Out-of-network services performed during the PHE
Since the beginning of the COVID-19 pandemic, many insurance payers have lifted or reversed their reimbursement policies. For example, some out-of-network services are temporary payable by various commercial, HMO and Medicare/Medicaid advantage plans. In New York, COVID-19 vaccine administration is covered by all the insurance payers regardless of a provider’s participation status. This widespread availability has resulted from a respective regulation issued by the New York State Department of Financial Services back in 2020.
However, in most cases, coverage of certain procedures when performed out-of-network is still dictated by a patient’s benefit plan. For example, Metroplus Medicaid HMO plans, Essential plans, Medicare HMOs will only cover emergency room services for out-of-network providers, apart from COVID-19 vaccine administration. Other insurances apply a similar approach.
To sum up, despite the pandemic, out-of-network practitioners still cannot receive payment for the majority of services if a patient’s plan does not include out-of-network benefits.
Therefore, it is critical to check the eligibility of your patients prior to rendering a service.
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