Maximizing Out-of-Network Insurance Reimbursement With Payment and Claims-Filing Solution

Generally speaking, health care costs more when you go out-of-network. Unless you have prior authorization or your insurer negotiates a discounted rate, the cost will be subject to your insurance plan’s deductible.

A payment and claims filing solution simplifies this process for patients and providers alike.

Understand Your Deductible

When it comes to insurance, there are a lot of terms that need to be clarified. One of the most important is the deductible, which is the amount you must pay each year before your health insurance plan starts paying for covered services. A deductible is separate from your monthly premium, and it represents the annual cost of eligible expenses before your insurance company begins to share in the prices by covering copayments or coinsurance. When choosing a health insurance plan, you can select a lower deductible to reduce your monthly payments or a higher deductible to save money upfront on potential out-of-pocket medical costs.

For example, Ben, a 28-year-old security expert, recently took his 3-year-old to the emergency room after falling at the playground and breaking his arm. He was billed a few hundred dollars for the visit, but his insurer will cover 80 percent of the expense because they’ve already met their deductible. Understanding deductibles is key to maximizing out of network insurance reimbursement, and using a revolutionary new payment and claims-filing solution for healthcare providers and patients is a game changer. A  payment and claims-filing solution gives your patients the full cash pay rate without paying extra fees or a monthly subscription. Plus, providers save time filing claims and fighting denials by letting insurance experts do it all for them. If you have an out-of-network insurance claim, you can use a payment and claims-filing solution to submit it and get reimbursed.

Research Your Options

While most medical policies incentivize you to use in-network providers, having out-of-network coverage can be a good option for some reasons. Out-of-network services are generally cheaper than in-network services. This is because insurance companies pay providers a prearranged rate for out-of-network services. This is also known as coinsurance. Check your insurance policy and EOB for details on how much you’ll pay out-of-network. Knowing your coinsurance rates for out-of-network therapy before scheduling your appointment is important. Many insurers will reimburse you up to 80% of the cost of out-of-network therapy after meeting your deductible. You may be surprised by how affordable out-of-network therapy can be. Insurance claims are complicated, and it is easy to make mistakes. Many health insurance claims are rejected, even when the claimant is right. When you file a claim with a payment and claims-filing solution, they will keep fighting for you, correcting any errors made by the insurance company, until they finally give you the reimbursement you deserve. While other online patient payments systems and healthcare management solutions help you collect and process payments from patients, these do not offer the additional benefits of maximizing out-of-network reimbursements on behalf of your clients. A payment and claims-filing solution does both, enabling your practice to focus on providing excellent care and letting them take the burden of healthcare billing off your shoulders.

Negotiate With the Provider

While negotiating insurance contracts can seem difficult and uncomfortable, it is essential to the survival of your practice. It is important to have a strategy in place before entering the negotiating process. The right approach can allow you to achieve the most favorable contract terms possible. Start by finding out which payers are the most lucrative in your market. If you use a billing software program, this is simple: run reports on CPT codes used most frequently during three of your busiest months. You may also keep track of this information manually if you do not use billing software. Once you have identified the payers that generate the most revenue for your practice, focus on negotiating with them first. Start by contacting the person in charge of contracting for each payor. Depending on the payor’s organizational structure, this may be the manager or someone else who oversees the contracting department. Prepare a proposal outlining your expectations and why you deserve a higher reimbursement rate. Include a revenue analysis spreadsheet to illustrate how much you stand to gain with a higher reimbursement rate. In addition, it is helpful to emphasize how you can save the client money by providing care outside of their network. For example, a client with a high-deductible plan may need to see an out-of-network provider to make their care affordable.

Schedule an Appointment

Ultimately, if you’re seeking a specific type of care unavailable in your network, you may need to go out-of-network. Learning about your insurance plan’s fine print in advance is important to decide whether this will be the best option for you. Examples include a genetic disorder that doesn’t have an in-network provider with the appropriate expertise or a rare disease for which there aren’t any treatment options within your insurance network. Regardless of the reason, it’s often better to receive out-of-network care from a specialist than to go with an in-network provider who is less experienced or trained. If your insurer agrees to an out-of-network exception, they will generally apply your in-network benefits to the out-of-network service. This is typically a more cost-effective solution than paying out of pocket. A payment and claims-filing solution allows patients to easily take control of their healthcare costs and receive reimbursements from their health insurance providers. Online patient payments system is hassle-free for patients to pay for their medical services. At the same time, automated claim filing and tracking will take care of all the paperwork and follow-up with the insurance company. This takes the pressure off patients and providers alike so they can focus on what’s most important – providing their patients with excellent medical care.

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