What I Need to Know
Non-Participating Provider

The ability to choose participating or non participating is not always under a patient's control, oftentimes, when hospital confined, some of the care that may be received will be provided by staff that are not employees of the hospital.

These caretakers are considered outside contractors and they will bill separately for the services that they provide. The health carrier WILL pay these claims out of network at a lower reimbursement level.

Caretakers or patients in this situation should not be penalized, all underpaid claims should be appealed based on the inability to preselect or prenegotiate for in network coverage.  

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