Logo, Stockbridge Resources, Inc (516) 387-6612
40 Cutter Mill Road, Suite 405
Great Neck, NY 11021

Stockbridge Resources, Inc

(516) 387-6612
40 Cuttermill Road, Suite 405, Great Neck, NY 11021

The Latest Insurance News on Out-of-Network Payments


Keep up to date with the latest insurance news from Stockbridge Resources. We bring you cutting-edge research on topics such as out-of-network payments.

Mecial Imaging Equipment

Out-of-Network Claims

Have you ever submitted an out-of-network claim to only receive back pennies on the dollar? Out of network claim reimbursement has recently been re-evaluated by insurance companies. The days of 70th, 80th, and 90th percentile payments of the Usual and Customary (U&C) amount are over. Carriers are moving away from usual and customary (UCR) and paying a percentage of Medicare's published rates instead. Most companies are paying anywhere from 110% to 150% of Medicare rates.

Carriers have a number of motivating factors for reducing out-of-network reimbursements; lower payments help insurance companies:

• Obtain greater member in-network utilization (in-network providers are paid at an agreed-upon
   discounted rate).
• Obtain a greater number of providers who agree to participate in the network by making out-of-network
  services cost prohibitive to members thereby depleting the out-of-network doctor patient base.
• Grow the network by greater in-network member utilization.
• Keep health benefits affordable & control cost.

                                                               Contact us to find out more about why out-of-network payment policies are changing.