One of the most common (and most of expensive mistakes) to make when using your health insurance is to use “out-of-network” physicians, labs, hospitals, etc. Whether you are in a PPO or an HMO, your insurance company has providers with whom they have negotiated reduced rates. That’s why the total bill (let’s say for a doctor’s office visit) is $300—but the “allowed amount”—negotiated rate is only $80. If you use this “in-network” doctor, the insurer pays 80% of the $80($64) and you 20% coinsurance share would be only $16.
BUT, if you saw the same type of doctor with the same fee doctor who was NOT part of your insurer’s network (an out-of-network doctor), the insurance company would pay its 80 %( of the SAME) allowable amount-$64.00 and you could be billed $236. BIG DIFFERENCE. You would save $172 merely by staying in-network.
You can typically locate in-network providers on your insurance company’s website. The best practice is to also verify with both the provider and your insurance company verbally (get a reference number of the call), as sometimes a provider leaves a network and the website isn’t updated quickly.
Be informed. Knowledge is Power! Save Money, Avoid Surprises, and Headaches. USE IN-NETWORK HEALTH PROVIDERS!
It seems that everyone has problems with medical bills and insurance claims. There are many ways way to improve this. Access to information empowers patients. One of the greatest traps insured patients can avoid is incurring sky-high fees by unnecessarily using the services of out-of-network providers. California’s new law has gone a long way in addressing this problem. Florida did so, as well-when it outlawed balance billing ion July 1st and required insurers to maintain current identification of in-network providers on their websites.
Many medical bill problems can be avoided by observing that simple distinction. The claims for a visit to an internist may be $300.00. The in-network internist has a negotiated rate of $90.00—of which you might pay 20% ($18.00). The same internist, were she out-of-network might cost you as much as $228(her $200 fee less the $78 paid by the insurer).An insurance appeal wouldn’t help. But having information posted informing both of the identities of in-network providers and the distinction in costs between using their services and those of out-of-network providers can go far in avoiding medical bill problems.