To begin: I have never done any work in network contracting or the laws surrounding physician payments.
If a plan offers out of network benefits, is it at all possible for that plan to selectively exclude facilities / doctors from even out of network coverage (i.e. they refuse to pay anything to those facilities)?
Can anyone refer me to regulations regarding out of network plans and payments to facilities? I know there was the whole Ingenix kurfuffle about determining R&C - but to what extent can insurers say that they will not pay a facility at all?
If a plan offers out of network benefits, is it at all possible for that plan to selectively exclude facilities / doctors from even out of network coverage (i.e. they refuse to pay anything to those facilities)?
Can anyone refer me to regulations regarding out of network plans and payments to facilities? I know there was the whole Ingenix kurfuffle about determining R&C - but to what extent can insurers say that they will not pay a facility at all?
Excluding Facilities from Coverage in Plan with OON Coverage?
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