Here at Advanced Pelvic Surgery, we strive to give our patients the best care. That care includes from a medical and financial standpoint. Insurance changes almost daily and sometimes it is impossible to determine coverage from one day to the next. Therefore, it is important to verify your coverage before seeing any provider to make sure you have coverage at the highest benefit your insurance offers. Some insurance plans also do not have out of network benefits, which means your visit wouldn't be covered at all. To save on costly bills, please make sure you verify coverage and if Dr. Robert Gregory Owens is in network with your plan. See attached for more information on in and out of network insurance benefits.
What It Means If Your Doctor is Out of Network
If your physician is out of network, does that mean you're out of options? Learn how to make an informed decision about your medical care.
Whether you switched insurance providers or your doctor's office changed its list of accepted plans, chances are that you've heard those dreaded words, "out of network." But what does out of network really mean to you and what are your options if you want to keep your doctor?
What is the difference between in-network and out-of-network providers?
Out of network simply means that the doctor or facility providing your care does not have a contract with your health insurance company. Conversely, in-network means that your provider has negotiated a contracted rate with your health insurance company.
Health insurance companies would prefer you to seek care from their in-network providers because it costs them less. If you choose to see an out-of-network provider, it will cost you more.
Why would my doctor choose to be an out-of-network provider for my insurance?
The most common reason a medical practice will choose not to contract with an insurance company is poor reimbursement, meaning the fees approved by the insurance company are insufficient to cover the cost of providing quality care.
The Issue of Health Insurance
I don't want to change doctors. What are my options?
To continue seeing a doctor who is now out of network, you have a couple of choices:
- Submit a claim to your insurance for out-of-network benefits.
If you submit a claim to your insurance for an out-of-network provider, the insurance company will cover less of the expense, if it covers any at all. Make sure you know your specific plan's out-of-network benefits so that you can make an informed decision.
- Choose to be seen on a cash basis.
This doesn't mean you must pay with a stack of cash. Under this option, you pay a provider directly for your care without filing a claim through your health insurance. Many practices now offer discounted cash rates to patients, as well as bundled pricing options for common procedures such as knee replacement.
I want to keep seeing my doctor, but I'm worried about the costs getting out of control.
With the in-network model, the insurance company does the negotiating. When your provider is out of network, the negotiating is in your hands. A few tips to keep your costs low:
- Speak with a practice representative before being seen to understand the costs of seeing your doctor on an out-ofnetwork or a cash basis. Ask about setting up a payment plan.
- If you need additional services, such as surgery, imaging or physical therapy, ask your doctor to refer you to an innetwork facility to keep your costs down.
- Check about whether bundled pricing is available for your procedure, or if there is a discount for paying on a cash basis. If you have a high-deductible health plan, bypassing your insurance claims process actually might save you money.