Out-of-Network in the Time of COVID-19

Negotiations between payors and providers are a standard and common practice in the healthcare industry. Less, but increasingly common, is when both sides can’t come to an agreement before the date a contract ends. Normally, health systems in this situation are focused on alerting patients and employees to the fact that their facilities and physicians may be out of network.

But this is not a normal time. As COVID-19 captures national attention, it’s important for health systems facing a potential out-of-network (OON) scenario to carefully consider how they communicate about the new coronavirus and COVID-19. Every health system in the midst of a negotiation or OON scenario will of course encounter unique circumstances or factors, but the key communication principles will be fairly consistent. So from our vantage point, ReviveHealth has developed a framework for approaching COVID-19 communications while simultaneously facing a non-par scenario with a payor.

All organizations and brands—not just health systems—must ensure their communications during this time are not tone deaf, or seen as taking advantage of a crisis. It’s critical that health systems, especially, avoid the appearance of trying to leverage COVID-19 in a business negotiation with a payor. Any organization or brand seen as financially benefiting from this crisis will lose in the court of public opinion. The focus, as always, must continue to be on caring for patients. It’s precisely for this reason that as a general rule, communications about COVID-19 and communications about OON status should be kept separate. If nothing else, remember: not all patients will be impacted by an OON situation, but all patients are potentially impacted by COVID-19. However, it is reasonable to cross-link to content about COVID-19 as you might any other health system resource that is timely and relevant (e.g., price estimator tools), but try to keep it direct and simple.

That being said, health systems must be prepared to communicate about what an OON scenario means for patients in the world of the novel coronavirus.

To that end, we’re seeing health systems make certain operational changes to respond to COVID-19, including free telehealth visits to anyone, regardless of insurance, or standing up community call centers. These are important because they factor into a response about what being OON means for patients. If your health system hasn’t already decided, now is the time for you to consider your operational response to the novel coronavirus/COVID-19, and if those operational changes will be accessible to anybody in your community, regardless of network status. The more health system resources and services a community has access to, regardless of insurance coverage, the stronger the health system’s message when looking at a possible OON situation. How can your health system ensure to position itself as the guardian of public health?

Here are some suggested components for communications about OON in context of COVID-19, designed to reassure patients that they have options in this uncertain time.

  1. Follow CDC guidance.” Encourage patients to wash their hands, practice social distancing, refrain from visiting the emergency department unless they believe they are experiencing an emergency, and to call ahead before visiting any non-emergent facilities. This information is already on many hospitals’ websites, and the CDC has great communications resources available here.


  1. “Here is what we’re doing for the community.” State any operational adjustments in response to COVID-19, such as offering free telehealth visits to everyone, regardless of insurance, or setting up a  24-hour community hotline. You can also refer to resources available from community partners that are available to everyone regardless of insurance coverage.


  1. “Here’s what it means for you.” The answer to this question depends heavily on the answer to the previous one. This needs to be a direct message that clearly states, “If our healthcare system is forced out of Payor’s network, then patients with Payor insurance will have options A, B, and C.”


  1. “Here’s how to find out if you’re covered.” Patients need a source for answers about what’s covered, now and in the future, by their plan. And ultimately, the payor decides what they will and will not cover for their members’ care. It’s important to empower patients to seek out that information. These messages need to be clear, direct, and simple: “If you have questions about what your health insurance will cover, call the number on the back of your insurance card.”


It’s a rapidly evolving situation, one that we’re monitoring closely. We’ll continue to assess our point-of-view and provide updates about what we’re seeing as it changes. Until then, stay well and keep in touch. 


March 19, 2020
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