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As the saying goes, forewarned is forearmed. But when that medical bill shows up inflated like a hot air balloon, patients are left scratching their heads wondering what happened.

The culprit?

Non-participating providers who don’t play by the insurance rules.

Therefore, healthcare providers must learn how to write to patients explaining the non-PAR puzzle to prevent financial frustration.

Physicians can help patients better understand the implications of their non-participating status by sending an explanatory letter. The letter should clearly explain the practice’s non-participating status, warn patients they may face higher out-of-pocket costs, and suggest options like fee negotiation or switching to an in-network provider to lower bills.

With open communication, non-participating doctors and patients can navigate this uncertain territory together and find the ideal balance of choice and budget-friendliness for each patient’s needs.

About Non-Participating Providers (non-PAR)

Non-participating providers are those medical professionals who have signed up for Medicare but decided not to accept the approved Medicare payment as full compensation for their services. These healthcare workers can choose on a case-by-case basis whether to accept Medicare’s proposed payment amount.

When a provider chooses not to accept an assignment from Medicare, they must follow the rules for limiting how much they can charge for services. If the non-participating doctor does not agree with the Medicare payment, they can charge the patient up to 115% of the Medicare-approved amount. This is known as “limiting charging.”

Things patients must keep in mind:

• Medicare beneficiaries are not answerable for paying more than the limiting charge for a covered healthcare service.
• While non-PARs can charge more than participating providers, the difference is comparatively minor (typically around 9.25%).
• Non-PARs can submit claims to Medicare, but they bill the patient straight for the outstanding amount after Medicare pays its own piece.

How to Write a Non Participating Provider Letter to Patients?

When crafting a thoughtful letter to patients regarding a practice’s change in insurance participation status, it’s best to be transparent yet reassuring.

The letter should open with a warm greeting to the patient by name and clearly state its purpose. The doctor can then explain the specifics of the non-participation status in simple, friendly terms. Most importantly, the letter should extend a helping hand, assuring patients their care team remains committed to their health and encouraging them to reach out with any questions. In the end, a sincerely penned send-off leaves the patient feeling valued.

Major Sections of the Letter

Every letter written to patients should have elementary sections:

➙ Letterhead consist of [Practice Name, Address, Contact Info]

➙ Date [Mention the Date when the letter is written]

➙ Patient Information [Name, Address, Contact Information]

➙ Salutation [Formal greeting for patients, like Dear or To Whom it may concern (Patients Name)]

*Always make sure you have written the correct spelling for the recipient name.

The Pattern of Writing a Non-Participating Provider Letter

It can be frustrating when a patient’s trusted doctor is suddenly no longer part of their insurance network. To soften the blow, physicians will often write a thoughtful letter to patients explaining the change in a caring and personal tone. The goal is to convey the news in an empathetic way while also easing the transition to a new provider.

Part #1 – Writing the GREETINGS section:

When crafting the greeting for a non-participating provider letter, it’s key to start things off on the right foot. You want to come across as warm, humble, and respectful – not cold or distant.

I’d recommend opening with a simple “Dear [Patient’s Name],” followed by their first name if you’re on a first-name basis. This establishes a personal connection right off the bat.

Dear John,

Part #2 – Writing the INTRODUCTION section:

To hook the reader, start the introduction with a short, friendly greeting that establishes your relationship. Then transition smoothly into the purpose of your letter – be transparent about the change in insurance participation status. End with a reassuring statement about continuing care.

Express your regret that you won’t be able to provide continued care, but reassure them that you’ll do your best to make the transition as smooth as possible.

This is Dr. [your name] contacting you about a change in my practice. I know this may come as unwelcome news, but effective 2024 I will no longer be a participating provider with [name of insurance plan]. Please know that I will do my best to make your transition to a new provider as seamless as possible.

Part #3 – Writing the MAIN BODY of the letter:

Use the main body section of the letter to write the news in detail. Try to explain things in a calm and composed manner, like telling a child that Santa Claus isn’t real.

First, set the scene with a warm opening paragraph. Perhaps reminisce about the relationship you’ve built together over the years. Speak to the trust between doctor and patient.

Then transition smoothly into the topic at hand. Don’t just blurt out the change in blunt terms. Ease into it. Say you’ve given this careful thought but feel it’s the right decision for your practice. Apologize for any inconvenience while stressing that top-notch care remains your priority.

When explaining the impact, use a light touch. This isn’t the time for complex insurance jargon. Keep it simple. They may pay more out-of-pocket. Reassure them you’ll provide estimates. If applicable, share ways to mitigate extra costs like payment plans.

Close with optimism and appreciation. Convey eagerness to continue the relationship. Let positivity and goodwill shine through.

I still remember our first appointment 15 years ago, when little Tommy had the chickenpox. My how time flies! Watching your children grow into young adults has been a privilege. As their trusted pediatrician, I cherish the bond we’ve formed over the years.

It is with mixed emotions that I share my practice will no longer participate with [insurance company’s name here] insurance plans starting 2024. This difficult decision was made after much careful consideration. Though I will deeply miss working closely with [patient’s insurance company name], I feel this change is necessary to sustain the high quality of care my patients expect and deserve.

Please know that your family’s health and wellbeing remain my top priority. You may incur higher out-of-pocket costs for appointments, but my team and I will provide estimates beforehand so you can plan accordingly. We also offer flexible payment options. Above all, you can expect the same thoughtful, dedicated care from someone who has had the honor of caring for your children since the chickenpox days.

