In this short video, I review the 4 different options for dietitians billing for out-of-network patients. The term out of network simply means you don’t have a contract with that particular insurance company. You might not have a contract for numerous reasons: you decided not to participate with them, the network might be closed or you may actually be in the credentialing process but are not yet considered in-network. Therefore, all of these options would qualify you as an out-of-network provider. When a patient reaches and wants a visit BUT they have insurance you don’t accept you have four options.
The 4 different options for dietitians billing for out-of-network patients
1. Charge them your cash rate (in many instances known as your prompt pay rates), then collect the money at the time of service & ultimately provide them an invoice.
2. Issue them a superbill. Then on the superbill charge your usual and customary rates (aka your insurance rates), collect the money at the time of service & the patient takes the superbill & submits it to their carrier on their own. Most importantly, they will ONLY receive money from the insurance company if they have out-of-network MNT benefits on their policy. So there is no guarantee when you issue a superbill that the patient will ever see that money.
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3. Charge their HSA card (Health Savings Account) your usual & customary rates by running the HSA card through your credit card processor. Remember you must be set up as a health care provider with the credit card company. If you are not the HSA card will be declined.
4. Submit the claim through your EMR or clearinghouse on behalf of the patient as an out-of-network claim. I would suggest collecting the money upfront (usual & customary rates in this situation as well) and THEN submitting it. If you click ‘no’ for box 27 on the CMS 1500 where it says ‘Accept Assignment’ IF the patient has out-of-network benefits on their policy the insurance company will send & issue the check to the patient (not you!).
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