Do insurance carriers consider you out-of-network?

If so, here are a few tips that may help you get paid for the services you provide to your patients.

  • Verify the coverage, as well as benefits, for out-of-network facilities.
  • Discuss deductible and/or co-insurance amounts with patients prior to seeing them. Inform the patients that their insurance carrier may make payment directly to them. Create a form stating this and have the patient sign it acknowledging responsibility for any balance. Should the insurance carrier make payment to the patient, call the patient and remind him/her to send in the payment.
  • Verify all demographic and insurance information for new and established patients.
  • Make sure the medical record supports the procedure(s) performed.

        This is a must if the claim is denied, and an appeal is filed.

  • Submit your charges timely - within a day or two. Some insurance companies deny claims if they are not filed within 90 days.
  • Check claim status within 14 days of submission. Many times claims are lost.

By following these practices, you can improve your payment cycle for out of-network claims.