Part #4 – Writing the CONCLUDING LINES of the letter:

As you wrap things up, speak not as a distant doctor but as a fellow human. Tell them you care and want to help. Provide your personal contact information. Make it clear you’re still on their team and will continue to support them, even if from the sidelines. Reassure them they are not alone in this difficult transition.

I know this news is disappointing. Please know I remain your advocate and will help you find a new provider. You can reach me directly at [number] if you have any questions or need assistance. Your health remains important to me. I’m here for you.

Part #5 – Writing the CONCLUSION part:

End with a courteous and well mannered sign-off.

Best Regards,

Dr. [Your Name]

[Contact Information]

[Your Signature]

Writing a Non Participating Provider Letter to Patients – Sample #1

CASE: Sketching out patient responsibilities to bear healthcare expenses

Dear [Patient Name],

I am writing this letter with a heavy heart to inform you that unfortunately, as of 2024, our practice will no longer be participating with your [insurance plan name] insurance plan. Please know that this difficult decision was not made lightly, and in no way reflects on the value we place on our relationship with you, or the high quality of care you have received as our patient.

Over the years, you have become more than just a patient to us – you are a cherished part of our practice family. The trust and rapport we have built together is something I hold in the highest esteem. However, the business realities of running a practice have made continued participation in your insurance plan unsustainable for us.

While this news may come as an unwelcome surprise, I want to assure you that our commitment to your health and well-being remains as strong as ever. Your options at this point include: 1) switching to an insurance plan we do participate in, if available to you, 2) paying out of pocket for your care at our practice at a reduced rate, or 3) finding another provider who accepts your current insurance. Please know that whatever you decide, we fully support you and only want the best for your health.

You have been an invaluable part of our practice, and we consider it an honor and privilege to have served as your healthcare providers. We hope that we can continue to do so for many years to come. Please contact us right away to discuss how we can make that possible.

With deep appreciation and warmest regards,

[Provider Name & Signature]

[Practice Name]

[Contact Information]

[Patient Acknowledgement Signature]

Writing a Non Participating Provider Letter to Patients – Sample #2

CASE: Patient having a Catastrophic Health Insurance Plan

Dear [Patient Name],

We are writing to share some news about our practice that will impact your care. Over the years, we have been honored to provide you with the highest quality cardiovascular care and support. You have become more than just a patient – you are part of our family.

Unfortunately, your insurance carrier recently reclassified us as a non-participating provider for your catastrophic health insurance plan. What this means is that for any future appointments or procedures, your insurance will likely cover only a small portion of the total cost, leaving you responsible for the remainder.

We understand this is disappointing and frustrating news. Our top priority has always been providing you the best care and service. However, as a small practice, we have little control or influence over insurance company policies and network decisions.

Please know that we remain fully committed to your health and well-being. While insurance coverage may change, our dedication to you will not. We encourage you to review your specific insurance policy details to understand your benefits and financial obligations going forward. Do not hesitate to call us with any questions or concerns you may have.

You have been with us through life’s ups and downs, and together we have celebrated many victories. We hope to continue being your trusted partner in health for many more years to come. Our door is always open.

Wishing you the very best of health,

[Provider Name & Signature]

[Practice Name]

[Contact Information]

[Patient Acknowledgement Signature]

Writing a Non Participating Provider Letter to Patients – Sample #3

CASE: Patient insured with Medicaid plan

Dear [Patient Name],

We have had the honor of caring for you and watching you blossom in health over the years. Your warm smile and friendly conversations have brought joy to our office. It is with deep regret that we share this difficult news.

Due to changes in your insurance coverage, we are now considered an out-of-network provider under your new Medicare Advantage Plan. We value the trust you placed in us as your healthcare providers. However, the rules of your new plan mean you will face higher out-of-pocket costs if you continue seeing us.

We want to see you continue thriving, which is why we encourage you to explore your in-network options. Connect with your Medicare Advantage Plan to fully understand your benefits and find new providers. This transition can be challenging, but we have faith you will find the right fit.

Although it saddens us, we must ask you to acknowledge responsibility for the full cost of any future care with us. Please review the payment terms and conditions.

You will always have a special place in our hearts. We wish you the very best and will be here if you need help navigating this change. Stay healthy and be well!

Regards,

[Provider Name & Signature]

[Practice Name]

[Contact Information]

[Patient Acknowledgement Signature]

Writing a Non Participating Provider Letter to Patients – Sample #4

CASE: Notice for Self Payment of all Medical Expenses

Dear [Patient’s Name],

It is with a heavy heart that I must inform you of a change in our medical services. Our practice is no longer able to accept insurance coverage for appointments and procedures.

I understand this may come as an unexpected burden, especially during an already difficult time in your health journey. Please know we care deeply about your wellbeing and want to continue supporting you on the road to recovery.

Although we cannot directly assist with insurance claims, our dedicated staff is here to help explore financial aid options that may be available to you. We offer flexible payment plans and will work diligently to find a solution that eases this transition.

Your health and comfort are our highest priority. We value the trust you have placed in us and remain committed to providing exceptional care, regardless of insurance limitations.

Please do not hesitate to call us with any questions or concerns. We are in this together and will get through this change as a team, with compassion and understanding on both sides.

You are so much more than a patient to us – you are family. We look forward to continuing this relationship for many healthy years to come.

Sincerely,

[Provider Name & Signature]

[Practice Name]

[Contact Information]

[Patient Acknowledgement Signature]

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