Healthcare Uncovered Episode 12: Why More and More Doctors are Choosing Alternative Networks

Dr. Eric Bricker
Dr. Eric Bricker
July 19, 2023

Doctors – have you thought about joining an unconventional or alternative network? Do you know what all the buzz is about? Well, there are a lot of advantages that you might not be aware of and this week I am going to be breaking it all down for you for this episode of Healthcare Uncovered.

More and more doctors are signing direct contracts and agreements with networks outside of traditional health insurance carriers.  The reason for this shift is due to Three Main Factors:

  1. Increased Patient Volume,  
  2. Better Rates than Medicare and...  
  3. Faster Payment.

Increased Patient Volume  

Direct contracts and alternative networks have a lower or zero out-of-pocket cost for patients.  

Typically, with traditional insurance, a patient will have at least a $1,000 to $2,000 deductible and then an additional 20% coinsurance after that, meaning their out-of-pocket cost could be thousands of dollars for a test or a procedure.  

The result... often the patient chooses not to have the care at all... care that they may truly need. Alternatively, when an employer offers a direct contract or alternative network to plan members, the out-of-pocket cost is much lower or even $0.  

That decreased out-of-pocket cost and additional benefits removes the financial barrier for the patient to receive care from the doctor that signed up for the direct contract or alternative network. The result is that more patients get the care they need, and doctors see more patient volume.

Better Rates than Medicare  

Direct Contracts and Alternative Networks pay MORE than Medicare... 25% more, 50% more, sometimes 100% more than Medicare. The payment amount may be less than what a traditional insurance contract offers, but it’s much better than Medicare. And remember, Medicare Advantage plans through an insurance carrier essentially reimburse the same or even less than Traditional Medicare. So with the growth of Medicare Advantage, you are NOT going to see an improvement in your payer mix.  

Faster Payment  

Direct contracts and alternative networks pay much faster than traditional insurance carriers.  The typical time period for payment from traditional insurance carriers is anywhere from 30 to 70 days... that’s over 2 months from when you submit a bill.  

Now the insurance carrier may ‘say’ they pay faster, but you need to track your accounts receivable days to see how much outstanding revenue you have that is still unpaid. Conversely, direct contracts and alternative networks pay in as little as 2 weeks, giving your practice the cashflow it needs to pay its own bills.

Example: Mercy Hospital

Mercy Hospital in Springfield, Missouri has direct contracts with multiple employers including Walmart, Lowe’s, JetBlue and McKesson. 

Health plan members at these companies can have joint replacements and spine surgery with the orthopedic surgeons at Mercy for $0 out-of-pocket costs. Additionally, Mercy has dedicated care navigators that arrange travel and hotel accommodations for the patient and a family member, with all expenses paid by the employer at no cost to the patient. 

 The result:

The patients receive great care at no cost to them, their employers save money through better surgical outcomes and lower complication rates and the doctors at Mercy have higher patient volume from a payer that pays more than Medicare. 

Doctors, you can provide care to more patients who need it, get paid more than Medicare and get paid faster, but it requires doing things differently. Are you ready to change? Check out Nomi Health’s Open Network.

Healthcare shouldn’t be complicated. Check out Nomi Health’s Open Network of physicians to break through the red tape, collect the money you’ve earned, and get back to why you’re doing this in the first place.... helping patients.

Join the Nomi Open Network

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