Health Insurance Articles
The Pros And Cons Of Having An Out Of Network Care Provider
2010-06-09
Your primary care provider is your point of contact for all things healthcare. Perhaps you've been seeing him for years, or perhaps she is new. Maybe they operate out of a modern new clinic or a familiar and slightly run-down office. But no matter their history or location, they represent the link between your family and the rest of the healthcare industry. Having a good family doctor can make all of the difference if a critical illness should arise, or if a chronic condition needs to be treated. Not only can your primary healthcare provider assist with referrals and basic treatments, but can give the comfort that comes from knowing they understand your needs and your history, and have the best chance at helping you get back on your feet. Unfortunately, some Americans are forced to make a choice between their family doctor and a new health insurance policy which does not include that doctor as a part of the network.
For many Americans, this is not a problem as they deliberately seek out the insurance company that has their doctor among its members. There are situations, however, be they financial or simply circumstantial, which leave a patient on one side of the healthcare aisle and a doctor on the other. There are both pros and cons to staying with a primary care physician even if they are not a part of your network. The first pro is familiarity. This doctor knows you, has your records, and has the best chance of helping you find the treatment you need. In addition, they are able to refer you to other specialists that share their philosophy and point of view on medicine, which can make families, especially those with young children, feel far more at ease when facing a medical crisis.
The drawbacks are just as obvious. Visits to a healthcare provider which lies outside of the scope of your health insurance policy may not be covered by your insurance in full or at all, depending on the type of plan you have chosen, and it may not be possible to use your current doctor to obtain referrals within the system. In order to access the network, it may be necessary to find a second family doctor in the network that can then do the proper referrals. This can be not only time consuming but difficult for parents and children alike.
At the end of the day, the cost versus benefit must be weighed. If what the doctor does for the family outweighs the monetary loss and inconvenience of not using the network, they should be kept. If the loss is simply too great, they may be able to recommend someone with in the new network.
