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The Inside Scoop

Insights on how to work the health care system and be a more savvy shopper.

The essential question you're probably not asking

Ever get a bill from a doctor and discover that—GULP!—that provider is out-of-network and now you’re paying A LOT more? But how could that happen? Your regular doctor, who’s definitely in-network, set things up, and you even double-checked that the place you were going is in-network. Why are you still getting slapped with a big bill when you thought you were playing by the rules?

Insurance carriers often have a network of facilities and a separate network of physicians. Assuming that they’re one and the same is a common, and costly, mistake.

When you get planned medical care (not emergency care), like an MRI or colonoscopy, you should make sure that where you’re going and who’s working on your case are both in-network. Because even if you use an in-network facility, not every doctor who works there may be a part of the network. Some doctors, especially certain specialists, may not have contracts with your insurance company. That means you could be billed for out-of-network care, even at an in-network place.

So the next time you need medical care, first make sure the facility is in-network. You can do that by checking your insurance carrier’s website or by calling ahead. Then ask the staff: “Is every doctor and health care professional who will be involved in my care in my insurance carrier’s network?”

The hard reality is that there might be a doctor involved in your case, somewhere along the line, that isn’t in-network … like the anesthesiologist keeping you comfortable, the radiologist reading your X-ray, the pathologist examining your tissue sample, or the neonatologist taking care of your baby. And if they’re not in-network, the bill from that doctor will likely be MUCH higher. So ask the question up front and you could save LOTS of money.

Benefits and services available may vary from plan to plan—please refer to your plan’s Summary Plan Description for exact coverage details. This article is not intended to provide medical advice. Aon does not recommend or endorse a particular course of medical treatment. If you have any questions concerning your medical condition or any drugs, treatment plans, or new symptoms, consult your health care provider.
© 2024 Aon plc. All rights reserved.

Tags: doctor, hospital, network, out-of-pocket
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