Non-Participating Provider Letter to Patients: Editable Samples & Writing Guide

Sometimes, the patients get confused after receiving bills that are higher than their expectations. This happens because the healthcare provider is non-participating with their insurance. To resolve this issue, medical clinics or medical billing service providers should clearly inform patients about their insurance status. For this, they can send a letter to the patients to clear their confusion. 

What Is An Non-Participating Provider? 

A Medical Provider who accepts Medicare but does not accept the Medicare-approved payment as the total payment. It simply means that it depends on the doctor whether he wants to accept the Medicare payment or not. 

The doctors who do not accept Medicare’s payment can charge more, but they cannot charge more than 115% of the Medicare-approved payment. This is known as a limiting charge. Therefore, when the doctor does not accept the Medicare payment, the patient has to pay a little more to them. 

What Is The Difference Between Participating And Non-Participating Providers? 

Things That Patients Should Know: 

The following are the things that patients should know, because when they know things clearly, it creates ease for them in paying bills. 

• The Medicare patients do not have to pay more than the limit set by Medicare. 
• When Medicare pays its part of the bill, the remaining bill is paid by the patient.
• The additional amount is mostly 9% more. 
• Non-participating providers can also send claims to Medicare. 

Why Is It Important To Write A Letter To The Patients? 

If the provider becomes non-participating, patients should be informed about it. You should write a letter to the patient to inform them. It helps the patients: 

• To know about the bills clearly, because when they get surprise bills that are more than their expectation. They get confused and upset. 
• It builds a trustworthy relationship. 
• It provides options to the patients. So, they can choose the option thatsuits their financial condition. 
• Avoid misunderstandings. 

How to Write a Non-Participating Provider Letter? 

The letter that is written to the patients informing them about the non-participating provider should be clear and honest. You must write everything clearly, so that it is easy to understand by the patient. This helps the patients to clear the confusion and the pateint feel supported and comfortable. 

What Are The Major Parts Of The Letter? 

The following sections are the major parts of the letter that is written to the patient: 

Letterhead: 

• It is the first portion or beginning of the letter. This holds the practice name, contact details, email information, and address details. 

Pateint Data: 

• This portion holds the information related to the patient, like pateint’s name, contact details of pateint, and their addressdetails. While writing a letter,,r the spelling of the patient’s name and address should be checked carefully to avoid mistakes. 

Greetings: 

• Polite and sweet words should be written at the start of the letter, that make thm feel respected and creates a strong relationship. 

Introduction: 

• Write the reason why you are writing the letter to the patient. Tell them clearly and honestly about the main objective of writing la etter to them.

For example: 

• If you are writting letter to inform the patient about your insurance status. Keep this part short. Just tell them the reason for writing the letter. 

Explanation: 

• This is the most important portion. Explain everything thatis related to non-participating providers. Tell them what it means, what the possible amount you have to pay is, when the change can occur, etc. Do not use difficult words that cannot be easily understood by the patients. 

Patients Options: 

• Tell the patients about different choices clearly. 

Closing: 

• End the letter with polite words. Also, write the Doctor’s name, signature, and their Contact details. 

What are the Things You should Avoid In Writting A Letter? 

• Do not use difficult terms. 
• Do not use cold and harsh words. 
• Writing unclear payments. 
• Not writing contact details. 
• Do not blame the insurance companies. `

Role Of Medical Billing Services In Non Participating Status

Managing non-participating billing needs:

• Accurate coding and claim submissions.
• Ministering restructuring charges.
• Verifying Medicare repayment.
• Managing patient billing inquiries.

Expert support for DocVaz Medical Billing supports practices in sustaining revenue perfectly while lowering patient dissatisfaction. Professional medical billing services lower administrative mistakes and enhance communication strategies.

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