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In Virginia can health care providers opt to participate in some (but not all) of a Insurance carrier's plans? |
For example, do doctors have legal a basis to choose whether to participate in only the PPO plans for a health insurance company and not in their HMOs? What if the insurance company farms out its credentialing to a 3rd party payor? Any one know the section in the code ov virginia that would be applicable to this? yes they can do it. It's up to the provider to decide which plans to participate. If the physician has decided not to participate, some insurance companies offer the members a chance to get their physican in network. Source(s): claims specialist - 10 years I do not know the code, but I know they can do it. claims person Absolutely they have a legal basis to pick and choose what forms of a plan to take. There are hundreds of plans, each with dozens of networks, it's impossible to take them all. Often, HMO forms of plans require the doctor to have a certain number of patients on this plan and if they're a small practice or limiting the number of patients they take on for logistical purposes (personally, I'd rather not go to a Doc-in-the-Box patient mill. I'd rather they treat me as a person, not a case number.) then it doesn't work for them to take the HMO, but the PPOs don't usually have these requirements. I'm a medical biller in NY |
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