When you have insurance, you are protected against unexpected bills that can leave you wondering how to pay. The first step is understanding your policy and learning the cost breakdowns for different services.
Each insurance plan has a network of doctors, hospitals, and other healthcare providers contracted to provide care at discounted rates. However, receiving care from a provider outside the web is considered out-of-network, and you’ll have to pay a higher out-of-pocket cost for a visit.
Contact Your Insurance Company
The first step in how to get insurance to cover out-of-network services is to contact your insurance company and ask whether out-of-network services are covered under the plan. The insurer will tell you what it covers and how much you are responsible for paying.
You can also ask the health care provider for a referral for coverage. It can be an excellent way to save money and prevent surprise medical bills.
Generally, you want to go with a healthcare provider in-network with your health insurance plan. However, this is only possible for some services.
Getting care from a doctor or facility that is not in-network can be a hassle. It can also be expensive and leave you with unanticipated medical bills.
Many doctors and hospitals need to be in-network with every health insurance plan. So before you go, you must ask if your doctor or hospital will be in-network with your plan.
You can also compare prices from different providers to get the best deal. It is essential to find out if your health insurance company posts the cost of services online so you can determine whether an out-of-network provider will save you money or not.
Health insurance that includes out-of-network coverage can be important for those with specialized needs. It can also help protect you from unexpected expenses or bankruptcy.
Get a Referral
Getting the proper care for your health concerns is critical. That’s why health insurance companies require patients to seek a referral from their primary care physician (PCP) before seeing a specialist.
Although it could seem like an extra step, doing so can help patients save money by keeping them from paying for medical services not covered by their insurance. Checking with your insurance provider to learn about your policies is the first step in getting a referral.
Many HMOs and some point of service (POS) plans require patients to get a referral from their PCP before seeing a specialist, regardless of whether the specialist is in-network or out-of-network. That means you can avoid unexpected costs by ensuring that your PCP has referred you to the right specialist in the first place.
In many cases, a referral is only sometimes necessary for services that are considered specialized, such as lab tests or X-rays. However, if your specialist isn’t in your network or the specialist you’re seeing charges higher rates than your insurance plan has set for its network, your insurance will likely not cover these services.
While it’s essential to check with your health insurance company and get a referral before you see a specialist, it’s also a good idea to negotiate directly with the doctor or other out-of-network provider for a lower rate than your health insurance plan has set for its network. Dealing with a healthcare provider can be frustrating, but it’s an effective way to ensure you get the best possible rate for the services you need.
Ask for a Discount
Many people have to use an out-of-network doctor or hospital for various reasons. Maybe they’re living in a region that doesn’t have a network doctor or hospital, or they need to see a specialist outside your network. Either way, paying for out-of-network care can be a financial burden.
But some insurance plans will pay for out-of-network services at in-network rates, which can make those costs much less of a strain. And it’s always a good idea to ask for a discount when you’re getting a service or procedure from a doctor or hospital outside your plan’s network.
Getting a discount can involve asking the doctor or hospital to charge you a lower rate or even offering another payment option.
Once you have a price estimate, you can negotiate with the doctor or hospital. The provider often agrees to a discounted price in exchange for a lower out-of-pocket or extended payment plan. It’s a good idea to keep your negotiations in writing so you can refer to them later. In addition, it will help you avoid surprises when you’re looking at your bill.
You may need to go to an out-of-network doctor for a medical emergency or see a specialist far from your insurance plan’s coverage area. In either case, the cost of your out-of-network care will likely be more than what you can afford. But you can find a way to get some or all of that money covered by your insurance.
To do that, you need to negotiate the price of your out-of-network care with the provider. The two key areas to deal with are cost-sharing and a reasonable fee.
Generally, you’ll have to pay higher deductibles and coinsurance for out-of-network care than in-network care. It is because out-of-network providers don’t have to accept a lower fee than in-network ones do. However, consider negotiating for your out-of-network costs to be covered at an in-network rate. In that case, you’ll have a better chance of getting your deductible, and coinsurance paid for with money from your insurance plan instead of using up cash.
When negotiating with an out-of-network medical provider, be professional and polite. Ask questions and make sure you get all the information in writing. It will help you avoid surprises. In addition, consider writing a letter or email summarizing your conversation with the provider as a reminder to yourself and your insurer about the details of your discussions.