• What does “out-of-network” care mean?
• What causes out-of-network medical bills?
• The most common out-of-network health care situations

The secret to minimizing out-of-network health care risk

When it comes to out-of-network health care costs, the more you know, the better. Easier said than done, right? Well, that’s why Naviguard^® is here. We help people navigate the confusing world of out-of-network health care so you can make smart decisions about your care and steer clear of excessive balance medical bills.

One third of privately insured people have received an unexpected out-of-network balance bill.¹ What’s the secret to not getting one? Get ahead of them. In other words, know when you’re most at risk of going out-of-network so you can hopefully avoid getting the balance bill. But before we get into the specifics, let’s start with the basics.

What does “out-of-network” care mean?

“Out-of-network” means the health care provider is outside your plan’s network and there’s no contracted or negotiated rate between them and your plan. While in-network providers agree in advance to specific rates, out-of-network providers do not. Their fees may be much higher than market rates and higher than the amount allowed under your plan.

How to know what’s out-of-network for your plan

Become familiar with your health plan to know what you’re responsible for paying and to plan for potential bills. Before any doctor visit, surgery or procedure, log in to your account to check your plan details, then use the provider search tool to see if your provider is in your network.

You can also call the number on the back of your health plan ID card to find an in-network provider. Taking the time to understand your plan is worth it.

Out-of-network balance medical bills often occur when your doctor involves additional providers or specialists. These providers may operate separately from your main provider, which means they could be out-of-network for your plan.

Under the No Surprises Act (NSA), providers are prohibited from balance billing patients. But this protection only applies to specific services, like emergency services or when an out-of-network provider is involved in your care at an in-network facility. Ground ambulances are not covered by the NSA protections. Despite the NSA, there are many ways to wind up with an expensive balance medical bill for out-of-network charges you’re responsible for.

Good news: Many out-of-network health care costs can be avoided

It takes some effort up front to possibly save money down the line. Here’s what you should do to outsmart out-of-network costs: Before any medical visit or procedure, ask your physician what providers and services will be involved. Here are the most common out-of-network care situations: