When searching for health care providers, you will notice that some are listed as “in-network” and others are listed as “out-of-network.” Also, sometimes a doctor you have been using in the past goes from “in-network” to “out-of-network” due to changes made by insurance companies. It’s important to understand what out-of-network care is and if it is worth obtaining.
In-Network Vs. Out-of-Network
Insurance companies negotiate with providers to accept discounted rates on health care services. These providers are in-network.
Out-of-network providers have not negotiated with the insurance companies to accept the discounted rates. Patients can still receive health care from out-of-network providers, but they agree to pay a higher fee for the services.
Out-of-network providers don’t just charge more for services. Insurance companies cover less, so patients have higher out-of-pocket costs. The amount people have to pay depends on the type of insurance they have.
Many PPOs only cover 50% of the bills for out-of-network care while covering 80% of bills from in-network providers. Considering that the amount of the bill will likely be higher because the price has not been negotiated, this can be a significant expense for policyholders.
It can be even worse for those who have an HMO plan. Often, HMOs do not cover any out-of-network expenses, so the insured is forced to pay for the entire bill.
In both cases, the patient will be billed at the time of or immediately following the service. The entire balance will be due immediately. Those who are unable to pay can end up in collections at the hospital.
People also might have to pay a higher deductible when receiving out-of-network care. Many plans have separate deductibles for in-network and out-of-network care, and the deductible for out-of-network care is significantly higher. Even if someone has met the in-network deductible for the year, he or she might have to pay a substantial deductible when using an out-of-network physician.
Health care companies set out-of-pocket maximums for policyholders. People do not pay more than the maximum each calendar year. This is a form of protection, so people do not spend an excessive amount of money on health care costs.
However, many plans do not include out-of-pocket maximums for out-of-network providers. That means people can spend as much as the doctor chooses to charge.
Those who do have out-of-pocket maximums might realize they are much higher for out-of-network providers, which can lead to financial hardship.
Choose an Insurance Plan With the Best In-network Providers
It is a good idea to stick with in-network providers to limit costs. The insured spends much less money when utilizing these providers. From deductibles to co-payments, in-network providers help the insured save lots of money.
People can find an affordable health care plan with a large list of in-network providers by calling 1-855-614-5057. Consumers can also browse for plans online and compare them. Look at both in-network and out-of-network coverage, as well as the list of providers, before selecting a plan.