Wiki Out of Network Appeals

[mlelkins]

I would love to talk with anyone who has experience with out of network appeals for higher reimbursement. My doctor is out of network with many insurance plans (commercial and WC) and my PA's are out of network with all plans. I would like to discuss how you have successfully appealed payment reductions, methods, etc. You can email me at kygirl10280@aol.com also. Thanks in advance!

 

[Kimberlyfaith]

You don't have appeal rights

Appeals are for if you feel they did not reimburse you correctly. You are indeed out of network, so they did pay you correctly. You have every right to bill the patient the remainder of the bill. The patient chose to come to your provider so they must pay for what their insurance does not cover.