Before you pay a surprise out-of-network bill, know what to look for. You may not have to pay the full amount, or any amount.
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Most medical procedures or services involve lots of players, some of which you might not be aware of from the get-go. And some of those service providers may not be In-Network, which could result in a surprise bill down the road.
Identify the usual suspects.
These are the top sources of OON services that you might receive:
Your doctor may refer you or schedule a procedure at a different facility. Check to make that it’s within your network, and ask to be referred or scheduled elsewhere if it’s not.
Many procedures require local or general anesthesia. Even though they work in the hospital or facility, they might not be part of the same network.
If you leave a sample, such as blood or urine, the laboratory that processes it may be OON.
If you’re having a biopsy, it will be analyzed by a a pathologist, who may operate independently of the hospital’s network.
For more complicated procedures, doctors may bring in surgical or physician’s assistants, who may not be covered by your network.
It’s your health—and your money. You get a say.
Getting a procedure planned and scheduled can be complicated, but it’s important for you to be involved! Call your doctor and ask who is providing the service, and then check to see if they’re in your network. You can usually find this information online pretty easily.
If you find yourself with an OON provider, you have options!
Call your doctor and see if they can schedule an in-network procedure
Call the hospital or surgery center to see if they have in-network providers contracted within the facility.
Ask for an up-front estimate for OON services.
Do you know the basics?
Dealing with a health issue is hard enough without having to worry about finances as well. Knowing what your insurance plan covers before your office visit or procedure can go a long way to alleviating extra stress.
Your OON benefits may be different from your In-Network ones, so getting familiar with your plan is worth the time. Visit your insurer’s website to find out about:
Your plan type (HMO, PPO, High Deductible)
Your deductibles (individual and family)
Your out-of-pocket maximums
Your co-pays (primary care, office visit, specialist, urgent care, and ER)
Your co-insurance (primary care, office visit, specialist, urgent care, and ER)
Emergencies are scary enough without having to worry about cost.
To state the obvious, emergencies aren’t something you can really plan for. But you can still get a little bit ahead, should the unthinkable happen. Take the time now to find the emergency room closest to your home and to your work/school that is in your network. It’s also a good idea to find your closest In-Network Urgent Care facility.
You should also check to see if ER staff are considered in-network resources. As we’ve said, just because the facility is covered by your plan doesn’t mean the providers are as well.
Finally, check to see if OON ER visits are covered by your plan, in full or in part.