In-network Vs Out-of-network – A Detailed Understanding |
Posted: October 31, 2014 |
Understanding a health insurance provider network and its types is very important, as it not only impacts the costs of the healthcare services provided, but also the Provider reimbursements. Providers and Healthcare Facilities are categorized into in-network and out-of-network. They may be contracted either with an HMO or PPO. When patients get their care from in-network Providers, their co-pays and coinsurances will be lesser. The same will be higher, if patients choose to get their care from out-of-network Providers. The medical claims processing at the Provider’s or the outsourcing medical billing company’s office also gets impacted due to this variation. Therefore, understanding the differences between these two networks is highly essential for patients, Providers, and medical billing companies. In-network Provider:
In-network Medical Billing: The medical claims processing services associated with in-network providers is easier than billing out-of-network claims. In addition, patients will not be charged what is called a ‘Balance Billing’ that is usually charged for patients who are out of network. Out-of-network Providers:
Out-of-network Medical Billing: The medical claims processing services associated with out-of-network providers is quite complicated. Out-of-network providers will bill patients what is called a ‘Balance Billing.’ It is the difference between the Providers’ billed amount and the Payer’s reimbursement to the out-of-network provider. One of the major issues faced by Providers and outsourcing medical billing companies who are out of network is that the rate of denied claims increases. Another main disadvantage is that many Payers do not accept AOBs or Assignment of Benefits between patients and Providers. Outsourcing medical billing companies will find out-of-network medical claims processing easier if they choose to offshore medical billing. About e-care India: e-care India has 14 years of experience in the industry. e-care’s 3 offshore medical billing delivery centers have been providing end-to-end medical claims processing services seamlessly to its clients. To know more about e-care and its services, log on to www.ecareindia.com.
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