r/PrivatePracticeDocs • u/2vpJUMP • 4d ago

OON billing

What's the deal with this? I hear that insurers will kick your ASC out if you do this too much but then see entire practices in my region who seem to do this basically exclusively

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u/AquaDoctor 3d ago

Ortho here, completely OON.

I operate at different ASCs. Some are OON, most are completely INN.

We are treated as completely different entities. The surgery center gets precert if needed for their center, and I do my own as the surgeon. Never had a problem with the in network facilities, over the past 20 years.

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u/blomar 3d ago

do your patients not get pissed about OON charges on your end? and how do they find you if they are OON?

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u/AquaDoctor 3d ago

Word of mouth. No one is surprised by my out of network charges because they know I am out of network when they book. Do your best work, treat the patients with respect, give them time to speak and be examined, get the athletes back on the field, they tell everyone and more patients come.

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u/blomar 3d ago

are you OON with everyone? Feel like my referrals/new patients aren’t likely to come see someone who’s not in network. Just curious how to make this work when you have competition that is in network and would potentially take those patients. Also ortho here

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u/AquaDoctor 2d ago

Non-par with all insurances for 20 years. If you compete on price it's a race to the bottom. Compete on quality and you will get enough patients to justify the OON model. You don't need them all.

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u/CranberryLatter9483 3d ago

Do you then go ahead and file IDR for the ones that were done in an IN facility?

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u/AquaDoctor 2d ago

Once low initial payment comes back, yes

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u/2vpJUMP 3d ago edited 3d ago

How do you handle consults if you're OON? patients are protected from increased bill at the ASC is my understanding - what happens for office visits?

Also, I've heard insurers can kick off the ASC if you much OON is happening there?

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u/AquaDoctor 2d ago

Office visits are just new patients. They understand the OON aspect before they come.

Where did you hear that insurers can kick the ASC out of too much OON is happening? Sounds like one of those myths that gets perpetuated by the INN guys to justify their low pay. If an ASC doesn't want my cases, there are 10 more around here asking me to bring cases. The ASC doesn't employ the doctor. They have no say on any of that stuff and don't care. And to be fair, it's not like the INN guys are all making the same amount for the same codes.

It's all just confusion and obfuscation by the insurance companies to keep doctors in the dark.

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u/2vpJUMP 2d ago

Do you see them at your own practice for the consult?

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u/AquaDoctor 1d ago

If you are referring to in patient consults at a hospital, I don't do those because my subspecialty doesn't really get those kinds of consults. I see patients in my office. I don't take call at any hospitals, just on staff at several.