As the costs of billing and collecting from insurance companies increase and reimbursements decrease, many plastic surgeons are opting-out as innetwork providers for some or all insurance companies. Out-of-network reimbursement is often based on a percentage of billed charges and can be higher than in-network rates. Physicians often waive the increased patient deductibles or co-pays because, even without the patient responsibility, out-of-network payments can be thousands of dollars more than in-network rates. If the surgeon accepts the higher payments from the insurance company and writes off the balance, this would seemto be a win-win for both the patient and the physician. The physician is paid more and the patient pays less because they don’t pay a deductible or co-pay. As surgeons don’t have a contract with the insurance company, they feel they don’t have to follow the patient’s insurance rules. Unfortunately, it’s not that simple. Here are answers to frequently asked questions to help you better understand outof- network billing and reimbursement.
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