As an out-of-network (OON) provider, you can bill insurances, but claims are processed under the patient’s out-of-network benefits, often leading to higher patient costs. To ensure smooth reimbursement and patient satisfaction:
- Verify OON Benefits: Confirm the patient’s out-of-network coverage with their insurer and clearly explain their financial responsibility.
- Obtain Consent: Secure patient agreement to pay any balance after insurance processes the claim.
- Check Payer Rules: Some insurers, like BCBS, require providers to be listed in their directory. Medicare does not cover non-credentialed providers.
Understanding these steps helps avoid claim denials, delays, and ensures transparent patient communication.