Health Insurance Articles
Three Things To Know Before Seeing Doctors Out Of Network
2011-02-05
Most health insurance plans fall into two categories. They are either an HMO or a PPO. A HMO plan provides health insurance coverage based upon a co-pay system. Most of the doctors that you can use are in an approved network. To see a physician you would need a referral from your primary care doctor. A PPO plan gives people the choice of choosing a doctor in the network plan or outside of the network plan. The health insurance plan you have will determine whether or not they will pay any amounts towards the doctor visit it is out of network. Before you decide to make an appointment with a doctor that is not listed in your network plan there are three things that you should know.
Cost is the major concern that people have when they want to see a doctor that is not within their insurance network. Prior to your visit you need to see if they accept the insurance that you have. If so you need to find out how much that visit will cost you out of your pocket. Some PPO plans will pay a smaller portion towards your visit. If you have an annual deductible that must be met before you have a co-pay amount or a percentage payment you need to ask your insurance company if it can be applied towards this figure.
Is the visit to this doctor necessary? If you can see a comparable physician within your network then it would be advantageous to do so. If you have a health condition or ailment that warrants visiting a specialist that is not a part of your network then see what your options are from your insurance company. They may be able to recommend another person that is just as qualified. This will save you money.
Realize that even if some form of payment can be received from your insurance company you may need approval from your primary doctor. If not done, you may be required to pay for the cost of the visit. If your HMO or PPO plan does not pay for an out of network doctor you need to know the expected cost from the future visit. If it is a lot of money, inquire if you need to have a plan to be able to pay for it. Some may accept a payment plan, while others require the full amount upfront.
Health insurance coverage will vary depending on the type of plan that you have. Some pay a portion or none of the cost to see a doctor outside of your network. You can see a comparable doctor, use it towards your annual deductible, or pay for everything yourself.
