It is critical that you stay “in-network” with your health insurance plan to keep healthcare costs down. With the onset of the Affordable Care Act, health insurance networks have shrunk and the restrictions have increased. Before you go in for any type of treatment, I advise that you check your network so that you “know before you go.” Healthcare providers are hardly your advocates when it comes to checking whether your plan is in-network. What incentive do they have? Healthcare providers get paid one way or another and they want your business. Regardless, I want you to request that the healthcare provider run your insurance before you go in for treatment. You are a customer and you deserve to know how much the treatment will cost. Hold firm against common setbacks such as “Don’t worry, your insurance covers it” or “Check with your insurance company.” Understand that you, as the patient, have the most power in any healthcare transaction. They make money from you, so they rely on you.
Of course, check with your insurance company as well to determine what healthcare providers are in-network and how much the insurance company will pay for a certain treatment. Remember that the health insurance company works for you. Call the insurance company. Utilize their online tools to better understand your network. If you do not understand something, ask questions.
Some treatments require special approval before your insurance company will cover them. These approvals are generally for special treatments or referrals to specialists. Some health insurance plans require “prior authorizations” or pre-approval for certain treatments or medications. The best way to stay safe is to ALWAYS check in with your insurance company before purchasing new medications or seeing a new doctor, even if you were told to do so by your current doctor. The number one complaint I receive as a healthcare attorney is a patient being referred to an out-of-network doctor by their in-network doctor, and it isn’t covered.
Here is another tricky out-of-network trap. When you go in for treatment at an in-network healthcare provider, there are out-of-network specialists working there. Always question new doctors or specialists before accepting treatment. One specialist that is most commonly out-of-network is an anesthesiologist. Before any type of surgery, confirm that all doctors and specialists are in-network.
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