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  • Not Participating With Commercial Carrier and its Medicare Advantage Plan

    Our practice has decided to not renew its contract with a commercial carrier and its Medicare Advantage plan. What rules apply to seeing the Medicare Advantage plan participants when we still participate with traditional Medicare? Are they now private pay?


    Some Medicare Advantage plans offer out of network benefits. You can submit claims, but you must follow the explanation of benefits (EOB) remarks regarding patient responsibility. Being out of network, you may be denied requests for necessary prior authorizations.

    Follow developments about the No Surprises Act rules for out-of-network billing of the patient’s responsibility.