Should I become an in-network provider or stay out of network?

Often times we get asked if the provider should become in network with insurance companies or stay out of the network. Here are some of the pros and cons when deciding what is best for your practice.

If you are an out of network provider you are limited to only being able to see patients with PPO polices. It is important to note that not all PPO polices have benefits which you acupuncturist are able to bill for.  The good part about this is that reimbursements to out of network providers are usually significantly higher than to those who are in network. As an in network provider you are able to take any type of insurance whether it be an HMO or a PPO, allowing for a bigger flow of patients. The downside of that, is that as an HMO provider you have a legal contract that forces you to follow their fee schedules. With that said you might be seeing three or four patients for a payout that an out of network provider can make for seeing only one.

As an in network provider you are more easily accessible to patients. A lot of patients chose their providers out of the handy dandy insurance books that come with their insurance card. Therefore, if you are out of network your name will not be on that book. If you are in network patients will be able to locate you a lot easier.

One of the biggest headaches you can encounter as an out of network provider is that some insurance companies include anti-assignment clauses in member contracts. This requires that reimbursements be made directly to the member instead of the provider, which in turn leaves the provider with the hassle of having to track down the patient to try and recover the funds.