CBP 54: The Logistics of Billing OON on Behalf of Patients – Cash PT Lunch Hour interview of Jerry Durham PT – PPS Conference Episode Part 2

Some cash-based practices, like mine, don’t bill insurances out-of-network (OON) on behalf of their cash-paying patients. However, many practices do offer this service. Especially those that have transitioned from in-network to out-of-network… and that’s where things can get really tricky.

This interview is from an in-person interview Aaron LeBauer and I did with Jerry Durham at the 2016 PPS annual conference in Las Vegas. Jerry and his partner, Sturdy McKee, have a 3-clinic practice in San Francisco that has transitioned completely OON with all private payors.

He has spent years perfecting the art of billing OON and having conversations with prospective patients that leads to the patient to going OON rather than sticking with their in-network PT options. This interview is absolutely packed with high level strategy as well as nitty gritty details and logistics of how billing insurances completely changes when you’re no longer in-network with them.


In this episode, you’ll learn:

  • How to Survive When Insurance Companies Try to Strong Arm Your Practice
  • How to Set a Fair Fee Schedule and Balance Bill Your Patient for “Out-Of-Network” Benefits
  • Learn The Difference Between In-Network, Out-of-Network & Cash-Based PT
  • How Being “Out-of-Network” is Better for Everyone
  • The Customer Lifecycle
  • The Benefits Call Back
  • The Best Way to Respond When Asked “Do You Take My Insurance?”
  • What He Is Doing with the Patients Who’s Insurance Don’t Pay…
  • Essential Advice to Anyone who Wants to Get Rid of Money-Losing Contracts
  • Jerry’s Top Strategies to Develop Customers for Life

Resources and Links mentioned in this episode:

Click Here to learn how to start your own Cash-Based Practice

Let us know if you enjoyed the show:

[Click to Tweet] Thank you @Jerry_DurhamPT for being an awesome guest on the Cash-Based Practice Podcast w/ @DrJarodCarter & @LeBauerPT

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{ 2 comments… read them below or add one }

Aaron LeBauer December 13, 2016 at 3:35 pm

This was such an awesome interview! I’m stoked to have had the opportunity to work with you on this and get this vital information out in front of everyone. It was awesome having you there to help tease out the details and ask some great questions.
It was also great to finally meet you in person at PPS this year and I’m looking forward to the next time!


Dr Jarod Carter December 14, 2016 at 1:57 pm

Thank YOU so much for including me! It was great to meet you too and look forward to many more of these in the future


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