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  • Writer's pictureDr. David Carter

Being an Out-of-Network Provider

In-Network Vs. Out-of-Network

Every provider has his or her own reasons for choosing to either be in-network or out-of-network with insurance providers.

Providers on an in-network plan have a contract with each insurance provider agreeing to accept that plan's fee schedule which is typically lower than the full price for the service. Basically, the insurance company determines what reimbursement is to be provided for services rendered and which services are deemed medically necessary. Patients may find this cost effective, however, the provider is faced with a bigger workload. Some providers are equipped with the necessary staff or outsource their billing, so it does not have a major impact on their patient care routine.

Out-of-network providers can be more costly, but they can still provide services to patients with insurance. In this case, the insurance company does not decide how much the provider should be reimbursed, so you are generally paying the full costs of services rendered.

Why I Chose to be an Out-of-Network Provider

As a consumer myself, I understand that the cost of services is usually in the top 3 things to consider when choosing a provider/service. Recently, I've received a lot of questions about why I don't take insurance. As a chiropractor, my goal is to provide my patients with quality care at a reasonable price. I got into this profession so that I could help people, not to make myself rich. With me, there is no production line style of treatment, and you will never be rushed out and replaced by someone else (this doesn't quite fit for my mobile style services, but I hope it conveys the message). One of the main reasons I opted to remain out of network is that I would rather spend my time treating my patients, rather than spending my time submitting claims and calling insurance companies. I'd rather concentrate on helping my patients. What I do is small and family-oriented, and I don't plan to hire a lot of staff or growing a company so large that I can't handle most tasks myself. I love what I do, and I love being able to spend time with my family.

Having said that, my goal for the cost to patients is the same as being an in-network provider, I want to keep your costs low. I am able to keep my prices low by not hiring on a lot of staff and by spending most of my time face-to-face with patients and providing the best care I can. Though I am out of network, I do accept HSA and I am able to provide patients with a superbill (basically an itemized receipt), which they can submit to their insurance company in order to get reimbursed directly. Should my cost be a deterrent to you considering my services, please don't hesitate to call!

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