out-of-Network Insurance Payments

This video explains how out-of-network doctors can manage payments, balance bill, and submit claims without accepting assignment to ensure full compensation.

Transcript:

We’ve received a number of questions and emails asking us about how doctors can handle payments when they are out of network. Now this applies to insurance companies that typically have a network and the doctors are out of network, they’re not in that network, and also to those insurance companies that simply have no chiropractic network, have no panel of chiropractic physicians. In those cases, all of these things that we’re going to talk about today in this video apply, and they’re things you need to be aware of.

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First of all, this is super important. If you’re not in network, if you’re out of network, then you’re not bound by a contract, because there is no contract you have chosen not to sign a contract for those that have a panel, and there is no contract for those who don’t have a panel. So in those cases, you’re not bound by a contract. We’ll cover one exception to that here at the end of the video, but just know that. Now, I also want to make sure and touch on this. This is super important. This video, and everything that we’re going to talk about changes when we start talking about Medicare, Medicaid and Medicare Advantage plans, just if that’s not what we’re talking about, we’re talking about, you know, individual insurance plans. We’re talking about the corporate plans, if you will, commercial insurance plans, all of those. That’s what we’re talking about. We’re not talking about Medicare, Medicaid and Medicare Advantage. We’ll handle those in a different panel, so let’s set that aside for today. Now, this is super important. There are a couple of different ways to handle this, and the questions that we’re typically getting are when the doctors are submitting as a courtesy for the patient, submitting the insurance, but then also accepting assignment. And this is typically where we’re seeing the greatest amount of challenge, because there are problems with that allowable amount and the covered services that the insurance companies that you’ve chosen to not be in network with. In those cases, those are the problems that we that we’re running into. Now here’s the most recent thing, and what you’re going to want to know is you’re not required to accept that network allowed amount as full and final payment. You’re not required to do that if that has a check that they’ve sent you and it says the allowed amount. In those cases, you can balance bill the patient because you have no contract with them, so you’re not bound by that.

The second is, you’re also, and this is important, no, you’re not required to accept assignment if you’re billing as a courtesy. If you’re billing the insurance as a courtesy to the patient, you’re not required to accept assignment. One of the things that you may want to consider doing is you may want to choose to have the patient pay for all of the services rendered at the time of service for your standard office fee. You’re going to submit the insurance claim on their behalf as a courtesy. And then what you don’t do is you don’t select the box on the claim form, and you can do this electronically or on a paper 1500 claim form. In those cases, don’t check the accept assignment box, and in those cases, the insurance company will send the check directly to the patient, reimbursing that patient for the payments that they made you. So that is super important to note, that is an option for you.

The last one is you could choose to to hand the patient a super bill and allow the patient to handle all of their own insurance filing. And what we found is those doctors who are not fully cash practices, those doctors that choose to be out of network, or simply because there is no panel being, by virtue of no panel being out of network, those out of network doctors that typically do file health insurance claims. In those cases, you can do the other which is file as a courtesy for that patient and help them out. Now, here is where the exception that I talked about earlier, that kind of comes in a little bit of a hiccup, but not that big of a deal, as long as you know what’s going on. If you do choose to accept assignment, and one of them comes back, and you’ll see either on the check or in the EOB form that comes with that check, it says, by endorsing the check and by depositing the check you were accepting that allowed amount, or that paid amount, or what they deem to be reasonable and customary, which is not always what may match up to what you believe is reasonable and customary. But if they’ve identified that as by accepting that check, or by depositing or endorsing it, that you are accepting that as full and final payment. In essence, by endorsing and depositing that check, you’re agreeing to those terms. So in those cases, if you don’t agree to those terms, your best bet in those cases to go ahead and return that money back to the insurer and tell them that you’re rejecting the payment altogether. That way, you’re not agreeing to those terms. And then go to the patient and go ahead and collect for your your normal, standard office fees directly from that patient. And then at that stage, the insurance company would be forced then to reimburse that patient for those services.

So, hopefully this helps you out, and hopefully this kind of guides through some of this process, as we find there are a few insurance companies out there that do not have a panel of chiropractic physicians, and it gives you your choices in these particular situations when you’re out of network. Hopefully this information helps you out. We’ll catch you next week.