Clarification on BCBS par plan

[Steve Verno]

My answers contain NO leagal ramifications, but are provided for training only.  Legal questions should be answered by a healthcare or contract attorney!

1    If you are in the par plan is the patient considered out of network?
This should be better answered by a lawyer.  If the doctor agrees to be contracted with the insurance company, the contract specifies whether the provider is in network with the patient's insurance company.  The patient has nothing to do with par.  For example, if you agree to be a contracted or participating provider with Aetna, BCBS,or any other commercial insurance company, you may agree to be part of a network of providers who agrees to treat the insurace company members.

2    If we remove ourselves from the plan we were told the check would go the patients. We already have electronic deposits setup with BCBS.

Payment of the benefit can be according to State Law or the insurance company's internal payment policies.

3    Does BCBS pay more if you are out of network versus the PAR agreement.

We have nothing to do with what an insurance company pays on claims for health benefits.

4    What is the advantage of the par plan?
That depends on the insurance company and the contract terms.

5    What would you do

Talk with a healthcare attorney rather than try to get free legal advice on a billing forum and leave the contracting up to the provider and not interfere with his practice. Just remember, you asked what "I" would do. 

[Pay_My_Claims]

I am assuming that you mean the "par plan" as you are a BCBS par provider.
A few questions.
 
1    If you are in the par plan is the patient considered out of network?
* if you are a par provider, the patient is in network
2    If we remove ourselves from the plan we were told the check would go the   
      patients.
* Yes, BCBS does send the clients the checks if you are an out of network (non par) provider. Been there, its hell when you have cases like we do in DME and we have had clients cash the check (what a mess)
      We already have electronic deposits setup with BCBS.
3    Does BCBS pay more if you are out of network versus the PAR agreement.
* NO, being out of network only means you can balance bill the client. BCBS will only pay what they allow per HCPCS or CPT code. In network you have to adjust off, out of network you can balance bill.
4    What is the advantage of the par plan?
* The advantage is you will be paid per the clients in network rate, and it decreases your AR so that you are not chasing clients for monies. Its an advantage to the client so that they get a lower out of pocket expense. Disadvantage is, you can't balance bill.
5    What would you do?
* I would stay a Par provider....but that is just my opinion

[Chiropay]

We are currently in BCBS Par plan.
The plan initially 4 years ago was to go in network with BCBS.
We applied twice and got denied twice. I have left us in the par
plan for the last 3 years. We are not in any other networks.
I am evaluating as to whether it it beneficial to us to stay in the par plan.
I don't see any benefits to stay in the par plan. In fact I like the idea
of being out of network. A little bit less control via the insurance carrier.
 
A few questions.
 
1    If you are in the par plan is the patient considered out of network?
2    If we remove ourselves from the plan we were told the check would go the   
      patients.
      We already have electronic deposits setup with BCBS.
3    Does BCBS pay more if you are out of network versus the PAR agreement.
4    What is the advantage of the par plan?
5    What would you do?
I appreciate, if any body can help me in this regard.
Thank you for your help.