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!