Deliberately Stealth Out of Network Docs May Be Teaming with in Network Pals

[yorkriver1]

Story in the news, where docs actually have consultants help them with ways to make back money from insurer's lowering reimbursements. Doesn't go well for the patients/insureds.
http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html
So, even though we work hard to drill into clients to be sure providers are in network, there are situations beyond the ER, where there are not controls or rules to follow to avoid out of network charges when the providers are determined to find ways to add them in.
This is an older story, but illustrates the thinking in dwindling reimbursements and the push/pull. http://www.managedcaremag.com/archives/1206/1206.outnet.html

 

[somarco]

InsureBlog has posted on the hidden provider problem for several years now.

Not a new phenomenon, this impacts any managed care plan including Medicare Advantage.