Understanding Out-of-Network Benefits

Dr. Nance is not in-network with any health insurance. That means that she does not have a contract with any health insurance to accept their in-network rates for her services. In-network reimbursement rates cover less than the cost of providing services as a solo, private practicing surgeon. In-network reimbursement rates decrease every year, forcing physicians to see more patients in less time each year.

What Are Out-of-Network Benefits?

Many health insurance plans have out of network benefits. These are benefits that pay a percentage of the fair rate for health services (the fair rates for out of network services can be found here: https://www.fairhealthconsumer.org/)

Every individual has a different plan with different benefits and payment responsibilities. According to your plan you may be eligible for out of network reimbursement for these fees.

How We Help You Navigate Out-of-Network Benefits

Insurance Verification:

• Our practice checks if you have out-of-network coverage on your behalf.

Claims Submission:

• Our practice handles paperwork and submits claims to insurance for you, simplifying the process.

Reimbursement Process:

• Depending on your benefits, deductible, and co-insurance, you may receive direct reimbursement from your insurance, or, sometimes if an insurance company pays the physician, you will be reimbursed by the practice. This process can take weeks to months and is dictated by your insurance company.

Why Choosing an Out-of-Network Provider Can Be Beneficial

Access to Specialized Care:

• Patients can choose the best provider for their needs, rather than being limited to an insurance network.

More Personalized Care:

• Out-of-network providers often have more flexibility and time to spend with patients, allowing for more thorough consultations and treatment.

Higher Quality Services:

• Many out-of-network providers prioritize patient care over volume, leading to higher quality and more comprehensive services.

Tailored Treatment Plans:

• Customized approaches to patient care that may not be possible within insurance constraints.

How to Maximize Your Out-of-Network Benefits

Know Your Plan:

• We encourage patients to review their plan’s out-of-network benefits, deductibles, and limits.

Keep Track of Claims:

• We remind patients to track submitted claims and follow up with their insurance provider.

Whether or not you have out of network benefits, we want to work with each individual to help them get the care they need. Please speak with our office staff for any questions.