Out of network question

We read echos for a group. Some of these patients are out of our network. What do I need to do to get paid by carrier or patient? Fill me in..........Thanks!

Get in network!

It is not clear what "group" you read for. I assume you are cardiologists and a physician group contracts with you to read the ECHOs. They must bill for the technical component and you bill for the professional component. In that case the best situation is to both be contracted with the same insurers so you are both in network for the patients (or both be out of network so patients know they are responsible).

The problem you are having is that the patient's doctor is in, for example, Aetna, but you are not. The ECHO is done, the technical component charge is paid in network at 90% since it comes from their office with no deductible but your bill is charged to the deductible and the patient calls and complains (or just tears up the bill). It is up to your docs to decide how to handle this- in some cases the docs choose to collect what the insurance pays as an out of network provider and forget the rest (even if that means getting nothing) and realize it probably balances with the insurances that pay out of network docs at 100% of charges. Or you can try to collect from the patient and decide how hard to try. if they pay, great; if not then write it off. Last thing you want is to get the docs who send you the business to be mad at you for strong-arming their patients because you'll lose the ECHO business and the caths/ stress tests, etc.

Hope that helps.

Out of Netwrok

It helps tremendously! You are right we are cardiologists. Is there a waiver the patient can sign knowingly they are out of network? THANKS!

A waiver wold be good

since you are not in the insurance, you can draft anything you want. It might be better to work with the primary care docs to figure this out; the waiver is just going to create confusion and patients will not want to pay even if they sign. If there is a small volume, just eat the charge- it is only cognitive time you are giving up- no supplies. if you are giving away a lot of services then either join the network or ask the primary care docs to send those patients to the hospital for their ECHO's.