The Nuts and Bolts of Being an Out-of-Network Medical Practice in the 21st Century

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Get an Understanding of Consents and Disclosures Needed To Handle Out-Of-Network Claims

Patients are increasingly seeking out-of-network (OON) services and this trend is expected to continue. As consumer demand drives out of network activity, insurance companies are coming up with OON benefits integrated in their policies.

Since OON reimbursement tends to be higher than in-network reimbursement, payers use different strategies to discourage it, including bill reduction tactics, limits on benefits policies and third-party rental agreements that lower reimbursement. Out-of-network represents the last great opportunity for many providers to increase their reimbursement. But remember, what has worked for you in the past is no longer effective in recovering revenue for your practice. The climate has changed and so must you!

Join Thomas J. Force, Esq. in this webinar to get an overview of various methods out-of-network providers can use to maximize claims payments by insurers and patients. Also learn about office policies, appeals processes, and how to handle recoupment attempts. Additionally, understand the various types of consents and disclosures needed to handle out-of-network claims, and more!

Session Agenda:

  • Best Practices—Ways to avoid raising a red flag; policies to implement; and forms to use.
  • ERISA—How this act obligates insurers, plan administrators, benefit providers and patients with certain rights.
  • Appeals Process—Time frames, applicable bases for no benefit and low benefit determinations.
  • Patient Responsibility—Various policies and practices to implement, to maximize recovery.
  • General Eligibility—Summary of recent changes in out-of-network recovery.

Session Highlights:

  • Discussion on Out-of-Network claims
  • Out-of-Network v. In-Network—the advantages and disadvantages
  • The importance of patient disclosures and upfront estimates of charges
  • ERISA: Friend or Foe?
  • How to use ERISA law to appeal denied and under-reimbursed claims for employer-sponsored plans
  • Are You Getting an Appropriate Response From the Health Plan?
  • What is a recoupment and what to do when faced with one?
  • How to get a full and fair review in case of a recoupment?
  • Affordable Care Act (ACA) Emergency Services Mandate
  • How to object to and defend health plan recoupments
  • The importance of Charity Care Program/ Financial Hardship Policy
  • Review of dispute resolution for emergency services
  • Review of dispute resolution for non-emergency "Surprise Bills"
  • Timing of Benefit Determination
  • Interplay with State Insurancè Laws
  • Disclosure rules
  • Dispute Resolution for Emergency and Non-Emergency Services
  • Mandatory disclosures for OON providers
  • Insurers’ Obligations: Prompt Payment Law
  • Best practices for OONs

Who should attend

Administrative, Front Office and Billing Staff of Out-Of-Network Practices, Physicians and Compliance Specialist.

 Order Below or Call 1-866-458-2965 Today

You can also order through:




About Our Speaker

Thomas Force - Compliance Coding Expert

Thomas J. Force, Esq. is a licensed attorney since 1994 in both state and federal courts in New Jersey and New York, with 27 years of experience in the healthcare and insurance industries. He is the president and founder of The Patriot Group, a full-service healthcare physician advocacy and revenue recovery company providing billing, appeals, collections and follow-up services for healthcare. Thomas is also the former CEO, general counsel and...   More Info
More Events By The Speaker

Why AudioEducator?
  • Save money on travel.
  • Meet your specific training needs.
  • Keep learning after the event.
  • Save time training your whole staff.
Join Our Mailing List
Our Accreditation Partners
Facebook Twitter Linkedin Youtube RSS Feeds Google Plus
Audio Educator


Dear Valued Customers


We regret to announce that ProEdTech LLC and all its affiliate brands will cease operations on April 1, 2019.


We are no longer able to fulfill online orders. We will fullfill all DVD and book orders already placed.


Customers of canceled webinars and subscription products may request a refund at (800) 223-8720 or You must do so by April 1, 2019.


Thank you for your business and loyalty over the years. We sincerely apologize for any inconvenience caused.


Best regards,

The ProEdTech Team