Here’s what I recommend on how to handle out of network financial arrangements:
Let’s say the patient needs a crown, and your UCR is $1000.00.
Verify the patient’s benefits to determine how much the insurance company is expected to pay. Let’s say for this example, it is $350.00.
Tell the patient you will bill insurance company for the $350.00.
Ensure the patient signs off on your financial policy, which should include that they are responsible for payment if the insurance company doesn't pay in a timely manner.
Collect the $650.00 balance at the time of service.
If the $350.00 is not received within at least 30 days, inform the patient so they have a chance to contact the insurance company to handle it.
If you still get no joy from the insurance company by the 45th day, collect the $350.00 directly from the patient.
DMOs: Be very precise in telling the patient their DMO has no value outside the office they are assigned to.