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October 01, 2021

Health Law Connections

Payment for Out-Of-Network Services: The Provider's Perspective

  • October 01, 2021
  • Salvatore G Rotella Jr. , Buchanan Ingersoll & Rooney PC
  • Tanya C. Leshko , Buchanan Ingersoll & Rooney PC

This article identifies the relevant issues, and reports on the current state of the law, in connection with payment to health care providers for services rendered to members of commercial health insurance plans on an “out-of-network” (OON) basis.1 Specifically, it addresses the key factors for a provider to consider if it believes a plan has not properly adjudicated and paid a reimbursement claim for OON services.2 These factors involve not only the provider’s interactions with the plan, but also how the provider obligates the patient for the cost of the care, as well as bills and seeks to collect cost-sharing payments from the patient.

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