How to Deal with Out of Network Patients
Nor can the patients themselves be blamed. Healthcare is a complicated field to navigate and patients don't always have a good understanding of their coverage options. Terms like deductible and co-pay only complicate things further, making the entire medical billing process a conundrum for most patients.
However, there are a few ways to solve it:
File claims.
It is advisable to always file a claim before moving forward. Depending on the type of insurance, the payer may still pay a portion even though the practice is out-of-network.
Negotiate
Once the insurance company has made its decision, you can begin negotiating with the patient. With how expensive healthcare services can be, it is unlikely that most patients will be able to pay the entire bill out of pocket, so be flexible and understanding by offering payment plans that are reasonable considering their financial situation.
Collect payment upfront
Another method to capture out-of-network patients early is to establish a policy of collecting the patient's portion of the payment upfront. This way, patients who are not covered will know how much they have to pay and may choose to go to a practice that is covered by their policy.
Verify coverage before appointments
Due to the constantly changing nature of insurance policies, another smart move would be to instruct front desk staff to always verify insurance prior to the actual appointment. This will avoid the hassle of having to verify once patients have already arrived, and will also catch patients out of network very early.
Be transparent with the billing policy
Transparency in the billing policy will be greatly appreciated by all patients, whether they are in-network or out-of-network. Once the appointment is confirmed, ask the front desk staff to send the policies to patients, either by email or text message, along with a reminder to bring insurance paperwork when they arrive.
