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!

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