Sample Change in Network Status: A Guide for Private Healthcare Practices

Notice of Change in Network Status

Communicating with patients during significant transitions, like a change in your network status, is crucial for maintaining trust and minimizing confusion. When your practice moves out of network with certain insurance providers, it’s essential to notify patients effectively. This blog provides a sample patient letter that your private healthcare practice can use to inform patients of this change. We’ll also offer tips on how to use the patient notification letter effectively and tailor it to your specific needs. 

Additionally, as a CPA and Medical Practice Management Consultant for Physicians, we will guide you through this process, ensuring both your practice and your patients experience a smooth transition. 

Why a Change in Network Status Requires a Patient Notification Letter

When a practice moves out of network, it can have a significant financial and logistical impact on patients. Depending on their insurance plan, patients may face higher out-of-pocket costs, or they may need to switch to in-network providers. If communicated poorly or too late, this can lead to confusion, frustration, and potentially a loss of trust in your practice. 

A clear and proactive network status letter is key to minimizing these disruptions. A well-written patient notification letter helps to set expectations and provides reassurance that your practice is still committed to their care. 

Sample Patient Letter: Notice of Change in Network Status

Here is a model letter your practice can use to notify patients of your upcoming change in network status. You can adapt this sample patient letter to reflect the specifics of your situation. 

[Insert Your Practice Name]
[Insert Practice Address]
[Insert Date] 

Dear Patient, 

We would like to inform you of a significant step for our practice that will take place in phases over the next few months. By January 200_, we will no longer participate as in-network providers for private insurance plans. Some of these contract terminations will occur earlier (our participation in government-funded plans such as Medicare, Medicaid, and worker's compensation will not change). 

There are two important outcomes of these changes: 

1. Our practice is open to patients with all types of plans that allow choice of provider (PPOs), in addition to patients who choose to receive care outside of their plan (HMOs). We certainly hope to continue to provide care for all of our patients. 

1. We are reducing our fees in an effort to make it possible for most patients to continue with us. 

We will continue to file your insurance claims and accept payments directly from carriers (as nonnetwork providers). The deductible and coinsurance are your responsibilities, although in many cases your total out-of-pocket amounts may not change or may be less because our fee structure will be reduced. 

Because nonnetwork providers are not contracted to accept office copays, some patients may pay somewhat higher fees for office visits until their deductibles are met—typically around the first of the year. We will also offer prompt-pay discounts for those who pay at the time of service. 

We have revised and printed out our policies and procedures for cases of financial hardship. There are several ways in which we can work with patients in these circumstances. Please contact our financial coordinator (name and telephone number) to discuss specifics. 

These changes are due to a careful analysis of the additional cost of providing medical care that has increased in recent years due to insurance complexity. 

We support the goals of health plans and employers seeking to reduce unnecessary costs and utilization and will continue to do so. We believe that our practice, patients, area employers, and even health plans will benefit from the steps that we are taking toward a more efficient and straightforward process in handling insurance issues. In other words, our changes should provide a win-win for all parties in the long run. 

We recognize that individual benefit plans and circumstances differ and that questions will remain. We ask that you direct your questions to our Patient Accounts Department (telephone number), who will be happy to assist you. 

Thank you for continuing to entrust your care to the ABC Medical Group. 

Sincerely,
[Insert Signature] 

How to Use the Network Status Letter Effectively 

The sample network status letter provided can serve as a starting point, but it’s important to adapt it to the specifics of your practice’s situation. Here are some key tips to ensure the letter communicates the right message and addresses patient concerns: 

1. Personalize the Letter

Include the patient's name, your practice's contact information, and any specific details relevant to the patient’s care. Personalizing the letter helps build trust and ensures the patient feels seen and valued during this transition. 

2. Clearly Outline Next Steps

Patients will want to know what happens next. The patient notification letter should explain what they can expect during the transition, such as how their out-of-pocket costs may change, what payment options are available, and who they can contact for more information. 

3. Provide Support and Reassurance

Transitions like these can be unsettling for patients, so it’s essential to provide reassurances. Emphasize your commitment to continuing their care, even if the financial arrangements change. Offer multiple ways for patients to contact your team, such as through a dedicated financial coordinator or patient accounts department. 

4. Highlight Financial Options

Be upfront about potential cost increases but also offer solutions. For example, explain any prompt-pay discounts, new fee structures, or financial hardship policies that might apply. This will help ease concerns about affordability and show that you are prepared to support patients during this transition. 

5. Send the Letter in Advance

Ideally, the letter should be sent to patients several months before the network status changes take effect. This gives them time to prepare and ask questions. It also reduces the likelihood of last-minute confusion or disruptions to their care. 

Proactive Communication Builds Trust

A change in network status doesn’t have to result in a loss of patients—if communicated properly, it can even strengthen your relationship with them. By using this sample patient letter and following the guidance provided, you can ensure a smooth transition and demonstrate your commitment to delivering high-quality care, regardless of insurance coverage. 

As a CPA + Medical Practice Management Consultant for Physicians, we understand the complexities involved in network changes and patient communication. With careful planning and thoughtful communication, your practice can navigate these transitions while maintaining patient trust and satisfaction