Template Letter for Going Out-of-Network:

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“Breaking up is hard to do” was once a popular song, and physicians might think of it as they wonder how to extricate themselves from the grasp of insurance companies. But only three things are really needed: the proper address for mailing your termination notice to the insurer, the use of “certified mail, return-receipt requested” at the post office, and the retention of a copy of your letter with the tracking number. Remember, insurance networks are merely contractual, and contracts are broken every day. We have never heard of an insurance company trying to sue a physician for leaving, and the contract probably has a termination clause with which you can comply in departing. Here is a template letter for going out-of-network:

Checklist for physician:

1. Be sure to include a date on the letter.
2. Be sure to send it to the correct address.
3. Be sure to keep a signed copy of the letter along with the paperwork to track delivery.

Template:

[Date]

BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED

[address in insurance contract for notice purposes]

To Whom It May Concern:

This constitutes notice that I am voluntarily terminating my contract with your company and all its affiliates at the earliest date allowed by the contract. My [EIN or NPI] number is __________.

Immediately upon the effective date of this termination, I will then be “out of network” with your company. All patients in your plans will then be expected to pay my out-of-network fees.

Please let me know promptly if you have any issues concerning this termination.

Sincerely,

[physician signature] [physician name]

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