In Network vs. Out-Of-Network with Guest: John Lin MD

Today I had a great chat with Dr. John Lin about how to think about choosing to be In-Network vs. Out-of-Network. We all know that dealing with health insurance companies can be very frustrating. But reimbursement rates are only a part of what makes dealing with these companies a headache.

Trying to decide whether it makes sense for you and your practice to be In-Network or Out-of-Network has to be an informed calculation rather than an emotional decision.  Here are some of the topics we hit on:

• What is the demographics of your practice?
  • Can you "afford" to lose that patient population?
• What percentage of your payor mix does the insurance company make up?
• How much time (% of an FTE) does it take you and your staff to get prior authorizations and payment for this insurance company?

One of the key points of our discussion is that being In-Network or Out-of-Network is not an all or none decision. Both Dr. Lin and I started our practices In-Network with most payors in order to get our practices full. And then, with time and experience, evaluated and re-evaluated each payor and their contracts to decide whether it was beneficial to our practices.

You'll want to listen to our discussion of the decision-making process as you consider these choices for yourself.

Dr. Lin is a private practice urologist in Gilbert, Arizona. He is also an immigrant, operates multiple businesses, is an angel investor, and is a very grateful winner. He is an avid student of efficient practice management and frequently speaks on coding, billing, practice management, and online reputation management.

Urologists from across the U.S. and the U.K. have visited his practice to learn about practice efficiencies.

Dr. Lin consults for numerous physicians who are starting and running successful practices.

He believes in sharing knowledge and paying it forward.

Dr. Lin helps urology practices throughout the U.S. as the host of The Thriving Urology Practice Facebook Group. He runs multiple YouTube channels. You can also find him on all the popular social media channels as @jclinmd.

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