I recently wrote an article for E-Zine about billing as an out of network provider. Here is an overview of that article. I hope it helps you increase your client base and help out your clients who have out-of-network coverage on their insurance.
That being said, not all insurance plans include out of network coverage, and those that do sometimes have restrictions about what types of providers they will consider. It is important to find out that information BEFORE you bill them.
When a new client calls me and I don’t take their insurance, I offer to call their insurance company to find out their out of network coverage. I get their full name, date of birth, insurance ID number, and the insurance company contact number from the back of their benefit card. Once i have all of that I can call the insurance company.
Sometimes I’m told outright that there is no out-of-network insurance. Other times, I’m told the client has the same benefit for out-of -etwork as it is with in-network providers. Most often however, I’m told that the client has a deductible ($200, $500, $1000, etc.) and then a (percentage) co pay.
Let’s say that your posted fee is $100/session. That is what you bill insurance. There are times, however, when your private pay clients cannot pay $100. So, you accept $75 and write off the rest. That is perfectly okay to do.
Further, let’s say that your client’s out of network benefit has a $100 deductible and after that the insurance reimburses 80%. Here’s how it would work.
- You would charge the client $100 (and bill the insurance company for that session)
- The first session would be applied to the $100 deductible, so your client would be responsible for that session. If you are going to discount the rate, you will write off the balance after the fact
- Subsequent sessions would be billed to the insurance company for $100. You would collect a $20 co pay and expect an $80 payment from the insurance according to the client’s contract
Please note that not all insurance companies will reimburse the provider. Some companies will only reimburse the subscriber (client). So… if that is the case (in my practice), the client pays up front and they wait for the insurance reimbursement.
Next time, I’ll tell you about some other little nuances when billing insurance companies…