Research advantages and drawbacks of joining other plans

May 10, 2012

Are commercial payers asking if you'll join their networks? Discover what you should look for to determine if joining the network is right for your practice.

Q: I've been getting contacted by more and more commercial payers about enrolling in their networks. What are a few things I should keep in mind when deciding?

Also, figure out whether you'll be able to see patients with a particular carrier on an out-of-network basis. There are usually advantages to remaining out of some networks. Before signing up, contact the payer and request a sample fee schedule. Ask about coverage limitations, prior authorization processes, and out-of-network billing. If the fee schedule is low, it might be a financial risk to participate. Remaining out-of-network may allow you to bill patients for your full fee.

Answers to readers' questions were provided by Judy Bee, Practice Performance Group, La Jolla, California. She is also an editorial consultant for Medical Economics Send your practice management questions to medec@advanstar.com Also engage at http://www.twitter.com/MedEconomics and http://www.facebook.com/MedicalEconomics.