At the 12th Annual Spine, Orthopedic and Pain Management-Driven Conference + Future of Spine in Chicago on June 13, John Bartos, JD, CEO of Collect Rx, discussed, and debunked, common myths regarding out-of-network reimbursements.
1. The days of out-of-network are over. Not only are the days of out-of-network not over, but out-of-network will continue to grow as a strong force, Mr. Bartos said. Given significant growth in PPO enrollment and more people insured than before, out-of-network services are on the rise. "The real reason by far that out-of-network is here to stay is that people want it," Mr. Bartos said. "People want to have the choice of seeing the providers they want to see. A lot of people want to have that choice and are willing to pay for it."
2. Being 100 percent in-network maximizes reimbursements. Mr. Bartos said out-of-network reimbursements can actually be higher than in-network reimbursements. However, he warns against transitioning full-fledged to out-of-network services. "The wise provider would do a detailed analysis of what's happening in their marketplace and adopt a hybrid approach."
3. We've got it covered. Instead of solely relying on individual policies regarding out-of-network reimbursements, facilities should seek experts and allocate resources to continually monitor how they are doing. "If you take a close look, you can identify places where you don't have it quite covered," Mr. Bartos said.
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1. The days of out-of-network are over. Not only are the days of out-of-network not over, but out-of-network will continue to grow as a strong force, Mr. Bartos said. Given significant growth in PPO enrollment and more people insured than before, out-of-network services are on the rise. "The real reason by far that out-of-network is here to stay is that people want it," Mr. Bartos said. "People want to have the choice of seeing the providers they want to see. A lot of people want to have that choice and are willing to pay for it."
2. Being 100 percent in-network maximizes reimbursements. Mr. Bartos said out-of-network reimbursements can actually be higher than in-network reimbursements. However, he warns against transitioning full-fledged to out-of-network services. "The wise provider would do a detailed analysis of what's happening in their marketplace and adopt a hybrid approach."
3. We've got it covered. Instead of solely relying on individual policies regarding out-of-network reimbursements, facilities should seek experts and allocate resources to continually monitor how they are doing. "If you take a close look, you can identify places where you don't have it quite covered," Mr. Bartos said.