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In the United States, medical providers sometimes indicate that they "take the patient's health insurance". This means they will bill the patient's health insurance regardless of whether they (the medical providers) are in or out-of-network.

Is there any point in a medical provider "taking the patient's health insurance" even though they aren't in-network, aside from the convenience for the patient of not having to send the bill/claim to the health insurance themselves (in case they want to reach / have reached the deductible)?

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    Point for the provider, or for the patient? – Acccumulation Feb 26 at 15:42
  • @Acccumulation I'm interested in both standpoints, but mostly the patient's standpoint – Franck Dernoncourt Feb 26 at 18:46
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    Out of network doesn't necessarily mean your insurance doesn't cover any of it. – Kevin Feb 26 at 19:25
  • @Kevin thanks yes definitely, that's why I mentioned the deductibles in the last sentence of the question, but definitely better to state it explicitly – Franck Dernoncourt Feb 26 at 19:30
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    Note that what out of network means rather varies by health plan. On an HMO, this might mean the insurance will pay none of the costs of non-emergency treatment (but many/most plans will still cover emergency treatment), but with a PPO "out of network" just means the insurance company pays a less and the patient is responsible for a larger portion of the cost: Example: bcbsm.com/index/health-insurance-help/faqs/topics/… – BrianH Feb 26 at 19:58
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"Out of network" does not, in most cases, mean that the insurance company won't pay at all, it just means that the insurance company doesn't pay as much. So, yes, there is definitely a point.

  • Insurance won't pay as much and/or doctor accepts less money. I assume it's usually both. – xyious Feb 28 at 15:03
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The patient, except in the situation of the small number of bills where not having insurance is cheaper, always wants the insurance company to see the bills. If the patient has to send the bills that takes some work on the part of the patient, but that also means they are in the middle if the insurance company has a question about the bill.

If the medical provider send the bills, they will address questions from the insurance company. This is a big convenience.

An important benefit to them taking the insurance even if they are out of network, is that they can give the patient time to send the bill to the insurance company, before asking for payment. This can be critical if the insurance company is paying for some or all of the bill. Giving the patient 30 days to get reimbursement can help the patient with their cash flow.

A big issue in some situations is with specialists or other procedures related to the main procedure. It can be frustrating if the doctor who is out of network, compounds the situation by sending the samples to a lab that is also out of network. In many doctors offices they will send their samples to one of several labs, depending on the patients insurance company rules. If the doctor's office knows the rules for your insurance company, they can save the patient hundreds of dollars, just by sending the sample to lab X instead of lab Y.

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The benefit for the patient, as mhoran_psprep says, is that they have less paperwork to deal with. They also don't have to come up with the money; often a patient would otherwise have to pay the money upfront and then have get the insurance company to reimburse them. Another big advantage to the provider saying that they accept the insurance is that now the provider has a relationship with the insurance.

How it works if the provider doesn't say they accept the insurance is that if a patient goes to a provider, and the insurance refuses to pay, the patient is on the hook for the money; any agreement between the patient and the insurance company is between just those two parties. The provider is not part of the agreement, and is not bound by any of its terms. If the procedure is covered but the insurance company claims it's not, the patient can't just say to the provider "Go talk to the insurance company". The provider has the right to recover the money from the patient, and it's up to the patient to sue the insurance company.

If the provider says they accept insurance, on the other hand, then depending on the wording, the patient can have their liability reduced or eliminated in the case of a dispute between the provider and insurance.

For the provider, one of the benefits from accepting insurance is that it's a selling point to patients. Another is that the provider now has a reliable source of payment. Instead of having to deal with billing hundreds of patients, they only have to bill a few insurance companies, and the insurance companies have less of a chance of saying things like "Can you wait until my new job starts in a few months?" or "I'm filing for bankruptcy".

  • RE the last paragraph: My bank gives me a discount on the interest rate on my mortgage if I agree to have the payment automatically deducted from my checking account every month. Why should they do that? They're getting less money. I'm sure they do it because that not only saves them the postage and printing cost to send me a bill, but more important, eliminates the possibility that I'll forget to pay this month, or that I'll delay paying until I get one more paycheck, etc. The reduced interest is worth it to save the hassle of dealing with irresponsible people. – Jay Feb 26 at 20:46

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