Out of Network - The Challenge to Educate: D.A.R.E
Hannah Ortiz, MD

  • Define: It is the responsibility of MSSNY to define what it means to be “out of network.” Physicians need to understand that non-participation is an option. This should be done in at least two simplified formats (trifold fold mailing and email) circulated to members and non-members alike. This would also be an excellent recruitment tool and potentially recoup lost revenues from frustrated physicians who have opted out of MSSNY membership.
  • Alert: Part of the definition should alert physicians of the potential for improved income for those who are out of network. More importantly, it provides a bargaining chip for those in-network physicians negotiating contracts with insurers. Absence of the out-of-network option as a bargaining chip translates into insurers effectively transforming physicians into lemmings, happily jumping off a cliff to their financial demise as less educated and talented people continue to augment their revenues at physicians’ expense.
  • Reject: MSSNY and non-MSSNY members alike need have the courage and understanding to reject low-revenue models through non-participation. Defining the terms, alerting physicians to the negotiating power of non-participation are the first two steps. Rejection of the in-network model is the third step, but it requires support and education.
  • Educate: Implied in the challenge to educate is the responsibility of MSSNY to provide committed one-on-one mentorship to physicians who elect to go out of network and seek guidance through the process. This should include telephone or online support from mentors, recommendations on out of network models (e.g. IPA), billing and collection services, EMR ideas, financing options, among others.  The Out of Network Preservation Group can grow into such a mentorship model.