This is a free website and it's only purpose is to educate you on Health Insurance!
IN NETWORK OUT OF NETWORK
We spoke about contracted rates and the benefits you receive from having contracted rates when visiting hospitals, clinics, and doctors. You will not receive the benefits of the contracted rate if you go outside the network the Insurance Company set-up, because they negotiated the contracted rates with specific hospitals, clinics, and doctors. In Network, are the facilities that accept your insurance! Hospitals, Physician Offices, Labs, Pharmacies, and any health care providers must accept your insurance from you to receive the contracted rates. The very best way to insure that these health care providers accept your insurance is to simply ask, and confirm! I would also have your insurance broker advise you on this subject, so no mistakes are made. Have your insurance broker handle all insurance claims, and confirm who is in Network and who is out of Network. Your insurance broker comes to you "free of charge", so build this relationship, and know a good broker is worth a lot to you. Your Insurance Agent or Insurance Company will be able to provide you with an online Provider Directory where you can look up hospitals, clinics, and doctors. It’s very important to check with your Agent or Insurance Company before you buy a policy to see if your existing hospital, clinics, and doctors are part of the network. If you have been seeing a doctor for years and have a good relationship and trust built up you are going to want to continue seeing that doctor. If your doctor is not part of the network you may have to look at other insurance companies versus changing a doctor you have a history with over many years.
Out of network is going to a hospital, clinic, or doctor that is not part of the network set-up by the insurance company. Every plan has deductibles, co-pays, and co-insurance for out of network. The Insurance Company does offer coverage if you go out of Network but the deductibles, co-pays, and co-insurance usually double from the In Network limits. Insurance companies know there will be times when you will have no choice but to use a hospital, clinic, or doctor out of network such as when you are traveling within the continental United States. When you are home you should do everything in your power to use the network. That’s why I like a PPO network or insurance plan because they have multiple hospitals, clinics, and doctors so you have a much greater choice of coverage.
Remember virtually none of the insurance plans cover you when you are outside the US traveling. There are a few plans that will cover you but very few. The most important thing to remember when traveling outside the US is that none of the hospitals, clinics, and doctors in foreign countries will accept your insurance even if it covers travel outside the US. To them your insurance means nothing in their country and they will not accept it nor will they file a claim for you. It is strictly cash and carry in foreign countries and you must pay for the service on the spot with cash or a credit card. When you get back to the US, if your policy covers foreign travel you will then file a claim to be reimbursed. You can buy foreign travel health insurance by the day and it is very reasonable, so check with your agent before you travel. Same thing applies though you will have to pay for all care upfront and file claim when you get back to the US.
