Eric J. Woollen, vice president of managed care for Birmingham, Ala.-based Practice Partners in Healthcare, cites three ways health plans are corralling out-of-network ambulatory surgery centers into their networks.
1. ASCs face growing collection burdens. With insurers selling benefit plans with deductibles as high as $10,000 for OON visits, surgery centers are under increasing pressure to collect very large sums of money from patients. This requires setting up extensive collection policies and procedures and spending more time with each patient to make sure they will pay. Some plans even send the payment directly to the patient, which confuses the patient and makes it more likely the ASC will not be paid.
2. Waiving patients' out-of-pocket becomes a problem. Some states have made it virtually impossible to waive any OON financial liability for patients. "Refer to your state laws and regulations and if you feel uncertain, be sure to consult a legal professional," Mr. Woollen advises.
3. Physicians' professional fees targeted. Some health insurers have threatened to terminate their professional contracts with the physicians when they perceive a pattern of referring cases to an out-of-network facility. "It's yet another way for health plans and payors to pressure out-of-network ASCs," Mr. Woollen says.
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Read more from the leadership of Practice Partners in Healthcare:
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