What’s better: In-network or out?
By Marty Kotlar, DC, CHCC

Healthcare providers notoriously provide low reimbursements. That leads me to question: Is it better to be “in network” or “out?”

Ultimately joining a network is an individual decision. The questions below may help you make an informed decision:

1. Do you meet the credentialing requirements? One common credentialing requirement is to carry a specified amount of malpractice coverage. Another requirement in many plans is a membership fee to join the plan. If you are not able or are unwilling to comply with these requirements, you would not be eligible to join.

2. Are you willing to do the paperwork? Ask to review required forms for authorized care for a covered patient. Balance the time required of you or your staff against the potential reimbursements. Is the paperwork worthwhile?

3. Are the fees fair? Review the fee schedule by code to decide if the plan will provide fair fees.

4. Are you able to collect money for a denied service? Some plans prohibit you from accepting money directly from the patient for non-covered services.

5. How many new patients can you expect? Some poor plans may be excellent sources of patients who are want treatment beyond plan benefits. Consider this in your equation.

6. What’s the difference between in-network and out-of-network pay? Call in-network and out-of-network colleagues and compare EOB (explanation of benefits) statements. Is the difference worthwhile?

Marty Kotlar, DC, CHCC is the president of Target Coding Inc. (www.TargetCoding.com). He is certified in healthcare compliance. He can be reached at 800-270-7044 or at drkotlar@targetcoding.com.