One of the difficult decisions facing hospitals is whether to be “in-network” or “out-of-network.” In-network hospitals have contracts with commercial insurers to accept discounted rates. In-network hospitals tend to have fewer denied claims and more timely payments from insurers. However, many hospitals find these advantages are outweighed by one huge disadvantage — extremely low in-network reimbursement rates. Low insurance reimbursement rates have been blamed for a wave of hospital closures and bankruptcy filings in New Jersey. This problem has driven a number of New Jersey hospitals to explore leaving insurance networks altogether and becoming out-of-network with respect to some or all of the state’s large commercial insurers.
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