Surprise Medical Billing Solutions

Proactive, Highly Attentive, and Smart: Your Trusted Out-of-Network Billing Partner, Wise Medical Billing

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What is Out-of-Network Billing?

In the realm of healthcare finance, out-of-network billing, often known as "surprise medical bills," emerges when a patient receives an unexpected invoice for the variance between the out-of-network provider's charges and their insurance coverage, after accounting for copays and deductibles. For individual clinical practitioners, comprehending the nuances of out-of-network (OON) billing can be a lucrative opportunity in today's ever-evolving and challenging insurance landscape.

Mastering this process is essential to ensuring an uninterrupted revenue flow and avoiding potential reimbursement roadblocks imposed by insurance companies. By navigating OON billing effectively, you can enhance your practice's financial stability and patient satisfaction while also capitalizing on this valuable revenue stream.

Wise Medical Billing Services

Our Out of Network Negotiation Process

When it comes to navigating the intricate world of out-of-network billing, especially for hospitals and freestanding emergency rooms, expert negotiation skills become a paramount feature. Wise Medical Billing (WMB) brings a wealth of experience to the table, with a specialized team dedicated to negotiation settlements. Our mastery in medical billing, coding, and revenue cycle management, honed over decades, is tailored for the unique needs of individual clinical practitioners, hospitals and ERs.

Partnering with WMB's adept medical bill negotiators unlocks a world of advantages for individual clinical practitioners. Dealing with insurance companies and their tactics to minimize bill reimbursements based on benefit limitations can be a formidable challenge. Our team acts as your ally, ensuring maximum reimbursements while you concentrate on what truly matters - your clinical practice.


Our Medical Billing Negotiation Service Approach

We make sure all necessary information is collected at initial contact, particularly regarding patient history and benefits.
Our staff will review your current practices and policies to make sure you’re abiding by all state and federal laws to protect you from future audits and/or litigation.
Our trained personnel will track each patient check so that the appropriate patient portion is collected.
We create the proper messaging so patients understand their responsibilities and expectations, which is helpful later when negotiations and/or appeals with insurance companies materialize.

Before and After the Claims

OON claims continue to be on the rise, even for patients with health insurance. Revenue can be lost before an OON claim is submitted due to being unaware of the different procedure codes or the medically necessary diagnosis for a procedure you’re performing. Since insurance companies are prohibited from underpaying you or withholding due reimbursements, they delay payment with various obstacles so that you relent and leave money on the table.

How does WMB handle the above?

We review notes, reports, and code selections. We also keep you up-to-date on changing codes and coding strategies from the various payers so you know the best methods for coding claims. We also adopt in being aggressive about follow-ups and in systematically going after each claim. Our experience helps to avoid delays in processing so you’re not waiting to get paid.

Our Expert Negotiation Strategies

At Wise Medical Billing, we prioritize safeguarding your patients by employing a creative and data-driven approach. Our expert team meticulously analyzes historical data relevant to your locality, leveraging it to negotiate claims effectively. We ensure that each claim is negotiated on your and your patients' behalf, sparing them from exorbitant out-of-pocket expenses.

With over a decade of experience, we've mastered the art of negotiating with insurance companies and their vendors both before and after claim reimbursement. This extensive experience has enabled us to build our own proprietary out-of-network (OON) database, a valuable resource for identifying underpaid claims. While insurance companies consider employer preferences and limitations when reimbursing medical claims, our skilled negotiation team knows how to pinpoint limited benefit policies and employer preferences, facilitating the negotiation of your bills for maximum repricing.

Pre-Payment: We actively engage with negotiation vendors, representing insurance companies, to secure favorable settlement offers prior to claim reimbursement, ensuring you receive optimal compensation.

Post-Payment: When a claim is reimbursed by the insurance company based on pricing provided by negotiation or pricing vendors, we revisit the claim and negotiate further, aiming to maximize reimbursement.

Negotiations and Filling Appeals

In negotiating with insurance companies, you have to be on your game to have consistent OON billing success. Moreover, OON billing regularly requires that you appeal not just denials, as insurance companies will attempt to delay everything from response times to claim or procedure denials.

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How does WMB overcome this?


In today’s healthcare landscape, insurance providers are increasingly stringent in limiting reimbursements for healthcare providers. To amplify your practice’s out-of-network revenue, align with Wise Medical Billing, a dedicated partner well-versed in navigating the complexities of out-of-network billing. With extensive experience in overcoming insurance roadblocks, we will craft a personalized solution and streamlined process for your practice. Trust us to elevate your revenue potential and seamlessly navigate the reimbursement journey.

Why Partner with WMB OON Billing:

Please do not hesitate to contact us today for a quick call consultation or a demonstration of our services.

1-(888) 816-6676

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