“PPM has worked with me at three practices in separate states. They have always impressed me with their professional, yet personal approach to our business. The attention to detail they give our practice is second to none.”
David White, D.O.,
Tulsa, OK
Partner Insight
When anesthesia providers have a contract with an insurance, the insurance has a set rate that they pay per unit for each claim. This is considered processing “in-network”. However, when providers are not contracted with an insurance, but they bill a claim to that insurance, the claim is processed as “out-of-network”. This means that the insurance will pay up to what they deem “usual and customary” for the procedure or services provided. This can leave the provider receiving little to no payment on the claim, and they must then decide to either balance bill the patient or take the hit and adjust off the remaining balance. With many states moving to enforce a No Balance Bill Law, balance billing the patient may not be a choice much longer, but there is another step to take before taking the adjustment for the remaining balance.
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