In my experience, many providers assume that they want to be in a payer’s network to obtain more patients / customers and, therefore, to generate more revenue. In many scenarios, this is true, but it is not always the case. The purpose of this article is to outline the pros and cons of being in a payer’s network as a participating provider (“Par”) provider or out of network (“Non-Par”) provider. I will also describe the factors that you can use to build a financial model or use one that I have built to evaluate this decision in a more objective manner. In my experience, many providers who are not offered fee schedules that meet or exceed their expectations will automatically jump to the conclusion that they are better off being out of the payer’s network and that the payer is “messing them over”. My first piece of advice is do not jump to a conclusion one way or the other. Take your time and evaluate both the qualitative and quantitative benefits, the pros and the cons.
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