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What does out of network mean?

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Out-of-network can be one of the more confusing health insurance terms. In order to understand it, however, it is first necessary to understand what it means to be in a network.

Health insurance networks are groups of doctors who agree to take the insurance company’s payments. An insurance company has negotiated with these providers. Each doctor, clinic, and lab in a network has agreed to accept a payment schedule worked out during the negotiations. These rates are typically a reduced rate than the fees a provider would charge to a person without insurance. In exchange, the provider is practically guaranteed patients.

When a insured person sees an in network provider, their insurance is accepted and they are billed in accordance with the negotiated rates. Because these rates are usually lower, deductibles for in network providers are usually lower.

When an insured person sees an out of network provider, however, he or she no longer has the protection of those previously agreed on rates. Out of network providers can still bill a person’s insurance, but their rates for everything from procedures to lab work will tend to be higher. Because of this, deductibles for out of network care tend to be higher. In addition, a patient may also have to pay a higher amount of the billed amount.

It can be difficult to determine if a doctor is in or out of network. In the case of scheduled visits such as check-ups, it’s possible to call the doctor’s office ahead of time and ask if they are in an insurance company’s network. Many insurance companies also keep an online database of the doctors in their network.

In an emergency situation, however, it can be difficult to choose which doctors and other healthcare professionals perform work. In some cases, not all of the doctors in a hospital that accepts a particular type of insurance will accept the same insurance. This may lead to being billed out of network rates for some services, but in network rates for other services.

Do as much research as you can before any procedure, and look for an emergency room in your area that is in network in order to save the most money on your healthcare expenses.



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