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Out-of-network providers often struggle on two levels to collect payment. First, the amount of money providers actually receive is an issue because sometimes the payer tries to pay using an alternate fee schedule instead of your billed charges. Second, providers often have a difficult time getting paid directly because many payments are instead sent directly to patients. In addition, some payers try to establish a usual, customary, and reasonable fee schedule to represent the prevalent price in that market for a specific service by which they pay out-of-network providers. This is another way payers try to avoid paying billed charges.