- Ask your provider if they are In Network with your insurance.
- Pay your co-pay or co-insurance each visit so it does not accumulate into a larger bill.
- Call your insurance company and know your benefits prior to your medical visit to determine if you have a deductible, co-pay, or co-insurance you have to pay.
What questions should I ask before seeing my healthcare provider? Many people ask the wrong question when they call a medical office. They ask, do you take my insurance? You should ask, are you In Network with my insurance? All medical facilities can take insurance even if they are Out of Network.
What does Out of Network Mean? A facility or provider is Out of Network when they do not have a contract with your insurance company. When a provider contracts with an insurance company they are agreeing to the insurance company’s negotiated fee schedule. A medical facility can charge whatever cost they want. If your insurance is Out of Network, the fee has not been negotiated and you are liable for the full cost. Your next question needs to be, what is your charge? Some facilities will file Out of Network insurance for the patient. At times, the patient does not know the facility is Out of Network and is surprised with a large bill.
Why do providers choose to be Out of Network? There are many reasons a medical facility will be Out of Network. Many times it is due to the insurance company’s negotiated fee being too low for operating expenses. Receiving Out of Netowrk care does not mean you will receive poor quality care. At times, it means you are provided better quality care due to providers being able to cover their expenses, but you should know your expenses up front.
How can I know what my cost will be upfront? Call your insurance to verify your beneifts prior to your visit and choose a facility that will verify your benefits, so you can plan to cover you medical cost. Ultimately it is the patient’s responsibilty to know what their insurance coverage, but good quality healthcare providers will assist in providing that information up front.
Pay co-pays, co-insurance, and deductibles each visit. It is important to prepare for and pay your medical expenses. Having a healthcare savings account can reduce your out of pocket expenses and give you the freedom to choose In or Out of Network care ,based on your needs. Healthcare providers are providing you a service and payment is expected following that service. Planning ahead can reduce large medical bills.
This information is provided for educational purposes only. Karen S Shuler PT, DPT is a private practice owner of Lifestyle Physical Therapy, LLC .