Out of Network Billing to Maximize Reimbursement

by Clair
(Mission Viejo, California)

I have started billing for a provider's out of network business (he is a surgeon). What is the best method to collect maximum reimbursement?


The reimbursement is usually low as the insurance are basing it on their U&C rate (from a mysterious data base that only they are privy to....) The process of appeals is very time consuming and does not produce any real results.

Should we just bill the patient informing them that they should contact the insurance and demand the claim be reprocess and the provider paid additional money and that they should not be made responsible for the doctor's bill as they are paying for the OON benefit that is included in their monthly premium?

Any suggestion would be greatly appreciated?

Response:
Thanks for your question Clair. Sorry to take so long to post.

We haven't billed a lot of out-of-network lately but will post in hopes that some of our visitors can share their advice or experiences.

Visitors please click on the "Click here to post comments" link below if you have any advice.

Thanks!

Click here to post comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Your Questions.

Recent Articles

  1. Is it possible to work in Medical Billing or Coding at night instead of during the day?

    Oct 23, 17 09:16 PM

    How common is it that a company would allow you to work from home as well as working at night so you can be with your children during the day? I'm an

    Read More

  2. Should I get my medical billing certificate from AAPC or somewhere else before I start my own business?

    Oct 23, 17 09:15 PM

    Hi! I am contemplating starting my own medical billing business and I was wondering if I should get my medical billing certificate from AAPC or some other

    Read More

  3. What is the CPT code for 'Male Hormone Panel'

    Oct 23, 17 08:57 PM

    What is the CPT code for 'Male Hormone Panel' ...testosterone/estrogen/PSA/IGF- 1 /DHEA -Sulfate/ Progesterone Response: We'll post in hopes our Visitors

    Read More

Disclaimer and Privacy

All-Things-Medical-Billing.com provides this website as a service. Please read our full Disclaimer and Privacy Policy here.


Copyright 2017 All-Things-Medical-Billing.com