I am an independent audiologist and own my own very successful practice. I am frequently solicited by networks that claim to have agreements with certain health plans. In order to receive reimbursement or patient flow, I am asked to sign up and follow certain rules. I am concerned about my autonomy and the role of networks in the profession of audiology. What is your advice? –

Congratulations on your success as an independent practice owner. It takes special skill to manage a practice as well as provide the services. Joining a network is a decision that is best evaluated on an individual practice basis. First, let’s differentiate between a network and a buying group. Networks are organized groups of licensed providers that meet and agree to certain requirements in order to receive directed business. Buying groups offer volume hearing aid purchasing discounts. Some networks have buying groups but not all buying groups are networks. It’s important to know the difference. Networks can bring value and opportunities to private practice owners under the right circumstances. Most networks have arrangements with health plans and other benefit sponsors to deliver a hearing program that offers their members consistent products, uniform pricing and usually, cost savings. The plans benefit from centralized administration of the plan, better customer service, and savings on administrative costs, such as credentialing, network management, and claims administration. Often networks invest a significant amount of money into marketing benefits and discounts, and the members responding are directed into participating provider offices. There can be a high level of benefit to all parties, as long as everyone plays by the rules. Consider the following in determining if joining a network makes sense for your practice.

– Is your practice at full capacity? You should look carefully at your appointments and identify if your schedule would benefit from additional patients.

-Do you turn patients away because they have a certain insurance coverage that is administered by the network? If so, it may be worthwhile to accept the terms of reimbursement rather that to direct them elsewhere or interrupt the continuity of care.

– Can you live with the terms and reimbursement levels of the network? Have a good understanding of the rules and whether or not they work for you. Note – If you agree to the rules, you should play by them. Agreeing to the terms and then directing patients away from the plan or inserting your rules is not just a violation of the agreement, but an unfair business practice.

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