In a recent newsletter article, I addressed the question of whether you can be in-network at a group (or online platform like Alma or Headway) and out-of-network at your private practice.

My response was that it should not be a problem, depending on how your health plan contract is set up. You are typically billing under the group’s Tax ID in one case, which will show up as in-network, and your own Tax ID for your private practice clients, which should show up as out-of-network, unless you have an individual contract with the health plan.

However, two providers wrote this week to tell me it wasn’t so simple. They said that being in-network at one group or online platform and out-of-network via another location had led to a health plan listing them in-network at both sites without their knowledge, and years of trying to unsnarl claim headaches.

One therapist’s story: Her group was out-of-network with Horizon Blue Cross, but billed Horizon directly for out-of-network clients. For her group to be paid by Horizon, she had to link each counselor’s Social Security Number to the group’s Tax ID and NPI.

But when two counselors went in-network with Horizon via Headway in their private practices, Horizon put the whole group in-network. This was only discovered months later when Horizon began reimbursing at lower rates. Headway had told the therapists that credentialing with the plan through Headway would not affect their group practice, but it did, and not just for them but for all the counselors with the same license at the group.

The group owner fought it, saying she had never signed anything to become in-network with Horizon. They eventually got Horizon to unlink the counselors’ Social Security numbers from the group’s Tax ID, and then Horizon reprocessed the claims. But it was a mess for over a year.

To add insult to injury, when Horizon did fix it, they took in-network money back from her group and sent the out-of-network checks to clients, instead of to her group. Some clients were no longer in treatment, so collecting from them was difficult.

The takeaway? This may be unique to Horizon, but I think it is safe to say that depending on the health plan and your contract with the health plan, it can sometimes be an issue to be in-network in one group and out-of-network in your private practice, or vice versa.

A second lesson here: This example is yet another reason why I STRONGLY recommend that you collect in full from out-of-network clients, and don’t seek direct health plan payments (read also my article here on why I recommend this).