out of network insurance billing ethical dilema- insane reimbursement rate
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I have recently left my group practice to go out on my own, and have realized that my former employer billed a particular insurance company (whom I'm out of network with) at $450 and they reimbursed at $241 until the max out of pocket was met, then $402. For the life of me I can't figure out why an insurance would reimburse at that rate. This feels like an ethical issue as I can't justify being paid $402 a session! Has anyone experienced this before? I also learned we were writing off the deductible for these clients, and it was justified because we were out of network and had no contract. Many of these clients with this particular insurance have followed me to my new practice and I'm trying to figure out how to bill. Any thoughts would be appreciated.

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    Gillian

    Hi Noelle, the SimplePractice team isn't able to advise regarding reimbursement rates, so I'll go ahead and leave it open to the community to help with your question.

    Hi Noelle, the SimplePractice team isn't able to advise regarding reimbursement rates, so I'll go ahead and leave it open to the community to help with your question.

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    Noelle Blacker

    Thanks, problem resoIved. just spoke with a very ethical private insurance biller and she set the record stragiht!

    Thanks, problem resoIved. just spoke with a very ethical private insurance biller and she set the record stragiht!

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    Gillian

    Glad to hear you found assistance with this! Let us know if you need help with anything SimplePractice. 

    Glad to hear you found assistance with this! Let us know if you need help with anything SimplePractice. 

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    Desyree Dixon

    Noelle,

     

    I have some questions regarding out of network billing. Would you mind speaking with me to compare notes?

    Noelle,

     

    I have some questions regarding out of network billing. Would you mind speaking with me to compare notes?

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    Noelle Blacker

    Hi,
    Sorry it took so long to reply. Basically I did some research and learned that the only reason that insurance was paying so high is because my old practice was billing at that rate.  Even though they were paying, I could never justify that my services were worth that rate- so ultimately I found out what other therapist in the area were billing at, and found an amount that was same or comparable. I also learned that it's bad practice if not worse to regularly be writing off deductibles regardless if you have a contact or not.
    I hope that helps!
    Noelle

    Hi,
    Sorry it took so long to reply. Basically I did some research and learned that the only reason that insurance was paying so high is because my old practice was billing at that rate.  Even though they were paying, I could never justify that my services were worth that rate- so ultimately I found out what other therapist in the area were billing at, and found an amount that was same or comparable. I also learned that it's bad practice if not worse to regularly be writing off deductibles regardless if you have a contact or not.
    I hope that helps!
    Noelle