Out of Network Payments
Receiving fair payments for services provided to patients who have health insurance from a payer with which the physician practice has not contracted presents some of the most daunting challenges in all of practice management. The AMA provides detailed resources to equip physician practices with the knowledge, tools, and confidence needed to navigate these challenges and ensure fair payment is received.
- Refer to the AMA document "Holding health insurers accountable for out-of-network services" for details about what out-of-network physicians might expect when dealing with the health insurer, how you can stay informed about payment laws and issues, and how you can collect fair and accurate payment for your services
- Refer to the AMA document "Out-of-network payment challenges for the physician practice" for an explanation of a third-party payer’s obligation for payment to out-of-network providers, as well as an overview of some payment challenges that may arise when a physician who is considered out of network requests payment from a patient and/or health insurer.
- Learn about billed charge resources available from FAIR Health, which many insurers use in the development of usual, customary and reasonable (UCR) schedules, compare your charges to those in FAIR Health's database of billed charges, and watch a webinar explaining FAIR Health.
- Make sure your retail fee schedule is up-to-date and defensible.