Some plans get very specific about In-Network Providers. So much so, you can only get benefits if you only go to in-network providers. There are other plans that allow for Out-Of-Network providers. Depending on the plans, the benefits can be a little less then in-network. But this is to encourage you to staying in-network. Why is this important?
When you go out-of-network there are no contracted rates to keep a provider charging anything. You won’t pay anymore than what the in-network rates are for a given eligible service. Where-as when you go out-of-network plans will go off the average cost of services and if the out-of-network provider charges more than the average, the difference usually falls back to you.
Second point I want to bring up is the fact, providers can choose which networks to be part of AND can change at almost any time. So, if you go to a doctor today and then don’t see them again for a year, double check to see if they are still in-network. No reason to get a surprise later.
With all the layers of insurance it is important to have an active role in every step. Next week, more great words to know and some tips that may save you money.