Is out-of-network right for your ASC?

As president and CEO of MedSynergies, Inc, Irving, Texas, John R. Thomas knows insurance benefits. After all, his company offers management and billing solutions to health care providers and facilities. So when Thomas opened an envelope to find his insurance company had sent him a higher-than-expected bill for spinal surgery by an out-of-network neurosurgeon, he thought the "misunderstanding" would be cleared up with a phone call. The surgeon's office had precertified the surgery. But Thomas was in for a shock. "After 45 unenlightening minutes with the company's support team, a personal letter, and other phone calls, the out-of-network surgery became ineligible," he says. This despite the fact Thomas could find no "ineligible" category in his policy.