Options for Out of Network Providers

Many providers opt to take the road of staying out of network, or not participating with insurance carriers. This has been going on for many years. Usually it tends to be specialty providers such as mental health providers but with the increasing changes of insurance billing more and more providers are opting to take this path.

What does that mean for the provider and the patient? Well for the patient it means that they need to verify if their insurance provides out of network benefits. If they do have out of network benefits, then the claim may be submitted and payment, if any, will be made directly to the patient. The provider may not necessarily file the insurance claim for the patient. They may simply provide the patient with a statement that will allow the patient to submit the claim themselves. Some, although in our experience, it is rare, actually still submit the claim even if they are not in network. For the provider it may mean that the patient may choose to go to a different provider that is in network with their insurance.

Are there any other options for these providers to assist the patient with the claim submission process while remaining out of network and not incurring expensive overhead costs such as office staff to submit the claims? We actually were introduced to a company that developed a phone app to assist patients with submitting out of network insurance claims! The app which is free to download, allows a patient to take the statement given to them, enter all of the information into the app with just a few questions, and submit the insurance claim to their insurance carrier. Then they receive notifications when the claim is sent, and when the claim is received by their insurance so that they can easily follow up.

The app actually allows providers to register themselves (no charge!) so that if their patients use the app the provider will come up on a search and the patient can simply select them without having to enter the provider’s demographics, NPI or tax ID. They also provide handouts for the out of network providers to give to their patients, or put out in their office to walk the patients through the process. There is even an option for providers to pay a small monthly fee that allows their patients to submit claims using the app at no charge to the patient. So if the provider would like to submit claims on behalf of the patient but they don’t want to have people on staff to handle that, they can incur the cost and it’s much cheaper than having an employee.

This may seem like an odd topic for a billing service to be discussing. After all, we are the ones doing the billing for most providers. However, we often come across a provider that is out of network, and our service really doesn’t make sense for them. Or we all know that patient that has a provider they love, but the provider is out of network and they need to submit the claim on their own. My daughter used to go to an out of network dentist that she absolutely loved. She had a slight fear of dentists and he was amazing. I wish this app had been available back then!

So if you know any out of network providers, or if you have a friend or family member that struggles with submitting their own claims, you can find out more about this program at https://reimbursify.com/