Managed Care Contract Negotiations
Apr 08

Sample change in network status letter

This is a model letter that you can use to alert patients of your planned change in network status.

Dear Patient,

We would like to inform you of a significant step for our practice that will take place in phases over the next few months. By January 200_, we will no longer participate as in-network providers for private insurance plans. Some of these contract terminations will occur earlier (our participation in government-funded plans such as Medicare, Medicaid, and worker’s compensation will not change).

There are two important outcomes of these changes:

1. Our practice is open to patients with all types of plans that allow choice of provider (PPOs), in addition to patients who choose to receive care outside of their plan (HMOs). We certainly hope to continue to provide care for all of our patients.

2. We are reducing our fees in an effort to make it possible for most patients to continue with us.

We will continue to file your insurance claims and accept payments directly from carriers (as nonnetwork providers). The deductible and coinsurance are your responsibilities, although in many cases your total out-of-pocket amounts may not change or may be less because our fee structure will be reduced.

Because nonnetwork providers are not contracted to accept office copays, some patients may pay somewhat higher fees for office visits until their deductibles are met—typically around the first of the year. We will also offer prompt-pay discounts for those who pay at the time of service.

We have revised and printed out our policies and procedures for cases of financial hardship. There are several ways in which we can work with patients in these circumstances. Please contact our financial coordinator (name and telephone number) to discuss specifics.

These changes are due to a careful analysis of the additional cost of providing medical care that has increased in recent years due to insurance complexity.

We support the goals of health plans and employers seeking to reduce unnecessary costs and utilization and will continue to do so. We believe that our practice, patients, area employers, and even health plans will benefit from the steps that we are taking toward a more efficient and straightforward process in handling insurance issues. In other words, our changes should provide a win-win for all parties in the long run.

We recognize that individual benefit plans and circumstances differ and that questions will remain. We ask that you direct your questions to our Patient Accounts Department (telephone number), who will be happy to assist you.

Thank you for continuing to entrust your care to the ABC Medical Group.

Sincerely,

Signature from person who wrote the letter

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →