Why would a doctor go "out of network" pertaining to insurance?
There are many, many different insurance companies and each has their own network of contracted healthcare providers. Any doctor can participate in any, all, or none of the networks available to them. It is usually not that a doctor chooses to go "out of network" but more that they simply choose to not participate in an insurance company's network.
When a physician does choose to participate in an insurance company's network, there are many contractual obligations that the doctor must accept. These obligations may include things like accepting a set rate for services rendered to that insurance company's clients or waiting a certain amount of time before the insurance company pays the doctor. Each company has its own set of requirements the doctor must comply with in order to be in-network. A physician may simply choose to not join available networks simply because of the administrative confusion involved in complying with multiple sets of rules and requirements.
In summary, it is the physician’s choice to not participate in an insurance company’s network and it is the patient’s right to seek care outside of their insurance company’s network if they feel that the care they receive may be better, or more personalized or more specialized for their specific needs. In such an event, the patient pays the physician for the services rendered at the time of service and then files a claim with their insurance which processes the claim under the insurance policy’s out of network benefits, reimbursing the patient for that amount permitted under the policy.
We are currently only accepting Medicare and Tricare providers.