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Should your ASC go out of network? 3 key details to consider

Lakewood, Colo.-based Pinnacle III shared three tips for working with out-of-network insurance providers.

The key details to know:

1. The costs of using an out-of-network provider. Insurance companies are lowering spending by limiting out-of-network provider use. Health plans are also telling members only a fraction of the cost will be paid by insurance if they use an out-of-network provider, even if the payer offers out-of-network benefits.

2. Penalties for surgery centers. If a surgical facility uses out-of-network services performed by another provider, the facility may face penalties due to contractual requirements.

3. Should you go out of network ? Potential obstacles include changes to patient payments, penalties and provider education on financial repercussions. ASCs should weigh the pros and cons of going out of network before taking the leap.

Read more here.

More articles on coding, billing and collections:
The ASC payment landscape: 4 Qs with Alfonso del Granado of Ashton Center for Day Surgery
Brooklyn Surgery Center partners with Fellow Health Partners for billing services — 3 insights
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