The Question of "Why"?

Out-Of-Network (OON) providers are putting themselves at risk of audits because they fear losing patients to in-network doctors. Many OON providers and facilities feel that if they charge patients their full bill, and disclose pre-services that patients are responsible for full charges, that their patients will not choose to use or continue to use their services. Out-Of-Network providers are required to balance bill patients in almost all cases. The trick is to obtain a proper patient disclosure.

In the short-term the decision not to balance bill may pay off in terms of attracting or retaining customers, but ultimately the insurance providers or government officials WILL audit you. The risk of penalties and/or criminal charges far outweighs the reward of retaining a few extra customers. The risk of audits for OON's are at an all time high and are not going away as many insurance providers look to push OON providers in-network.