What Are Out-of-Network Charges?

​As health insurance plans evolve and possibilities vary, the same is true for health care providers and institutions. Patients may have more treatment options today. Ensure you understand your insurance plan and whether or not your healthcare provider is in your network since out-of-network expenses can increase.

What Does Out-of-Network Mean?
An out-of-network provider doesn't have a contract with your insurance company. However, in most circumstances, providers are still in-network with other health plans, although they are out-of-network with your insurance. 

Because of this, costs may sometimes end up being higher. In an unexpected medical crisis, patients with certain types of health insurance, such as HMO plans, are the only ones who will cover treatment received from non-network medical professionals.

Out-of-Network Providers: How to Identify Them?
All in-network medical providers are included in the insurers' network directories; however, out-of-network providers aren't on a list. Calling the provider directly to see if they're in-network with your insurance plan is smart, you will also identify out-of-network providers this way. Various types of coverage are available from the same insurance provider in your state, and the networks might range from one type to another.

Reasons to Consider Out-of-Network Medical Care
Sometimes, an out-of-network provider is the best option for you, even if it costs more initially. Depending on your situation, you may be able to obtain in-network coverage, or it may be provided automatically. Below are some reasons to consider:

Emergencies
As the Affordable Treatment Act (ACA) requires, insurance must cover emergency care, but in many states, emergency providers may still issue a balance charge before 2022. According to the No Surprises Act, this is not permitted. Patients may no longer be billed by out-of-network providers in emergencies, save for ground ambulance charges.

Specialized care
Out-of-network care may be necessary if you have a condition not covered by your plan. You may be able to have the treatment covered by your health insurance provider even if it is not in-network. However, the provider may still charge you if they don't think the insurer's payment is acceptable.

Out-of-town care
If you get ill while you're away from home and require treatment, you may need to go out of network. However, some insurers may treat your visit to a non-participating provider as if it were in-network. Whether you're planning a vacation, check with your insurer to determine if you'll have anything other than emergency coverage while you're away.

Conclusion
When dealing with out-of-network costs, the essential thing to remember is to educate yourself and ask questions. Make the best healthcare choices for yourself by having an open conversation with your healthcare and insurance providers.

At Arnold, Bruce & Doerfler Insurance, we do our best to ensure that our clients are well-protected with affordable and comprehensive policies. We will go the extra mile to help you with your needs. Don't hesitate to contact our agency at (503) 222-1951 or Click Here to request a free quote if you want to know how we can help you. Topics and coverage discussed in this article are not guaranteed, consult with your agents to determine what your policy does and does not cover. We are more than happy to help!