Why Patients Should See Network Doctors
While most people have heard that it is better to see a network doctor than an out-of-network provider, they are not sure why it is better. The reason for this is that providers change rates and services to meet the standards of different health plans. This translates to lower out-of-pocket expenses. Seeing an out-of-network provider while on a health plan means that the policyholder must pay the difference between the provider's regular fees and what their insurer covers on a reimbursement schedule.
There are some exceptions for emergency care. Your insurance company pays the rate it normally would pay for policyholders seeing out-of-network doctors. In addition to this, the company pays amounts that comply with federal regulations. After your insurance company pays the amount it has already agreed to, the rest of the balance will still be outstanding and must be paid out of pocket.
Your insurance company works with a wide network of health care professionals. With access to physicians, specialists, hospitals and clinics, there is no need to take a chance by visiting an out-of-network provider. Lab work and other tests are also covered and performed by several network providers. Having lab work done by an out-of-network provider can easily reach into the thousands. Just a CT scan or MRI will also cost more than most people can afford upfront. Your insurance company can help find local providers for the quickest service possible.
In some cases, it may be necessary to wait for an appointment or referral. However, insurance companies typically work with urgent care facilities. When there is not a medical emergency but an issue that requires prompt attention, ask about an urgent care facility that is included in the network. This cuts down on the need to wait in long lines at an ER and ensures health needs are met in a timely manner. Your insurance company can help in finding a regular physician for new patients. A primary care provider is responsible for overseeing regular medical appointments and can provide referrals for other services.
Every policyholder should make a point to understand his or her policy thoroughly and what is covered. It is also important to review a list of providers and services. To learn more about a personal policy and for questions about making any changes, please call.