Unfortunately, knowing whether your provider is in or out of network can be difficult. According to a recent New York Times article, insurance plan directories of providers are often inaccurate and out of date. Doctors may be listed who are no longer accepting new patients or participating in the network. To add to the confusion, a single insurer may offer different plans with similar names but different networks.
Here are the five tips that may make your healthcare journey easier:
Make sure you know whether your provider is in network or out of network. Check with both your provider and your plan. Check your plan documents to be sure that you name your plan correctly when making inquiries. Remember: Out-of-network doctors such as radiologists and anesthesiologists may be involved in your care even if your hospital is in network. Make sure to ask before your appointment or procedure whether all doctors caring for you are in network.
If you are going out of network voluntarily, understand how your out-of-pocket expenses will be calculated. You will almost always pay more than you would in network, but how much more will vary according to your plan.
If you receive a “surprise” out-of-network bill for emergency care or otherwise, determine whether your state law protects consumers and whether it limits your responsibility to the in-network amount.
Understand that you can talk with your providers about out-of-network fees. Try to negotiate costs by comparing your provider’s’ fees with the typical local charges for specific procedures.
Familiarize yourself with the key terms and principles of health insurance so that you can be a better advocate for yourself as you navigate the healthcare system.
BY ROBIN GELBURD
See full story thehill.com