Eye care providers come in all different shapes and sizes, as do their patients. Different practices and different communities are going to require different approaches from their ECPs.

For some, that means changing the approach to vision plans and practicing as an out-of-network provider.

In-network vs. out-of-network providers

Some ECPs think out-of-network is the right move, but they’re not 100% sure what that means in practice. That’s alright! This isn’t something they teach you in school. However, it’s important to understand the difference—even if you plan to remain in-network.

Here are some of the changes you can expect as an out-of-network provider:

• Extra effort to capture patients: You’ll probably have to put in a little extra work to find patients. While extra work may not sound great, you do have greater control over your practice’s marketing and patient demographics. Many providers do this by focusing on a niche they enjoy specializing in, such as children. 
• The benefits battle: Verifying benefits as an out-of-network provider can be a hassle. You won’t have a handy payer portal to authorize benefits. Instead, you’ll have to call vision plans to verify individual patients’ benefits.
• Fun with filing claims: When you’re an out-of-network provider filing claims can be a pain. It’s a paper process and one that’s primed for errors. Some providers put claim-filing on their patients. Ultimately, this can hurt the patient experience. ‍
• Rising revenue per patient: Practices often see revenue per patient increase after going out-of-network. Typically, this is enough of a draw for providers to leave managed care—after all, it’s a pretty big draw. Anyway, with the right out-of-network solution you can eliminate most of the downsides while holding on to this very attractive upside

How to become an out-of-network provider

There are several steps to planning for and becoming an out-of-network provider. Here’s some of what you should consider before leaving managed care:

• Will you leave all payers at once or one-by-one? Plan out your extrication and start writing letters to the vision plans.
• How will you explain this to your community? You’ll have time after sending your letters. Communicate with patients. Explain the improved care your practice will offer as an out-of-network provider.
• Develop a marketing strategy. You won’t be on vision panels anymore. You should identify new channels for prospective patients. 

Determine whether an out-of-network verification and claim filing solution is right for your practice.

Verifying out-of-network benefits

Make sure to place some buffer time between collecting an out-of-network patient’s information and his or her appointment—you’ll need it. If you don’t have an out-of-network solution for verifying benefits you’ll probably have to call the payer.

Most providers prefer a digital solution. When you’re in-network you’ll typically have access to a portal for verifying benefits. However, when it comes to verifying out-of-network benefits, for most vision payers the only way to do it online is through Anagram.

Paper claim forms are prone to denials—which means more paperwork.

Filing out-of-network claims

Claim filing also changes when you’re an out-of-network provider. You have a few options:

• File paper claim forms and mail them to payers for your patients. 
• Have your patients pay for care and ask them to file their vision plan claims. 
• Use Anagram to digitally file out-of-network claims for your patients.

Filing paper out-of-network claim forms

For direct care practices, filing claims requires the correct form.

For example, for VSP reimbursement you’ll need an out-of-network VSP form for claims. And the same for Eyemed payment. You’ll need to submit the claim with the out-of-network Eyemed reimbursement form. Davis Vision out-of-network patients require the same as well.

If you’re OK with paper claim filing then more power to your practice! Everyone has their own processes. However, any ECPs find they don’t have time to fill out and submit paper claim forms. And if the provider makes a mistake handwriting an entry on the form a denial is likely in the works.

Without an out-of-network insurance solution, out-of-network claim filing can be a significant obstacle for practices eyeing direct care.

Patient engagement as an out-of-network eye care provider

Most people don’t know their vision plans come with out-of-network benefits. And many prospective patients tend to prefer in-network care.

In fact, 60% of patients who see out-of-network providers without knowing it would have preferred in-network care.

So, how do out-of-network ECPs capture more patients? By educating them!

You and your staff should develop and practice new scripts.

Train your staff for direct care

ECPs who go out-of-network typically develop new scripts for their staff to employ when engaging with patients. These scripts emphasize the benefits of direct care. Often, these explanations are enough to convert wary individuals.

With a little training, your employees should have the script down in no time! And from there you can help patients leverage their out-of-network benefits.

Explain the change in your marketing

You can also get ahead of the confused patients issue by communicating with them before the change.

If you can dispel the confusion around out-of-network patients before speaking them, you’ll make it easier for your staff to explain your direct care approach. You can social posts, emails, blogs, videos and much more to educate your community on out-of-network benefits. Just get your marketing content topics together and get started!

Deciding for your practice

Provider choice means patient choice. In the end, ensuring what’s best for your patients is the best move for your practice. If that means remaining in-network, that’s a great thing for the community you serve!

But for some providers, there’s an allure to practicing out-of-network. It’s up to you to make the decision that’ll work best for yourself, your staff, your practice and your patients.