STAY IN NETWORK: Avoid Surprises, Save Money, Stay out of Debt!

STAY IN NETWORK: Avoid Surprises, Save Money, Stay out of Debt!

Health insurance concept. Tag cloud.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!

Beware of the Trap of Pre-Authorizations (Part 2)

Earlier, I mentioned that insurance companies place the burden upon the insured to verify Pre-Authorization of certain services and procedure. Some physicians are beginning to do so, as well—placing language to that effect in their intake papers. I also mentioned that doctors’ offices sometimes make inadvertent mistakes. Well, this is what happened to me a few months ago…..

My shoulder hurt terribly. What ended being an impingement (fortunately nothing structural), almost cost me many thousands of dollars—a pain in both the shoulder and the pocketbook.

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