Lakewood, Colo.-based Pinnacle III shared three tips for working with out-of-network insurance providers.
The key details to know:
1. The costs of using an out-of-network provider. Insurance companies are lowering spending by limiting out-of-network provider use. Health plans are also telling members only a fraction of the cost will be paid by insurance if they use an out-of-network provider, even if the payer offers out-of-network benefits.
2. Penalties for surgery centers. If a surgical facility uses out-of-network services performed by another provider, the facility may face penalties due to contractual requirements.
3. Should you go out of network ? Potential obstacles include changes to patient payments, penalties and provider education on financial repercussions. ASCs should weigh the pros and cons of going out of network before taking the leap.
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